Grapefruit Juice and Medication

How does grapefruit juice affect medicines?

Grapefruit juice contains chemicals that can cause problems with enzymes that break down certain types of medicines in your intestines. When a medicine does not get broken down properly in the intestines, you can end up with too much medicine in your blood. Having too much medicine in your blood increases your chances of having serious side effects.

Which medicines are affected by grapefruit juice?

Most medicines are not affected by grapefruit juice. But more than 50 medicines are affected by grapefruit juice. These include medicines for:

• Abnormal heart rhythm.
• Allergies.
• Anxiety.
• Asthma.
• Blood clots.
• Cancer.
• Cough.
• Depression.
• Emphysema.
• Epilepsy.
• Erectile dysfunction.
• Heart attack or heart disease.
• High blood pressure.
• High cholesterol.
• HIV.
• Infection.
• Pain.
• Enlarged prostate.
• Stroke.

Not all medicines for the health problems listed above are affected by grapefruit juice. Ask your doctor how your medicines are affected by grapefruit juice and if you need to make any changes to avoid problems.

Is grapefruit juice safe for me?

If you regularly drink grapefruit juice, ask your doctor or pharmacist if any of your medicines are affected by grapefruit juice. If your medicine is making you feel sick or is causing unusual or uncomfortable side effects, talk to your doctor.

All new medicines are tested for problems caused by grapefruit juice before they are approved by the Food and Drug Administration (FDA). Medicines that are affected by grapefruit juice must have warnings in their patient information sheets. When you pick up a new medicine, your pharmacist will talk to you or give you written information about foods to avoid while taking your medicine. Some medicines may also have warnings on the “food-drug interactions” section of the bottle label.

In general, the more grapefruit juice you have, the greater the possible effects. ¹ It has been shown that even one glass of grapefruit juice—at any time of the day—is enough to cause certain medicines to work differently than they are supposed to. ² Sometimes the effects of one glass of juice can last up to 3 days.

In most cases, you may be able to have a glass of grapefruit juice without problems. Ask your doctor or pharmacist how much is safe for you.

What can happen if grapefruit juice affects my medicine?

The problems you may have from taking medicines that interact with grapefruit juice depend on the kind of medicine you are taking. Some problems are mild, while others are more serious. In general, older people are more likely than younger people to develop serious problems.

For example, if you are taking a medicine for high blood pressure, you may develop dangerously low blood pressure. If you are taking a medicine for high cholesterol, you may develop muscle breakdown problems or liver failure.

For more specific information on the kinds of health problems you could have if you drink grapefruit juice while taking a certain medicine, talk to your doctor or pharmacist.

How can I prevent problems?

You can take steps to avoid problems with grapefruit juice and your medicine.

• Before you take any medicine, ask your doctor or pharmacist if you can safely drink grapefruit juice.
• Read the labels on foods and natural health products to make sure they do not contain grapefruit, grapefruit juice, or grapefruit extract. You may also want to avoid Seville oranges (which are sometimes used in marmalade but not in orange juice), pomelos, and tangelos, because some studies have shown that they can also cause problems. ³
• Always read the warning labels for any medicine you are taking. If you have questions, ask your doctor or pharmacist.
• Tell your doctor if you are having unusual or uncomfortable side effects from your medicine.
• Tell your doctor and other health professionals about all the medicines you are taking, both prescription and over-the-counter.

Caffeine: How much is too much?

In less than an hour you start to feel caffeine’s effects. You’re more alert, energetic and productive. Your mood lifts and that foggy, tired feeling is gone.

If you rely on daily doses of caffeine to chase away fatigue and perk up your disposition, you aren’t alone. Nine out of 10 Americans consume some type of caffeine regularly, making it the most popular behavior-altering drug.

For most people, moderate doses of caffeine — 200 to 300 milligrams (mg), or about two to three cups of brewed coffee a day — aren’t harmful. But some circumstances, such as caffeine sensitivity or use of certain medications, may warrant limiting or even ending your caffeine routine. Find out if you need to decaffeinate your diet and, if so, how you can do it with minimal distress.

When to cut caffeine use

Certain circumstances call for reducing the amount of caffeine you consume. Evaluate your habits. If any of these situations apply, you may need to cut back.

You consume unhealthy amounts
Though moderate caffeine intake isn’t likely to cause harm, too much can noticeably affect your health. Heavy daily caffeine use — more than 500 to 600 mg a day, or about four to seven cups of coffee — can cause:

• Restlessness
• Anxiety
• Irritability
• Muscle tremors
• Sleeplessness
• Headaches
• Nausea, diarrhea or other gastrointestinal problems
• Abnormal heart rhythms

You have caffeine sensitivity
If you’re susceptible to the caffeine’s effects, just small amounts — even one cup of coffee or tea — may prompt unwanted results, such as anxiety, restlessness and irritability. The more sensitive you are to caffeine, the less you need to consume before feeling its influence.

Your sensitivity depends on many factors, including:

• Body mass. People with smaller body masses feel the effects of caffeine sooner than those with larger body masses.
• History of caffeine use. People who don’t regularly consume caffeine tend to be more susceptible to its negative effects than are people who do.
• Stress. All types of stress — for example, psychological stress or heat stress — can increase a person’s sensitivity to caffeine.

Other factors can contribute to variations in caffeine sensitivity as well, including age, smoking habits, drug or hormone use, and other health conditions, such as anxiety disorders.

You’re not sleeping well
Most adults need seven to eight hours of sleep each night. But caffeine can interfere with this much-needed sleep. Chronically losing sleep — whether it’s from work, travel, stress or too much caffeine — results in sleep deprivation. Sleep loss is cumulative, and even small nightly decreases can add up and disturb your daytime function. Sleep deprivation can cause impaired memory, mood swings, lack of concentration, and poor performance at work or school.

Using caffeine to mask sleep deprivation creates an unwelcome cycle. For example, you drink caffeinated beverages because you have trouble staying awake during the day. But the caffeine keeps you from falling asleep at night, shortening the length of time you sleep. Caffeine can also increase the number of times you wake up during the night and can interfere with deep sleep, which makes your night less restful. With less sleep and poor-quality sleep, you’re more tired the next day. To battle the fatigue and to feel more energetic, you reach for your morning jolt of Java.

The best way to break this cycle is to limit your caffeine and to add more hours of quality sleep to your day. Also, avoid caffeinated beverages eight hours before your desired bedtime. Your body doesn’t store caffeine, but it does take many hours for it to eliminate the stimulant and its effects.

You’re taking certain medications and supplements
Certain medications and herbal supplements negatively interact with caffeine. The following are some examples.

• Some antibiotics. Ciprofloxacin (Cipro) and norfloxacin (Noroxin) — types of antibacterial medications — can interfere with the breakdown of caffeine. This may increase the length of time caffeine remains in your body and amplify its unwanted effects.
• Theophylline (Theo-24, Uniphyl, others). This medication — which opens up bronchial airways by relaxing the surrounding muscles (a bronchodilator) — tends to have some caffeine-like effects. Taking this drug along with caffeinated foods and beverages may increase the concentration of theophylline in your blood. This can cause ill effects, such as nausea, vomiting and heart palpitations. If you take theophylline, your doctor may advise that you avoid caffeine.
• Ephedra (ma-huang). This herbal dietary supplement increases your risk of heart attack, stroke, seizures and death. Combined with caffeine, it becomes especially risky. The Food and Drug Administration has banned ephedra in the marketplace because of health concerns. This ban applies to dietary supplements but not herbal teas, which may still contain the herb.

Talk to your doctor or pharmacist about whether caffeine might affect your prescription. He or she can best direct you on whether you need to reduce or eliminate caffeine from your diet.

How to curb your caffeine consumption

Caffeine can be habit-forming, so any attempts to stop or lessen the amount you normally consume can be challenging. An abrupt decrease in caffeine can cause withdrawal symptoms, such as headaches, fatigue, irritability and nervousness. These symptoms usually resolve after several days.

To adopt new caffeine habits, try these tips:

• Know how much caffeine is in the foods and beverages you consume. You may be consuming more than you think.
• Gradually reduce the amount of caffeine you consume. For example, drink one less can of soda or drink a smaller cup of coffee each day. This will help your body get used to the lower levels of caffeine and thereby lessen the withdrawal effects.
• Replace caffeinated coffee, tea and soda with their decaffeinated counterparts. Most decaffeinated beverages look and taste the same.
• When preparing tea, brew for less time. This cuts down on its caffeine content. Or choose herbal teas, which don’t contain this stimulant.
• Check the caffeine content in over-the-counter medications that you take. Pain relief or headache medications, such as Excedrin or Anacin, can contain from 65 mg to 130 mg of caffeine in one dose. Switch to caffeine-free versions, if possible.

If you’re like most adults, caffeine is a part of your daily routine. And most often it doesn’t pose a health problem. But be mindful of those situations in which you need to curtail your caffeine consumption.

Coffee: Does it offer health benefits?

Q:

I’m confused. Is coffee good or bad for me?

A:

Coffee has a long history of being blamed for many ills — from the humorous, “It will stunt your growth” to the not-so-humorous claim that it causes heart disease and cancer. But some recent research indicates that coffee may not be so bad after all. So which is it — good or bad for your health? The best answer may be: It doesn’t seem to hurt and it may help.

To get an idea of where the confusion comes from, consider two recent studies. A study of 128,000 men and women showed no increase in the risk of heart disease from drinking filtered coffee. The findings of the study — which published in May 2006 in the journal “Circulation” — indicated that it didn’t matter how much coffee participants drank.

Another study of 4,000 coffee drinkers published in March 2006 in the “Journal of the American Medical Association” found that two or more cups of coffee a day can increase the risk of heart disease in people with a specific — and fairly common — genetic mutation that slows the breakdown of caffeine in the body.

The design of a study can have some effect on the interpretation of results, which may be another reason for the different conclusions. Overall, given the large number of participants in the study that showed no risks from drinking coffee, it would be reasonable to conclude that coffee poses little or no threat to health.

But this doesn’t mean you should disregard the old maxim, “Everything in moderation.” Although coffee may not be harmful, other beverages such as milk and juice contain important nutrients that coffee does not.

Regarding other health effects of coffee, some evidence suggests that drinking coffee may protect against type 2 diabetes and colon cancer. But there is much more evidence of a protective effect from fruits, vegetables and whole grains than from coffee. So don’t be afraid to enjoy your coffee as part of a healthy diet that includes a wide variety of foods.

Shopping strategies for healthy foods

To eat healthy foods, you don’t have to drastically change the way you shop. But these strategies will help ensure you have the right foods to follow your healthy eating plan.

Step 1: Plan ahead

Decide how many major meals you’ll be shopping for. Then, consider the number of food items you’ll need for breakfasts, lunches and snacks. Take an inventory of your staples, such as low-fat milk, fresh fruit and whole grains (brown rice, cereals and pasta).

Step 2: Make a list

A list will make your shopping trip more efficient and help you avoid impulse purchases. Try to stick only to what’s on your list, but don’t let your list prevent you from looking for or trying new healthy foods.

When making your shopping list, use your weight-loss menus as your guide. Make sure your list includes the food items you’ll need to follow the menus. Also, be sure your list includes healthy and convenient snack foods. Suggestions include:

• Baby carrots
• Celery sticks
• Broccoli florets
• Apples
• Oranges
• Pears
• Fresh berries
• Grapes
• Whole-grain bagels
• Animal crackers
• Pretzels
• Salsa and baked tortilla chips
• Low-fat cottage cheese
• Whole-grain snack crackers
• Reduced-calorie, fat-free yogurt

Step 3. Shop the perimeter of the store for fresh foods

Picture your grocery store in your mind. Chances are the fresh produce section, meat and seafood departments, and dairy case are all located on the perimeter. Great, because that’s where to concentrate your shopping when using the Mayo Clinic Healthy Weight Pyramid. Fresh foods are generally better than ready-to-eat foods because you can control what extra ingredients you add.

Step 4. Shop after a good meal

It can be hard to resist buying high-fat, high-calorie snack items, especially when you’re hungry. So set yourself up for success and shop after you’ve eaten a good meal. If you do find yourself shopping on an empty stomach, drink some water or buy a piece of fruit to munch on.

Step 5. Read food labels

Since May 1994, packaged goods sold in the United States have carried the Nutrition Facts label. This panel is an at-a-glance method for verifying how a food fits into a typical weight management plan. Each label contains information pertaining to serving size, calories, nutrients and Daily Values. This information can inform you about foods that are healthy, and warn you of those that aren’t so healthy — often those that are highly processed or refined. Routinely checking food labels helps you compare the nutritional qualities of similar products.

Men Need More Fruits and Vegetables A Day

Do you know that men need to eat more fruits and vegetables than women?
The National 5 A Day program is encouraging men, who have greater health risks than women for some diseases, to shoot for nine servings of fruits and vegetables each day and women to aim for seven servings a day.

Fruits and vegetables contain many powerful and important nutrients such as vitamins, minerals, fiber and disease-fighting phytochemicals, and that helps reduce the risk of many cancers, heart disease, high blood pressure and diabetes.

Why do men need more than women?

The recommended servings are greater for men because more than two-thirds of men are overweight or obese, and men have a higher death rate for certain diseases than women.

Those diseases include:

• Cardiovascular disease (1 times greater)
• Lung cancer (About two times as high)
• Colorectal cancer (1 times greater)

Among Americans, at least 58 million have some form of cardiovascular disease, including high blood pressure, and 8.2 million Americans have a history of cancer.

How much equals one serving?

• cup fruit juice
• 1 medium banana
• 1 cup chopped or diced raw vegetables
• 1 medium apple
• cup cooked vegetables
• cup dried fruit
• cup cooked beans or peas

One serving of fruit or vegetables should fit in the palm of your hand. It’s a lot smaller than most people think.

How can you increase your intake of fruits and vegetables?

• Have fresh fruit in the morning
• Snack on fresh fruit throughout the day
• Eat a big salad at lunch
• Snack on raw vegetables with a healthful dip
• Eat at least two vegetables with dinner
• Add beans and peas to salads