Grapefruit Juice and Some Drugs Don’t Mix

Grapefruit juice and the actual grapefruit can be part of a healthy diet. Grapefruit has vitamin C and potassium—nutrients your body needs to work properly.

But it isn’t good for you when it affects the way your medicines work, especially if you have high blood pressure or arrhythmia (irregular or abnormal heart beat).

This food and drug interaction can be a concern, says Shiew Mei Huang, PhD, of the U.S. Food and Drug Administration. The FDA has required that some prescription and over-the-counter (OTC) drugs taken by mouth include warnings against drinking grapefruit juice or eating grapefruit while taking the drug, Huang says.

Here are examples of some types of drugs that grapefruit juice can cause problems with (interact):

  • Some statin drugs to lower cholesterol, such as Zocor (simvastatin) and Lipitor (atorvastatin).
  • Some drugs that treat high blood pressure, such as Procardia and Adalat CC (both nifedipine).
  • Some organ-transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine).
  • Some anti-anxiety drugs, such as buspirone.
  • Some corticosteroids that treat Crohn’s disease or ulcerative colitis, such as Entocort EC and Uceris (both budesonide).
  • Some drugs that treat abnormal heart rhythms, such as Pacerone and Nexterone (both amiodarone).
  • Some antihistamines, such as Allegra (fexofenadine).

Grapefruit juice does not affect all the drugs in the categories above. The severity of the interaction can be different depending on the person, the drug, and the amount of grapefruit juice you drink. Talk to your doctor, pharmacist or other health care provider and read any information provided with your prescription or OTC drug to find out:

  • If your specific drug may be affected.
  • How much, if any, grapefruit juice you can have.
  • What other fruits or juices may also affect your drug in a similar way to grapefruit juice.

b>How Grapefruit Juice Can Interfere With Medications

With most drugs that interact with grapefruit juice, “the juice lets more of the drug enter the blood,” Huang says. “When there is too much drug in the blood, you may have more side effects.”

For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver and muscle damage that can lead to kidney failure.

Many drugs are broken down (metabolized) with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of CYP3A4, so instead of being metabolized, more of the drug enters the blood and stays in the body longer. The result: too much drug in your body.

The amount of the CYP3A4 enzyme in the intestine varies from person to person, says Huang. Some people have a lot of enzymes and others just a little. So grapefruit juice may affect people differently even when they take the same drug.

Although scientists have known for several decades that grapefruit juice can cause too much of certain drugs in the body, Huang says more recent studies have found that the juice has the opposite effect on a few other drugs.

“Grapefruit juice can cause less fexofenadine to enter the blood,” decreasing how well the drug works, Huang says. Fexofenadine (brand name Allegra) is available as both prescription and OTC to relieve symptoms of seasonal allergies. Fexofenadine may also not work as well if taken with orange or apple juice, so the drug label states “do not take with fruit juices.”

Why this opposite effect? Instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, which help move a drug into our cells for absorption. As a result, less of the drug enters the blood and the drug may not work as well, Huang says.

How Grapefruit Juice Affects Some Drugs

When drugs are swallowed, they may be broken down (metabolized) by enzymes and/or absorbed using transporters in cells found in the small intestine. Grapefruit juice can cause problems with these enzymes and transporters, causing too much or too little drug in the body.

Some drugs, like statins used to lower cholesterol, are broken down by enzymes. Grapefruit juice can block the action of these enzymes, increasing the amount of drug in the body and may cause more side effects.

Other drugs, like Allegra (fexofenadine) used to treat allergies, are moved by transporters into the body’s cells. Grapefruit juice can block the action of transporters, decreasing the amount of drug in the body and may cause the drug to not work as well.

Find Out if You Should Avoid Grapefruit or Other Juices

  • Ask your doctor, pharmacist or other health care provider if you can drink grapefruit juice while taking your medication.
  • Read the medication guide or patient information sheet that comes with your prescription drug to find out if grapefruit juice affects your drug.
  • Read the Drug Facts label on your OTC drug, which will say whether you shouldn’t have grapefruit or other fruit juices with it.
  • If you must avoid grapefruit juice with your medicine, check the labels of fruit juices or drinks flavored with fruit juice to see whether they are made with grapefruit juice.
  • Seville oranges (often used to make orange marmalade), pomelos, and tangelos (a cross between tangerines and grapefruit) may have the same effect as grapefruit juice. Do not eat those fruits if your medicine interacts with grapefruit juice.

Source: U.S. Food and Drug

Grapefruit And Salt: The Science Behind This Unlikely Power Couple

Nadia Berenstein wrote . . . . .

Grapefruit’s bitterness can make it hard to love. Indeed, people often smother it in sugar just to get it down. And yet Americans were once urged to sweeten it with salt.

Ad campaigns from the first and second world wars tried to convince us that “Grapefruit Tastes Sweeter With Salt!” as one 1946 ad for Morton’s in Life magazine put it. The pairing, these ads swore, enhanced the flavor.

In our candy-crushed world, these curious culinary time capsules raise the question: Does salt really make grapefruit taste sweeter? And if this practice was once common, why do few people seem to eat grapefruit this way today?

Turns out, grapefruit and salt did have a history together. But, like a sham romance between co-stars dreamed up by Hollywood publicity departments to boost studio revenues, the pairing of the two in midcentury advertisements seems to have largely been manufactured buzz, hyped by companies with an interest in increasing sales of both products.

Still, this doesn’t mean the chemistry between salt and grapefruit isn’t real. It is, and there’s science to prove it.

The origins of our grapefruit habit

Grapefruits are relatively new to this earth, a hybrid formed from the spontaneous union of two foreign transplants — the Javanese pumelo and the East Asian sweet orange — in Barbados in the middle of the 18th century. First grown commercially in Florida at the end of the 19th century, grapefruit quickly went from being a novelty to being a daily necessity and made fortunes for farmers.

But how to eat it? When new kinds of foods like grapefruit become available, consumers have to figure out what to make of them.

In 1911, an Iowa woman wrote in to the “The Housemother’s Exchange,” a national advice column, to recommend salting grapefruits.

Early 20th century cookbooks and recipes in magazines offered an abundance of ways to use grapefruits in sweet confections, as well as in savory-sweet salads. But the most common option was the one that’s still familiar to us today — at breakfast, chilled, sliced in half, sprinkled with sugar and (optionally) crowned with a bright-red candied cherry.

Even then, though, salted grapefruit had its cheerleaders. In 1911, an Iowa woman calling herself “Gude Wife” wrote in to the “The Housemother’s Exchange,” a national advice column, to recommend salting grapefruits. “Salt neutralizes the bitter taste as well as the acidity,” she advised. Others wrote in to back up this endorsement. “I think you will find that many Southerners always salt their grapefruit,” wrote “M.B.L.” from Philadelphia. “I am sure that if you once try it you will agree with me that it is good.” In fact, salting fruit remains a regional practice alive and well in the South.

Go salty for Uncle Sam

But when World War I disrupted the global sugar supply chain, causing sugar shortages and skyrocketing prices, grapefruit sales plummeted. Americans were apparently reluctant to eat the fruit if they couldn’t drown out its pungency with sugar.

Panicked, the Florida Citrus Exchange, in an effort to boost sales, launched a national advertising campaign in 1919 to convince Americans that grapefruit “need no sugar, and never should have much.” After the sugar crisis ended, so did the campaign. But when World War II came along, and sugar once again became scarce, salt and grapefruit’s high-profile romance was rekindled — this time by salt manufacturers.

“Vitamin-rich Grapefruit — a ‘Victory Food Special’ — is one of the fruits Uncle Sam advises you to eat,” explained one 1943 ad from Morton’s Salt.

Ads like this made an overt appeal to patriotic sentiments. Eating grapefruit with salt was a way civilians could support the war effort, both by consuming nutritious, domestically grown food, and by limiting their use of rationed sugar. The campaign proved so successful that it continued into the 1950s, long after rationing had ended.

The science behind adding salt for sweetness

Even as salt-makers boasted about the taste-enhancing effects of salt on grapefruit, they were at a loss to explain just why the combination worked.

It wasn’t until the mid-1990s that Gary Beauchamp and Paul Breslin at the Monell Chemical Senses Center in Philadelphia began to unravel the complex, dynamic process through which salt transforms and enhances flavor. By testing the interaction between three taste sensations — salty, bitter and sweet — they found that salt increased the perception of sweetness by diminishing our ability to taste bitterness.

Beauchamp, now emeritus director of Monell, explains that this is because of the ions in the salt, which block many of the receptors on our tongues that detect bitterness.

But would reducing bitterness make something taste sweeter? Our sense of taste doesn’t just play out on the surface of our tongues. Our brains receive signals about what we eat from our mouths, noses, eyes, ears and skin, integrating and interpreting these different messages to produce the complex, multisensory experience that we know as flavor. There is strong evidence that, at this cognitive level, bitterness and sweetness inhibit each other. In other words, the more bitter something tastes, the less sweet we perceive it to be, and vice versa.

Grapefruit is rich in bitter-tasting plant compounds, especially one called naringin. By diminishing our tongue’s ability to sense naringin and other bitter compounds, salt also produces a secondary cognitive effect, which we perceive as “a relative bump in sweetness,” according to Breslin, a professor of nutrition at Rutgers University.

Something else might be going on, too, he says. Salt changes the chemistry of water. In a watery food like grapefruit, the addition of salt makes it easier for volatile molecules — the chemicals responsible for odor — to launch themselves into the air, where we can breathe them in and smell them, intensifying our experience of the fragrance of the fruit. So that enhanced scent might heighten our enjoyment as well.

But there’s much we still don’t know about how salt affects flavor, Beauchamp and Breslin both stress. “Of all the taste mechanisms,” Beauchamp says, “salt has been the most intractable — the most difficult to understand. It is still not fully understood.”

Yet other cultures have long embraced the beauty of pairing salt and fruit.

In Mexican and border cuisines, it is common to douse fruits (especially mango) with a combination of salt, chili powder and lime. Similarly, salting fruit like guava or, say, an unripe mango is common practice in India. Thai prik-kab-klua combines salt with the heat of fresh red chilies and sugar, and is served on tart fruits. Chinese li hing powder, a puckery mauve mixture based on salted, pickled dried plums, is often sprinkled on apples and pineapples.

This ain’t your grandma’s grapefruit

So why does the practice remain relatively uncommon in the U.S.?

In the case of grapefruit, the explanation may lie not with the salt, but with the fruit. We are eating different kinds of grapefruit than Americans were eating in the 1940s and 1950s. Generally speaking, as the 20th century progressed, grapefruits became redder, sweeter and more completely seedless.

Currently, about three-quarters of the grapefruits that we eat are red. Redder grapefruits contain less naringin, and therefore taste less bitter. This means that there is less of an incentive to curb bitterness with a dash of salt.

There may be another reason. Between 1950 and 2000, more and more processed foods got a boost in sweetness from high-fructose corn syrup and other refined sweeteners. So adding sugar may have increasingly seemed like the right solution to many domestic culinary quandaries.

Ripe for a reunion?

Since the turn of the millennium, however, the use of caloric sweeteners has steadily declined. Perhaps years of public health warnings about the consequences of excess sugar consumption are starting to change attitudes toward sweetness. Meanwhile, new federal government regulations requiring manufacturers to disclose added sugars on labels are driving food companies to reformulate their products.

In other words, is this the perfect moment for grapefruit and salt to get back together? With the Brangelina breakup, we could all use a new power couple to look up to.

Source: npr

Why Grapefruit and Medication Can Be a Dangerous Mix

Steve Mitchell wrote . . . . . .

This citrus fruit isn’t the only problem. Tangelos and Seville oranges also pose the same risk.

February is National Grapefruit Month, but before you down a glass of the juice in celebration, be sure to check whether it’s safe to pair grapefruit with the medication you take. Both grapefruit juice and the fruit itself can interact with more than 50 drugs—such as cholesterol-lowering statins, high blood pressure medications, and allergy drugs—raising the risk of side effects and other problems. Here’s how to know if you can safely enjoy grapefruit with your medication.

Grapefruit and medication could cause problems in two ways. First, grapefruit can block a key drug-metabolizing enzyme in your body, which in turn could lead to an increase in the blood levels of certain drugs. If that happens, it increases the risk of experiencing a side effect from that drug. On the flipside, it can also block absorption of certain drugs in your intestines. In that case, you could have less of the drug in your bloodstream than what you need, so the drug might not be effective for its intended purpose.

Surprisingly, it doesn’t take much of the fruit for a grapefruit and medication interaction to happen: As little as 1 cup of juice or two grapefruit wedges can be enough to cause problems, according to the Food and Drug Administration.

If you regularly eat grapefruit or drink its juice, find out if your medication interacts with the fruit, says David Bailey, Ph.D., a pharmacologist at the University of Western Ontario who first identified the dangerous interaction of grapefruit and medications. A phrase such as “Do not take with grapefruit” should be on the label or package insert that came with your medication, but you can also ask your physician or pharmacist, Bailey says.

Watch out for These Grapefruit and Medication Interactions

Medications that pose an interaction risk include:

  • Some statins, such as atorvastatin (Lipitor and generic), pravastatin (Pravachol and generic), and simvastatin (Zocor and generic).
  • The high blood pressure medication nifedipine (Afeditab, Procardia, and generic).
  • The organ transplant rejection drug cyclosporine (Neoral, Sandimmune, and generic).
  • The anti-anxiety drug alprazolam (Xanax and generic).
  • The anti-arrhythmia drug amiodarone (Cordarone, Nexterone, and generic).
  • The allergy medication fexofenadine (Allegra).

If there’s an interaction risk with your medication, one option is to stop eating the fruit or drinking the juice while you are on the drug, Bailey says. The FDA also recommends skipping tangelos and Seville oranges (used to make orange marmalade) because those affect the same enzyme as grapefruit juice.

Another option is to ask your physician whether there is an alternative medication that doesn’t interact with grapefruit.

If you find out that a medication you’ve already started taking poses an interaction risk, talk to your doctor before stopping it, because that could cause a sudden drop in the levels of medication in your blood.

Source: Consumer Reports


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