Living with von Willebrand disease (VWD) means managing the challenges of bleeding risks, but with the right treatment and lifestyle choices, you can still lead a healthy life. While there’s no cure, being mindful of certain foods that affect blood clotting can make your treatment more effective and predictable. Here are some key foods you may want to avoid (or eat less of) when living with VWD.

1. Green Leafy Vegetables

Dark leafy greens are usually among the first foods nutritionists encourage people to eat more often. However, those with VWD may need to be careful about having too many greens at once or varying their intake greatly from one day to the next.

This is because green vegetables are one of the best sources of vitamin K, which promotes blood clotting. As a result, they might interfere with the clotting process and the way coagulant therapies work.

In general, foods that are exceptionally high in vitamin K include:

• Natto (fermented soybeans)
• Collard greens
• Turnip greens
• Spinach
• Kale
• Broccoli
• Carrot juice
• Canned pumpkin
• Soybeans and soybean oil

Because most of these foods are so nutritious, you may not want to stop eating them completely. Instead, having a similar portion each day can help avoid sudden changes in coagulation.

2. Spicy Food

People diagnosed with VWD aren’t just at risk of bleeding after bumping their elbow or getting nosebleeds. They also need to be careful to avoid internal bleeding that’s not always as easy to spot. For some people, overly spicy food can irritate the digestive tract and lead to gastrointestinal (GI) bleeding. Opting for milder spice is a safer bet until you know whether this is a concern for you.

Signs of bleeding in the GI tract may include:

• Stool that’s black with a tarry consistency
• Stool with bright or dark red blood
• Bright red blood or “coffee grounds” in vomit

Contact your doctor if you suspect a GI bleed so you can get treatment quickly.

3. Caffeine

Caffeine has mild blood-thinning effects that can be a concern for people with VWD. Although most people with VWD don’t need to avoid caffeine altogether, you may want to be more thoughtful about your intake.

Caffeine can naturally be found in some plant-based foods. It can also be used as an additive in processed food items. Having more than one source of caffeinated foods and beverages throughout the day can add up to more than you might realize.

Here’s how much caffeine is in these drinks:

• Coffee — 75 to 100 milligrams per cup (6 ounces)
• Espresso — 40 milligrams per ounce
• Soda — 45 milligrams per can unless it’s labeled as caffeine-free
• Tea (green or black) — 60 to 100 milligrams per large cup (16 ounces)

Caffeine is also found in cocoa beans, which are used to make chocolate. Studies suggest that cocoa has anti-clotting effects. Other sources of caffeine include energy drinks, some medications, and candies or gum. You can usually find the amount of caffeine listed on the product label.

Cutting out caffeine suddenly, if it’s something you typically consume, can cause unpleasant withdrawal symptoms, like headaches and irritability. In addition, excessive intakes of over 1,200 milligrams at once can be toxic and cause seizures in some people. If you choose to include caffeine in your diet, it’s generally best to have a moderate daily amount (400 milligrams or less) and keep your intake more or less consistent.

4. Strawberries

Strawberries are another highly nutritious food normally considered a beneficial part of a healthy diet. They’re rich in dietary fiber and vitamin C. Strawberries are also high in antioxidants that show antiplatelet activity in lab studies. Those with VWD should be aware of these possible effects, as they could affect blood clotting.

5. Wine

Grapes are another high-antioxidant fruit that may prevent blood clotting. When grapes are fermented into wine, you also need to consider the added anticoagulation effects of alcohol.

In general, people with VWD should think carefully about alcohol consumption. Depending on how severe your bleeding disorder is and how you handle alcohol, the extra risks that come with drinking might not be worth it. Not only is alcohol a blood thinner, but it can also affect your judgment and coordination, raising the risk of accidents and dangerous bleeding episodes. Talk about your drinking habits with your hematologist to help you make an informed decision about whether you should drink wine.

6. Garlic

Garlic contains sulfur compounds that are responsible for its pungent smell and taste. These compounds also affect blood clotting. Various forms of garlic may reduce clotting, including:

• Aged garlic
• Fresh garlic
• Garlic oil
• Garlic powder

As with other anticoagulant foods, garlic can be part of your diet if you’re living with VWD. However, having a bunch of garlic at once (especially if it’s not something you usually eat) may affect your treatment. Make sure to consult your bleeding disorder specialist before using garlic supplements or other concentrated sources.

7. Herbal Teas and Extracts

Many people think of herbal teas and extracts as completely natural and safe. However, they do have medicinal effects that can interfere with medical treatment.

Various herbs affect blood clotting. A few examples of popular herbs that have antiplatelet effects include:

• Chamomile
• Echinacea
• Rosemary

If you regularly drink herbal tea or use essential oils or other herbal products, be sure to let your health care provider know. Because herbs aren’t always addressed during medical appointments, it can be easy to miss this hidden anticoagulant in your diet.

Practical Tips for Eating Well

Life with a bleeding disorder can be challenging enough to manage without worrying about everything you eat and drink. Although it’s helpful to understand how food affects blood clotting, it’s also important to include a variety of whole foods that you enjoy.

Many foods that have natural anticoagulation effects are also very healthy. A balanced diet provides essential nutrients for energy, a strong immune system, and the prevention of chronic diseases. If you’re having trouble figuring out the best way to eat, you may want to meet with a dietitian nutritionist who has experience with blood disorders for more guidance and support.

Talk With Others Who Understand

MyHemophiliaTeam is the social network for people living with bleeding disorders, such as hemophilia and von Willebrand disease. Here, more than 6,000 members come together to ask questions, give advice, and share their stories with others who understand life with hemophilia.

Have you changed your diet to help reduce the risk of excessive blood loss? What foods do you try to avoid? Share your experience below, or start a conversation by posting on your Activities page.