Red Grapefruit Earns a Star on Cholesterol Test

[Gifted Gourmet]

article from the science section of NYT

Grapefruit, especially the deep red star ruby variety, can help reduce cholesterol in some patients who do not respond to statin drugs, researchers in Israel are reporting.  But the group that ate red grapefruit every day also had significantly decreased blood levels of triglycerides.  Although it is well known that grapefruit and other citrus fruits contain antioxidants that help control lipid levels, the researchers are unsure exactly what components of red grapefruit make it so much more effective than other varieties. The star ruby grapefruit has a yellow peel with a red blush and an intensely red pulp. It is very sweet, and has few or no seeds.

I happen to love red grapefruit but can not have it since I am currently taking a statin drug.

Why is it good for others but not for people who take these medications? Anyone have some ideas as to when, or even if, I can ever enjoy a red, luscious grapefruit again?

Thanks for any and all advice,

Grapefruit-less Gifted Gourmet

[prasantrin]

Anyone have some ideas as to when, or even if, I can ever enjoy a red, luscious grapefruit again?

Thanks for any and all advice,

Grapefruit-less Gifted Gourmet

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My mother is on Lescol (fluvastatin) and she was told she could have grapefruit, but only after a certain number of hours after taking her medication.

And from about.com (while not the best place for medical advice, it at least provides some food for thought).

Grapefruit juice can increase the absorption of statins. Suggest to your doctor that if you agree to take your statin drug with grapefruit juice, you might be able to get by with a lower dose.

[docsconz]

The short version of the story is that enzymes in grapefruit juice alter the metabolism of certain drugs, amongst them various statins and as a result can wind up with elevated blood levels and a higher risk for side effects. Depending on your individual situation and desire for grapefruit you may wish to speak to your doctor about altering your statin dose to accomodate your diet. Unfortunately for me, grapefruit is also purportedly a kidney stone stimulant and people susceptible to stones should limit their grapefruit intake.

[wattacetti]

There has been at least one study looking at plasma levels of one statin with people who were drinking grapefruit juice. There was a significant change in plasma levels for people who had more than 1 L of juice/day (4 cups) during the entire period of the study. I measured this against whole grapefruits and it came to about 5 medium ones per day.

So, the odd grapefruit on occassion should probably be okay but you should really review this with your physician. If you're on a moderate or high dose of statin, you probably shouldn't chance it.

[jsolomon]

Everyone has given great responses. Here is another take on what it boils down to that takes into account everything all these people have said.

Grapefruit have been shown to have an effect on statin uptake and statin clearance (metabolism, too, I think). But, what your physician is trying to do is to CONTROL your statin levels to affect your cholesterol. But, when you eat grapefruit, you add another variable to the equation, so the same intake of statin now has a variable effect on your statin levels, and thus your cholesterol levels. This adds a second level of complexity.

So, remove the grapefruit, remove the complexity. Granted, you could remove the statin, too, but that has other medical effects. Grapefruit are such an enjoyable part of my diet, that I would want to speak to my physician.

[Bill Miller]

article from the science section of NYT

Grapefruit, especially the deep red star ruby variety, can help reduce cholesterol in some patients who do not respond to statin drugs, researchers in Israel are reporting.  But the group that ate red grapefruit every day also had significantly decreased blood levels of triglycerides.  Although it is well known that grapefruit and other citrus fruits contain antioxidants that help control lipid levels, the researchers are unsure exactly what components of red grapefruit make it so much more effective than other varieties. The star ruby grapefruit has a yellow peel with a red blush and an intensely red pulp. It is very sweet, and has few or no seeds.

I happen to love red grapefruit but can not have it since I am currently taking a statin drug.

Why is it good for others but not for people who take these medications? Anyone have some ideas as to when, or even if, I can ever enjoy a red, luscious grapefruit again?

Thanks for any and all advice,

Grapefruit-less Gifted Gourmet

←

I take Lipitor at bedtime because my doctor says it works better at night controlling the liver when it produces the most cholesterol. I believe it is mostly gone from the bloodstream by morning. I drink my Rio Star grapefruit juice in the morning and don't worry about it. Have for years. Check with your doctor.

[Patrick S]

Grapefruit juice actually interacts with many medications. To expand on what Docsconz said, this happens because there is something in grapefruit juice that is very good at occupying the same enzymes that break down simvastatin, the CYP-450 enzymes. Normally what happens is you take your medicine, the medicine reaches the circulation, and when the medicine in circulation passes through the liver, it is broken down by CYP-450. This is called hepatic metabolism. So anything that inhibits the activity or availability of CYP-450 will slow the metabolism of everything that is normally metabolized by these enzymes. Sometimes people try to exploit this effect deliberately, for instance to increase the duration of effects from fentanyl.

Grapefruit juice is far from the only thing that does this, there are other foods and medicines (like cimetidine or ketoconazole) that do the same thing to varying degrees. Conversely, there are foods and medicines that do just the opposite -- that appear to stimulate or increase the effectiveness of the CYP-450 system (e.g. phenobarbital), thus reducing or shortening the effects of drugs that are metabolized by the CYP-450 enzymes.

The grapefruit juice/simvastatin interaction appears to be particularly large. One study compared the pharmacokinetics

of simvastatin ingested with 200ml grapefruit juice and simvastatin taken with water (Lilja et al, 2004). What they found was that the Cmax (the peak blood concentration of the drug) was increased by an average of about 400%, while the AUC (a measure of how much drug remains in circulation and for how long) was increased by ~350%. Obviously taking the drug at the same time as the grapefruit juice is designed to accentuate the effect, but it is remarkable how large the effect is. Its like taking 3-4 times the dose of simvastatin.

Edited February 22, 2006 by Patrick S (log)

[Patrick S]

Melissa,

According to this pharmacist, grapefruit juice interaction with pravastatin, fluvastatin and rosuvastatin (Prevachol, Lescol and Crestor) appear to be minimal. On the other hand, I don't know how much I would trust this source, since he also claims that the effect of grapefruit juice in the morning has only a minimal effect on lovastatin taken in the evening, yet the source he cites for this actually says that drinking 8oz GF juice in the morning resulted in an approximately doubled AUC and Cmax for the lovastatin.

[purplewiz]

I'll add to the chorus of "ask your doctor". I'm on a different medication that interacts with grapefruit, and there are warnings all over the bottle "don't even think about grapefruit while taking this drug!".

The upshot of my conversation with my doctor was that yes, while there is an interaction, and if I was eating grapefruit every day there might be a problem. However, at my current rate of grapefruit consumption (about four per year), it really isn't a problem for me. The warnings are so severe because there are a lot of stupid people out there who if they're not beaten over the head won't listen and can't differentiate between occasional and constant, and as CYA for the pharmacy.

So check with your doctor about your own situation. There may be a compromise in there somewhere.

Marcia.

[Gifted Gourmet]

I just completed my reading of a few medical articles on the use of statin drugs and their interactions with grapefruit juice ... this one especially and will leave grapefruit juice alone until I know that I am doing no harm to myself .. I could switch to a pravastatin but the Lipitor is supposedly one of the best available and I won't risk that ...

Thanks for all of the insight which you have offered here everyone! Much appreciate your interest!

[SuzySushi]

I'm of the school of thought "ask your pharmacist" or "ask the manufacturer of your particular medication."

Doctors are rarely experts in pharmacology (sp?) and may not know all the possible interactions/side effects.

I'm also taking a statin drug, and wouldn't want to take my chances eating grapefruit unless I've seen reputable scientific studies saying it's okay. Overdose of statins can cause all sorts of unwanted side effects, including liver damage, and if grapefruit increases the medication's potency, it might increase the potential side effects. Personally, I'd rather not risk it.

(Now, if someone told me I had to avoid chocolate for the rest of my life, that might be a different story...)

[jsolomon]

Suzy, you're absolutely right that a physician may not be the most knowledgeable person, and a pharmacist is certainly a good resource.

Here are two reasons to ask your physician, though: your physician has the power to change your prescription, while your pharmacist doesn't; and, second, your physician does have the exposure to know WHERE to search for information--which is the same exposure a pharmacist has.

A lot of education revolves around learning how to cast a question, and how to research information around it. Physicians must be good at this, or they wouldn't make it through med school. Fortunately, pharmacists have similar experiences, and it is their area of expertise.

Edit to add: of course, I'm of the "Sin Boldly" party, as I wash down my missed dose of amoxicillin out-of-schedule with a beer.

Edited February 23, 2006 by jsolomon (log)

[Patrick S]

I'm also taking a statin drug, and wouldn't want to take my chances eating grapefruit unless I've seen reputable scientific studies saying it's okay. Overdose of statins can cause all sorts of unwanted side effects, including liver damage, and if grapefruit increases the medication's potency, it might increase the potential side effects.

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Definitely. One of the worst potential side effects is rhabdomyolysis, which is literally "breakdown of muscle fibers," and can cause kidney failure if it is serious enough (because the kidneys are basically clogged with all the muscle breakdown products). On the statin TV comericals when they say something to the effect of "If you experience muscle pain or weakness, contact you doctor, as this may indicate a potentially serious side effect," that's what they are referring to.

[Bill Miller]

I just completed my reading of a few medical articles on the use of statin drugs and their interactions with grapefruit juice ... this one especially and will leave grapefruit juice alone until I know that I am doing no harm to myself .. I could switch to a pravastatin but the Lipitor is supposedly one of the best available and I won't risk that ...

Thanks for all of the insight which you have offered here everyone! Much appreciate your interest!

←

I take the 20mg Lipitor dose at bedtime. My bloodwork is done every 6 months and has shown no liver problems (I do avoid Tylenol). my doctor and pharmacist tell me unless something changes I do not have to change my lifestyle. My cholesterol is so low my doctor said if there was an indication of a problem we would go back to the 10mg dose.

[purplewiz]

(Now, if someone told me I had to avoid chocolate for the rest of my life, that might be a different story...)

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I've already told my doctor in as many words that if it's a choice between dying and chocolate, well, it's been a nice life .

It's one of the things I have brought up every time we alter meds. Grapefruit I could live without, chocolate, never.

Marcia.