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  1. #1
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    Coumadin and Sportlegs

    Has anyone had any experience using Sportlegs and taking Coumadin?

    My INR was WAY low today and the only thing that's changed is that I've taken Sportlegs twice recently. Last time was before yesterday's ride.

    I can't find Coumadin interaction info for the product, or it's active ingredients.

    I've got a call in to Sportlegs, but no rsvp yet.

    any info would be appreciated.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  2. #2
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    Shouldn't be anything in Sportlegs that would cause a decrease in INR. As long as the ingredient list is accurate, not much in Sportlegs to begin with.

  3. #3
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    According to the label on Sportlegs website it has vegetable oils, and according to the FDA guideline on coumadin, vegetable oils can have high levels of vitamin K which reduces the effect of coumadin and should be avoided. So there's a start - took all of one minute to look up using google.
    miles to posts ratio is > 30:1

  4. #4
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    Quote Originally Posted by Kristatos View Post
    According to the label on Sportlegs website it has vegetable oils, and according to the FDA guideline on coumadin, vegetable oils can have high levels of vitamin K which reduces the effect of coumadin and should be avoided. So there's a start - took all of one minute to look up using google.
    Shouldn't be enough vegetable oils to move the INR.

  5. #5
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    well it's easy enough to stop using the supplement for a while and see if things go back to normal. The fact that the product has undefined and unquantified ingredients like "vegetable oils" in it means every lot is going to be different, and you have no way of really knowing what's in there.
    miles to posts ratio is > 30:1

  6. #6
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    Quote Originally Posted by Kristatos View Post
    According to the label on Sportlegs website it has vegetable oils, and according to the FDA guideline on coumadin, vegetable oils can have high levels of vitamin K which reduces the effect of coumadin and should be avoided. So there's a start - took all of one minute to look up using google.
    My wife is on blood thinners and it is very hard to keep a stable INR. If you've been tracking what you consume pretty carefully and Sport Legs is the only difference, seems like a straightforward decision regarding whether to use it -- is it more important to prevent blood clots that could damage muscle, heart, lungs, or cause a stroke? or is it more important to hope to achieve a very slight advantage in cycling that is highly unlikely to change how you finish in what are most likely amateur sporting events? I'm not trying to be snarky. Just trying to help you think it through. Blood clots are not something I would put myself at risk for, particularly in hopes of finishing a few places higher in a race that will be forgotten by most people in a few weeks or months.

  7. #7
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    I agree with Spade, they couldn't put enough vegetable oil into 10 Sportlegs to provide a quantity of vitamin K capable of a clinically significant decrease in the INR.

    Of course we can't judge the clinical significance if you descriptions like WAY LOW. When was your last therapeutic INR? What was the INR at that time? Have you missed any warfarin doeses? What times have you been taking your warfarin?

    Have you looked for hidden sources of Vitamin K (mayonaise, eating out where you don't know all the ingredients of the food, etc.)? Any new medications? Any new OTCs (besides Sportlegs)?

    If you can truly rule out other causes, I suggest you do a trial of no Sportlegs - check INR, Sportlegs - check INR and see if you have the expected results of a decreased INR.

    If you find it is the Sportlegs, can I write up your case for a report in the literature?
    Quote Originally Posted by uzziefly
    One word : wtf??
    Quote Originally Posted by Mel Erickson
    That's three.

  8. #8
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    I honestly don't really see any beneficial ingredients in most of these supplements. I highly doubt it would drop the INR like that. At the same time, save your $.

  9. #9
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    Spade! You're not supposed to say anything until he withdraws and re-challenges, this would be an unique case report (based on the interaction -if there is one- and the unique fashion in which it was discovered. Can't you see the report noting that the interaction was identified on roadbikereview.com?
    Quote Originally Posted by uzziefly
    One word : wtf??
    Quote Originally Posted by Mel Erickson
    That's three.

  10. #10
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    Quote Originally Posted by jspharmd View Post
    Spade! You're not supposed to say anything until he withdraws and re-challenges, this would be an unique case report (based on the interaction -if there is one- and the unique fashion in which it was discovered. Can't you see the report noting that the interaction was identified on roadbikereview.com?
    Short on research topics lately?

    Turf to resident or student!!!

  11. #11
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    I really appreciate the comments.

    I have to agree that for Sportlegs to affect my INR so drastically in such a short time there would have to be tons of vitamin K or some other bad substance. There isn't.

    I got a call back from Sportlegs, but that's turning into phone tag.

    My wife reminded me that I've been taking an over-the-counter cholesterol reducer. These sorts of medicine are known to counteract Coumadin at times.

    We consulted with my Dr last night and the plan is to cut out the Sportlegs and ColestOff until my INR gets back to where it's supposed to be. I may or may not return to Sportlegs after that, but not without keeping an eye on the INR at the same time. As someone correctly pointed out, it's not worth throwing another clot.

    I'll post the result of my convo with Sportlegs after I hear what they have to say.

    PS: I'm not racing.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  12. #12
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    I'd probably guess that the 2nd OTC would be causing the issue. Really, it's best to avoid starting or stopping OTCs without consulting the doc running your Coumadin.

    Best to avoid racing while on Coumadin. I'd probably be careful about group rides, too.

  13. #13
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    Quote Originally Posted by spade2you View Post
    I'd probably guess that the 2nd OTC would be causing the issue. Really, it's best to avoid starting or stopping OTCs without consulting the doc running your Coumadin.

    Best to avoid racing while on Coumadin. I'd probably be careful about group rides, too.
    I'm thinking the OTC is prolly the culprit although being a bit more careful about the Sportlegs.

    I try to be careful with my riding. Not racing is the best course but my reasoning has little/nothing to do with health issues. I try to stay clear of MUPs on weekend and high-traffic times.

    But sometimes accidents or other problems. I dumped my bike a couple weeks ago, and got bruised up. The worst bruising I've gotten on a bike didn't involve an accident. Mashing my pedals caused a black & blue mark the size of a grapefruit over the distal (down by the knee) end of the quads on my left leg - no trauma other than pedaling.

    I frikkin hate Coumadin, but you do what you gotta do.
    Last edited by Samadhi; 03-29-2013 at 07:49 AM.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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    Blog: Riding With Cancer

  14. #14
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    Just got off the phone with Carl @ Sportlegs.

    His opinion is that there's nothing in Sportlegs that would counter-act Coumadin.

    He says the FDA views his ingredients as safe.

    He's got a sales rep who's been on Rat Poison for 20 + years and has been using Sportlegs for 8 with no problem.

    Good enough for me.

    I'm still gonna be careful about taking it again.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  15. #15
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    Interactions or not, I see little reason to take any of that stuff.

  16. #16
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    Quote Originally Posted by spade2you View Post
    Interactions or not, I see little reason to take any of that stuff.
    I thought the sportlegs helped. Might be all in my head though. We'll see. I'll be riding Sunday without sportlegs so we'll see.

    And I'm curious - you seem to be speaking about this with some authority. Professional or experiential? Not trying to be argumentative or disrespectful- not in the least - just curious.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  17. #17
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    Quote Originally Posted by Samadhi View Post
    I thought the sportlegs helped. Might be all in my head though. We'll see. I'll be riding Sunday without sportlegs so we'll see.

    And I'm curious - you seem to be speaking about this with some authority. Professional or experiential? Not trying to be argumentative or disrespectful- not in the least - just curious.
    JS and I are professionals. OTOH, if this were in doping, a certain "doctor" might try to discredit my credentials.

  18. #18
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    Quote Originally Posted by spade2you View Post
    JS and I are professionals. OTOH, if this were in doping, a certain "doctor" might try to discredit my credentials.
    Speak the devils name ........

    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  19. #19
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    Quote Originally Posted by Samadhi View Post
    Speak the devils name ........

    The devil only cares about one thing and would never dare to help someone.

  20. #20
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    Quote Originally Posted by jspharmd View Post
    What was the INR at that time?
    It was 1.1 (tested twice - 1 at the clinic and 2 at an outside lab) on 3/28


    Have you missed any warfarin doeses?
    Nope

    What times have you been taking your warfarin?
    Evening for the last 6 months under Dr supervision.

    Have you looked for hidden sources of Vitamin K (mayonaise, eating out where you don't know all the ingredients of the food, etc.)?
    Nothing out of the ordinary, especially sources of vitamin K.

    Any new medications? Any new OTCs (besides Sportlegs)?
    Just an OTC for Cholesterol called Cholestoff or something like that. I never take asprin, ibuprofen, etc.

    I've already posted that we're going to lay of the OTCs until the INR is back where it should be. I may try Sportlegs again after that, but not without an INR test within the week.

    If you find it is the Sportlegs, can I write up your case for a report in the literature?
    Sure!
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  21. #21
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    Other option is keep everything the way it is and adjust the coumadin dose. I'd be way spooked to ride on coumadin, would never race on it. How long you supposed to be on it? If it's for a.fib you may want to consider a direct thrombin inhibitor like dabigatran (pradaxa). Spooky thing about pradaxa is there is no reversal agent in the case you have a bleed. But in practice it wears off after 12-17 hours, pretty tense 12 hours though. There are some options like PCC, hemodialysis, etc... but it's a cr@p shoot. Personally I'd go for the pradaxa if I had a.fib. If it's for a dvt or pe, there is good clinical evidence that it pradaxa is as effective as coumadin. But it's not FDA approved as few MD's would be comfortable with this off label use.

  22. #22
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    Quote Originally Posted by Samadhi View Post
    It was 1.1 (tested twice - 1 at the clinic and 2 at an


    Nope



    Evening for the last 6 months under Dr supervision.



    Nothing out of the ordinary, especially sources of vitamin K.



    Just an OTC for Cholesterol called Cholestoff or something like that. I never take asprin, ibuprofen, etc.

    I've already posted that we're going to lay of the OTCs until the INR is back where it should be. I may try Sportlegs again after that, but not without an INR test within the week.



    Sure!
    Keep us posted on what happens. 1.1 from goal (assuming 2-3) is a big interaction. An alternative interaction besides vitamin K could be induction of the enzymes in the liver that metabolizes warfarin. I'm curious to see what happens.
    Quote Originally Posted by uzziefly
    One word : wtf??
    Quote Originally Posted by Mel Erickson
    That's three.

  23. #23
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    Quote Originally Posted by zoikz View Post
    Other option is keep everything the way it is and adjust the coumadin dose.
    Mos def NOT the way to go. Gettinga correct Coumadin dosage can be extremely time-consuming. Lot's of trial & error. Easier to skip the non-essentials than to have to readjust.

    I'd be way spooked to ride on coumadin, would never race on it.
    The trick is to not fall or run into anything

    The doctor running my Coumadin was the same doctor who put me back on a bike. She's totally ok with my riding. She might object to my racing a crit or downhill, but I don't see why a grand fondo would be out of the question provided stayed in the clear and out of trouble. No thought of that happening, though, but my not racing has nothing to do with Rat Poison.

    How long you supposed to be on it?
    Lifetime commitment here. I have a condition where a blood protein called Factor 5 Lieden is mutated. It causes some serious clotting. This isn't disease that can be cured. It's just how things are. Rat Poison For Life!

    My doctor and I have talked about Pradaxa. We'll stay with Coumadin.
    Marco Pantani died for your sins.

    " I guess most guys don't think of themselves as larvae, but hey, we're all lucky that pterodactyls are no longer ruling the skies." ~Bob Roll


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  24. #24
    Master debator.
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    I was on warfarin for quite a while back during my first 2 ablations etc. Pradaxa was a godsend, other than the concerns about not being able to quickly reduce it's effect. I continued doing what I was doing and never adjusted my activity because of the blood thinners. I did really hate having to go in for a blood draw frequently. The only drawback to Pradaxa was the cost and heart burn, the heart burn could be managed by taking it with food.
    I'd never go back to rat poison again ugh.

    Good luck.
    "I felt bad because I couldn't wheelie; until I met a man with no bicycle"

  25. #25
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    Quote Originally Posted by zoikz View Post
    Other option is keep everything the way it is and adjust the coumadin dose. I'd be way spooked to ride on coumadin, would never race on it. How long you supposed to be on it? If it's for a.fib you may want to consider a direct thrombin inhibitor like dabigatran (pradaxa). Spooky thing about pradaxa is there is no reversal agent in the case you have a bleed. But in practice it wears off after 12-17 hours, pretty tense 12 hours though. There are some options like PCC, hemodialysis, etc... but it's a cr@p shoot. Personally I'd go for the pradaxa if I had a.fib. If it's for a dvt or pe, there is good clinical evidence that it pradaxa is as effective as coumadin. But it's not FDA approved as few MD's would be comfortable with this off label use.
    I would probably stop mass start racing and group rides. I'd probably still want to ride a lot and do the occasional TT.

    I haven't seen to many MDs and patients switch to Pradaxa at this point. Private ortho seems to like it while our academic ortho is still using Coumadin.

    Coumadin is a huge PITA, but Pradaxa is a little too new and has a few too many unknowns at this point IMO.

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