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Does Grapefruit Affect Cholesterol Medicine

Side Effects Of Eating Grapefruit You Should Know

Is it Dangerous to Drink on Medication? | Earth Lab

Over the last few years, grapefruit has been under scrutiny because of possible side effects. If youre someone who enjoys having a glass of grapefruit juice with your breakfast, these side effects might give you some cause for concern. The good news is that grapefruit is generally safe to consume for most people, but under certain conditions, it can have adverse effects on your body.;This list should give you a clear picture of whether you;should be worried at all.

Grapefruit Pomegranate Juice Not A Good Mix With Statins

Pomegranate juice, like grapefruit juice, may pose health risks with drugs.

April 23, 2009 — Recently, I talked about a study on “Good Morning America” showing that although statins effectively reduce low-density lipoprotein cholesterol, they also appear to reduce patients’ levels of energy and activity. I discussed five ways to deal with the problem of low energy or fatigue while on statins.

The response was tremendous, and I have learned what my own patients have been telling me for some time — not all people tolerate statins without side effects. Complaints of memory problems, fatigue, low energy and muscle weakness were fairly common — although with more than 13 million users, it is hard to know how many people suffer overall.

Yet, giving people the heads-up that side effects can occur while on statins is important. I believe many patients are led to think they are crazy when their doctors tell them that the symptoms aren’t likely from statins, or the doctors wrongly attribute the symptoms to something else rather than try to stop the statins, lower the dose or switch to another brand.

So many doctors believe the statin drugs are so safe and effective that the “joke,” or discussion, in the medical community is that perhaps most healthy adults would benefit from a low dose of statins just to prevent heart disease.

“Perhaps we should put statins in the drinking water,” a few will suggest.

As always, I welcome your questions and comments.

Could Increase Probability Of Kidney Stones

The debate is still on about whether grapefruit can cause kidney stones or help reduce the risk. Kidney stones are formed when dissolved minerals form crystals along the inner lining of the kidneys. These crystals are usually made up of calcium oxalate but may also contain other compound deposits.

A 6-year study done on men between the age of 40 and 75 years found that having 8 ounces of grapefruit juice every day increased the risk of kidney stones by about 37%.13 However, a short-term study found that having grapefruit juice regularly helped in flushing out citrates, calcium, and magnesium, thus reducing the risk of stone formation.14

Considering both studies, if you have a history of kidney stones or medical conditions which increase the risk of stone formation,;its best to have grapefruit in moderation and not make it a part of your daily diet. Medical conditions that increase the probability of kidney stones include15:

  • Hyperparathyroidism
  • Inflammatory Bowel Disease
  • Gout

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What Other Types Of Juice Interact With Drugs

Other kinds of fruit juice besides grapefruit juice may rarely interfere with medications. For most medications, orange juice, apple juice, or grape juice can be consumed instead of grapefruit juice without any concern for an interaction. However, orange or apple juice can cause an interaction with fexofenadine and aliskerin .

You should use caution when eating anything made with the seville orange , the pomelo , and limes. These fruits also contain furanocoumarins and may cause the same interactions as grapefruit. Studies with these fruits are not as frequent, so their risk level is not fully known.

Pomegranate juice is a delicious fruit that is full of antioxidants and vitamin C. However, this “superfood” has an interaction with the breast cancer treatment ribociclib , as noted in product labeling. The manufacturer recommends that patients avoid pomegranate or grapefruit and their juices while taking Kisqali. These juices can increase the blood levels of ribociclib, leading to enhanced side effects such as infections, changes in blood cell counts, reduced appetite, nausea and vomiting, diarrhea, hair loss , and fatigue.

People At Risk Of Cvd

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If you don’t have any form of CVD, statins may still be recommended if you’re thought to be at a high risk of developing the condition in the future.

The current recommendation is that you should be offered statins if:

  • there’s at least a 1 in 10 chance of you developing CVD at some point in the next 10 years
  • lifestyle measures, such as exercising regularly and eating a healthy diet, haven’t reduced this risk

Your GP may recommend carrying out a formal assessment of your CVD risk if they think you may be at an increased risk of CVD, based on your personal and family medical history.

For this formal assessment,;your GP;or practice nurse will use special CVD risk assessment computer software that takes into account factors such as:

  • your age

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Ask The Doctor: Does Pomelo Juice Affect Drugs The Same Way Grapefruit Juice Does

Q.;I avoid grapefruit juice because my doctor says it affects how my body handles the Lipitor I take for my cholesterol. Should I also stay away from pomelo?

A.;The pomelo is the largest citrus fruit, ranging from the size of a cantaloupe to that of a large watermelon. Botanists believe that crosses between pomelo and wild orange created grapefruit. Pomelo mixes the sweet taste of orange with the tang of lemon. Its lineage means that pomelo contains many of the same compounds as grapefruit.

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Is Any Amount Of Grapefruit Ok

Whether it is safe to consume grapefruit or grapefruit juice while taking statins depends on the statin and the persons specific condition.

Before consuming any grapefruit products, people taking statins should discuss with a healthcare provider whether it is safe for them.

It is not advisable to consume any grapefruit or grapefruit juice with the statin simvastatin. With this in mind, drinking a single, occasional glass of grapefruit juice while taking some statins is unlikely to cause harm, according to Harvard Health Publishing.

One analysis found that taking grapefruit juice with certain statins may actually have beneficial effects, reducing levels of low-density lipoprotein, or bad, cholesterol by up to approximately 6 percentage points.

Because of this likelihood, some scientists argue that healthcare providers should not prohibit people from taking grapefruit in moderation with certain statins.

A person taking some statins may only start to see harmful effects if they drink 1 quart or more of grapefruit juice.

Eating grapefruit is less risky because the typical serving size about half a grapefruit contains less than a typical glass of juice a person might have with breakfast.

However, taking a statin medication at a different time to consuming grapefruit may still cause an interaction. For some statins, this may be a lower interaction than if a person took them simultaneously.

Read Also: How Often Should You Check Your Cholesterol

Grapefruit And The Human Body

Grapefruit juice actually indirectly amplifies the effect of many;medications. This poses a risk, as doctors prescribe specific daily doses to meet your medical needs. When a drug is present in the body in a quantity higher than the recommended dose, it also causes more intense side effects.

The human body;produces an enzyme;called CYP3A4, located in the small intestine. This enzyme helps the body to break down many different kinds of medications. Consuming grapefruit, whether the whole fruit,;its juice, or any product that contains it, the normal functioning of the;CYP3A4 enzyme is blocked, causing a lower metabolization of the drugs. Consequently, a drug metabolized with the help of CYP3A4 will stay in your body for longer, in stronger quantities.

Scientists have discovered that the quantity of CYP3A4 in the;body varies from person to person, so the effects of grapefruit juice will also vary from one person to another. There have been a lot of studies conducted on the interaction between grapefruit and medicines. While the fruit causes some drugs to stay in the body for a longer period of time, it has an opposite effect on some other drugs.

Mistake : Youre Not Exercising Enough

Mixing grapefruit and your meds

Diet alone is often not enough. It should be combined with exercise, says Michos. When it comes to exercise, the equation is pretty simple: Being sedentary equals lower levels of HDL, according to the AHA. You can lower both cholesterol and high blood pressure by doing at least 150 minutes of moderate-intensity exercise, such as walking, bicycling, swimming, or even doing yard work, each week.

Even more good news: A review published in November 2018 in the journal BioMed Research International found that both low- and moderate-intensity aerobic exercise led to a significant reduction in total cholesterol, including LDL.

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What Are Statins And Can Some Be Combined With Grapefruit

Statins are a class of medications that aim to reduce elevated cholesterol levels in people with a high risk of developing cardiovascular disease , which may contribute to the development of heart attacks and strokes. Theyre also called HMG-CoA reductase inhibitors because they lower LDL cholesterol by blocking HMG-CoA reductase, an enzyme that controls the rate at which cholesterol is made by the body. This class of medications includes:

  • atorvastatin
  • Joint or muscle pain
  • Neurological effects

If youre put on any of these statins to improve your heart health, discuss with your prescribing healthcare professional whether grapefruit can be included in your diet.

Can I Take My Medicine At A Different Time From Grapefruit Juice To Prevent The Interaction

Taking medications at a different time from when grapefruit juice is consumed will not prevent the interaction. The effects of grapefruit juice on certain medications can last for over 24 hours. So, even if you take a medicine that is given only once per day, grapefruit and grapefruit juice should still be avoided for the entire treatment period.

In some cases, you may be able to drink smaller quantities of grapefruit juice, so you should follow the directions on the patient information leaflet for each individual drug or ask your healthcare provider.

Also Check: Which Cheese Has The Lowest Cholesterol

How Does Grapefruit Interact With Medicines

Eating grapefruit or drinking grapefruit juice can cause some medicines to enter your body faster. This makes it more likely that you will have side effects from the medicine.

Interactions can happen up to three days after eating or drinking grapefruit. This means you cannot drink grapefruit juice in the morning and take your medications later in the day to stop possible medicine interactions.

Grapefruit May Improve Cholesterol

Grapefruit oil and medication

Natural compounds called antioxidants may get the credit, but that’s not certain, the researchers note.

However, grapefruit and grapefruit juice interact with several types of medicine, including some cholesterol-lowering drugs. Grapefruit’s interaction with certain medications can cause levels of medicine to rise in the body and lead to serious side effects. Before you head to the grocery store, check with a doctor about grapefruit’s effects on your medications.

The new study was done in Israel. It was recently posted online in the Journal of Agricultural and Food Chemistry.

The researchers included Shela Gorinstein, PhD. Gorinstein works in Jerusalem at The Hebrew University-Hadassah Medical School’s department of medicinal chemistry and natural products.

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Mistake : Youve Cut Out All Fat From Your Diet

While its true that you should cut out trans fats and saturated fats often found in baked goods, such as crackers and cookies not all fats need to be avoided, says Michos. In fact, you should be eating heart-healthy monounsaturated and polyunsaturated fats the kind found in olive oil, olives, and nuts as well as foods rich in omega-3 fatty acids, such as salmon, tuna, and mackerel. But, she says, you should still watch the number of calories you eat, which can add up quickly, even with healthy fats.

Mistake : Youre Only Focusing On Ldl Cholesterol Levels

While its good to know what your so-called bad LDL cholesterol number is, that doesnt give you the complete picture, and numbers alone do not tell the story. Doctors order a blood test to look at your lipid panel, which consists of your high-density lipoprotein cholesterol, LDL cholesterol, triglycerides, and total blood cholesterol .

To evaluate your risk for cardiovascular disease, doctors will also consider other risk factors, such as your age, family history, and whether you have other health conditions related to heart disease, such as diabetes and high blood pressure, according to the American Heart Association .

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How Do Interactions Between Grapefruit And Medicines Happen

Grapefruit juice contains very high concentrations of a constituent called 6,7-dihydryoxybergamottin . 6,7-DHB is a furanocoumarin primarily responsible for enzyme inhibition. Enzyme inhibition is a risk factor for adverse drug effects. If we inhibit an enzyme, metabolism of medications and other substances goes down. Because of this, medication levels in the blood remain high instead of falling as expected.

Grapefruit flavonoids also contribute to the enzyme inhibition of grapefruit juice, but not to the same extent as 6,7-DHB.;Grapefruit essential oil contains fewer potent inhibitors of CYP3A4 such as bergamottin and bergapten. However, the action is weaker and not a source of major, clinicallysignificant drug interactions.; Importantly, while 6,7-DHB and grapefruit flavonoids exist in high concentrations in grapefruit juice, theyre not found in high concentrations in grapefruit essential oil. That makes them less likely to cause clinically important drug interactions.

Grapefruit Juice And Statins

atorvastatin and grapefruit

Q: I’ve heard that people shouldn’t drink grapefruit juice if they’re taking a statin. Why?

A: Certain classes of drugs most notably statins are metabolized in your intestines by an enzyme called CYP3A, which normally reduces the amount of drug that enters your bloodstream. Grapefruit juice contains compounds called furanocoumarins that stop CYP3A from doing its job. As a result, more of the drug is absorbed, making it more powerful than it’s meant to be even toxic in some cases.

Not all statins are affected equally by grapefruit juice, so grapefruit fans might want to switch to a statin that’s less affected . But if you can’t switch, experts say it’s probably okay to enjoy a small glass. That’s because the studies showing dangerous effects used massive amounts of furanocoumarins, the amount found in a quart or more of the juice. What’s more, eating half a grapefruit is even less risky than drinking grapefruit juice, since it takes several fruits to make a single glass of juice. But to be on the safe side, check with your doctor, and avoid taking your pills with grapefruit juice.

The grapefruit effect

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Does Grapefruit Affect Blood Pressure Medications

Normally, consuming grapefruit is good for the body, as this fruit is rich in vitamins and helps fortify the immune system. It contains both vitamin C and potassium, which are great for the optimal functioning of your body. If you have taken a liking to grapefruit, you’d normally be right in concluding that it’s a great addition to a very healthy and balanced diet.;

How Grapefruit Juice Can Interfere With Medications

With most drugs that are affected by grapefruit juice, the juice lets more of the drug enter the blood, says Shiew Mei Huang, Ph.D., of the FDA. 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 with the help of a vital enzyme called CYP3A4 in the small intestine. Grapefruit juice can block the action of intestinal 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. Some people have a lot of this enzyme 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, more recent studies have found that the juice has the opposite effect on a few other drugs.

Why this opposite effect? Instead of changing metabolism, grapefruit juice can affect proteins in the body known as drug transporters, some of 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.

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Mistake : You Forget To Take Your Medication Or Have Stopped Altogether

Drugs to treat high cholesterol, including statins, have a proven impact on cholesterol levels and may prevent heart attack in people with coronary heart disease. But according to an article published in May 2018 in the journal Vascular Health and Risk Management, not taking statins as prescribed was linked to a significantly higher risk of cardiovascular problems and even death.

The article cites reviews showing medication compliance problems worldwide:

  • One Italian study examining the effectiveness of statins found that only 61 percent were still taking their meds as prescribed after 3 months.
  • A Canadian study found that as many as 60 percent of patients who had experienced acute coronary syndrome, such as a heart attack, stopped taking their statin within 2 years of hospitalization.
  • Discontinuing statins is estimated to add a staggering $44 billion to healthcare costs in the U.S.

According to the Vascular Health and Risk Management article, researchers theorize that noncompliance may be due to a combination of factors, including cost, infrequent visits with cardiologists, concerns about side effects, and forgetting to take the medication. They also note that statins may be discontinued at a higher rate than other medications because high cholesterol is a symptomless condition with infrequent tests compared with something like diabetes, which requires constant monitoring of blood sugar levels.


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