3 ms·

It's generally not a problem as long as you eat exactly the same amount of grapefruit every day. You just have to adjust the dosing to suit. It's a lot easier

It's generally not a problem as long as you eat exactly the same amount of grapefruit every day. You just have to adjust the dosing to suit. It's a lot easier to say "don't eat grapefruit" than it is to explain that "eat exactly the same amount every day" is not a lighthearted joke.

_a_a_a_ 3y ago
That's an unsourced assertion with potentially serious medical implications if you happen to be wrong. Do you have anything to back it up?
- piceas 3y ago
  I believe "just adjust the dosing to suit" is the tricky part. One source wisely suggests asking your doctor. https://www.hopkinsmedicine.org/health/wellness-and-prevention/grapefruit-benefits https://www.hopkinsmedicine.org/health/wellness-and-preventi... Another has big words that needs a bit more time to digest. Grapefruit juice–drug interactions https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2125.1998.00764.x https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1046/j.1...
- devilbunny 3y ago
  I'm a practicing anesthesiologist whose wife is also a physician. I'm sure I can drag up a boatload of references if you're genuinely curious, but the short version is that almost anything can be adjusted for if you do it every day. If you're on warfarin for anticoagulation, eating vitamin K-rich foods will affect that. So it's not that eating spinach is forbidden; it's that you have to eat the same amount every day or very, very little ever. I mean, we do give drugs that have primarily renal excretion to people with nonfuctioning kidneys. After we consult a pharmacist, of course. And I have no control over my patients' behaviors, because I don't meet them until the day of surgery. I already have to take them as they are. I might delay or cancel a case if someone isn't optimized, but sometimes "really bad" is as good as they will ever be.
  - _a_a_a_ 3y ago
    No, it's okay. Coming from two people with your backgrounds, okay. What I really don't like is that sometimes people make assertions here and they really are not in a position to do so, and it looked like this was the case here until you clarified. Upvoted both.
    - devilbunny 3y ago
      No problem, nice internet person.
  - samstave 3y ago
    I just read this for the fifth time :-( Super sad and dark.
    - devilbunny 3y ago
      The part where I acknowledged that some people are horrifically ill? The American Society of Anesthesiologists has a Physical Status that is part of every pre-op examination we do. ASA 1: a normal healthy patient. (You almost never see these.) ASA 2: A patient with mild systemic disease. ASA 3: A patient with severe systemic disease. Subtext of the definition of this class notes that it causes some impairment of function. This is our most common class. ASA 4: A patient with severe systemic disease that is a constant threat to life. ASA 5: A moribund patient who is not expected to survive without the operation. ASA 6: A declared brain-dead patient whose organs are being removed for donor purposes. There's a bit of personal style in there - my 4 might be someone else's 3 - but it's a shorthand way of saying "they're very sick". A 5 is someone who is actively trying to die.
      - samstave 3y ago
        Hey, I am 100%%% on your side. <3
  - samstave 3y ago
    Probably the most "Drop The Mic" moments ever, thank you.
tzs 3y ago
Wouldn't you also have have the grapefruit at about the same time everyday, and take the affected drugs at the same time everyday? From what I've read there are two ways grapefruit interferes with medication. 1. For some drugs, such as statins, those drugs are broken down by certain enzymes. Grapefruit interferes with those enzymes, resulting in more of the drug circulating in your body. In effect it is as if you took a larger does of the drug. 2. For some drugs, fexofenadine is a common example, those drugs rely on certain transporters that move the drug into cells. Grapefruit interferes with those transporters, resulting in less of the drug reaching cells. In effect it is as if you took a smaller dose of the drug. It sounds like this would be sensitive to timing.
- devilbunny 3y ago
  Or more of it reaching the cells. It's complex, and yes, you would have to eat the same amount every day at the same time as you take the drug to be sure. As I said, it's a lot easier to say "don't eat it". I am a doctor. Don't ask a doctor. Ask a small-store (NOT CVS or Walgreens, they don't have the time) pharmacist and tell them they can get back to you later with the answer.
samstave 3y ago
>>"is not a lighthearted joke. " i LOVE THE UNINTENDED PUN IN THIS COMMENT (oops on caps) The reason is that after my grandfather passed, my grandmother (who a life-long nurse) got together with Francis Stutsman, one of the top cardiologists in the nation (and former mayor for Saratoga California - they were life-long tennis friends) and he had a famous joke ;; (he also is the biggest Pistachio grower in California) "Well, as your cardiologist, I am happy to tell you that your heart will last you the rest of your life.... which might be three months."

_a_a_a_ 3y ago

That's an unsourced assertion with potentially serious medical implications if you happen to be wrong. Do you have anything to back it up?

piceas 3y ago
I believe "just adjust the dosing to suit" is the tricky part. One source wisely suggests asking your doctor. https://www.hopkinsmedicine.org/health/wellness-and-prevention/grapefruit-benefits https://www.hopkinsmedicine.org/health/wellness-and-preventi... Another has big words that needs a bit more time to digest. Grapefruit juice–drug interactions https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2125.1998.00764.x https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1046/j.1...
devilbunny 3y ago
I'm a practicing anesthesiologist whose wife is also a physician. I'm sure I can drag up a boatload of references if you're genuinely curious, but the short version is that almost anything can be adjusted for if you do it every day. If you're on warfarin for anticoagulation, eating vitamin K-rich foods will affect that. So it's not that eating spinach is forbidden; it's that you have to eat the same amount every day or very, very little ever. I mean, we do give drugs that have primarily renal excretion to people with nonfuctioning kidneys. After we consult a pharmacist, of course. And I have no control over my patients' behaviors, because I don't meet them until the day of surgery. I already have to take them as they are. I might delay or cancel a case if someone isn't optimized, but sometimes "really bad" is as good as they will ever be.
- _a_a_a_ 3y ago
  No, it's okay. Coming from two people with your backgrounds, okay. What I really don't like is that sometimes people make assertions here and they really are not in a position to do so, and it looked like this was the case here until you clarified. Upvoted both.
  - devilbunny 3y ago
    No problem, nice internet person.
- samstave 3y ago
  I just read this for the fifth time :-( Super sad and dark.
  - devilbunny 3y ago
    The part where I acknowledged that some people are horrifically ill? The American Society of Anesthesiologists has a Physical Status that is part of every pre-op examination we do. ASA 1: a normal healthy patient. (You almost never see these.) ASA 2: A patient with mild systemic disease. ASA 3: A patient with severe systemic disease. Subtext of the definition of this class notes that it causes some impairment of function. This is our most common class. ASA 4: A patient with severe systemic disease that is a constant threat to life. ASA 5: A moribund patient who is not expected to survive without the operation. ASA 6: A declared brain-dead patient whose organs are being removed for donor purposes. There's a bit of personal style in there - my 4 might be someone else's 3 - but it's a shorthand way of saying "they're very sick". A 5 is someone who is actively trying to die.
    - samstave 3y ago
      Hey, I am 100%%% on your side. <3
- samstave 3y ago
  Probably the most "Drop The Mic" moments ever, thank you.

tzs 3y ago

Wouldn't you also have have the grapefruit at about the same time everyday, and take the affected drugs at the same time everyday? From what I've read there are two ways grapefruit interferes with medication. 1. For some drugs, such as statins, those drugs are broken down by certain enzymes. Grapefruit interferes with those enzymes, resulting in more of the drug circulating in your body. In effect it is as if you took a larger does of the drug. 2. For some drugs, fexofenadine is a common example, those drugs rely on certain transporters that move the drug into cells. Grapefruit interferes with those transporters, resulting in less of the drug reaching cells. In effect it is as if you took a smaller dose of the drug. It sounds like this would be sensitive to timing.

devilbunny 3y ago
Or more of it reaching the cells. It's complex, and yes, you would have to eat the same amount every day at the same time as you take the drug to be sure. As I said, it's a lot easier to say "don't eat it". I am a doctor. Don't ask a doctor. Ask a small-store (NOT CVS or Walgreens, they don't have the time) pharmacist and tell them they can get back to you later with the answer.

samstave 3y ago

>>"is not a lighthearted joke. " i LOVE THE UNINTENDED PUN IN THIS COMMENT (oops on caps) The reason is that after my grandfather passed, my grandmother (who a life-long nurse) got together with Francis Stutsman, one of the top cardiologists in the nation (and former mayor for Saratoga California - they were life-long tennis friends) and he had a famous joke ;; (he also is the biggest Pistachio grower in California) "Well, as your cardiologist, I am happy to tell you that your heart will last you the rest of your life.... which might be three months."