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> Trying to explain grapefruit to my elderly parents is like pulling teeth. It is not that hard. It is a fruit roughly the same size and appearance as an orang

> Trying to explain grapefruit to my elderly parents is like pulling teeth. It is not that hard. It is a fruit roughly the same size and appearance as an orange, but more bitter. See! I explained it. :) Joking asside, what are you trying to explain about grapefruit to your elderly parents? Is it the weird way it interacts with certain medicines?

xp84 2y ago
It can potentially double or triple the effective dose you’ll absorb of many medications, so weird doesn’t adequately describe it. “Potentially life-threatening” is better.
- mattgreenrocks 2y ago
  This is the first time I've heard of that. Glad I stumbled across this, even though I hate the taste.
  - krisoft 2y ago
    Have you heard the one about lychee? There is some compound in them which can lower your blood glucose levels. The sugar from digesting the fruit will eventually push up your sugar levels, so it all ends up okay eventually, and the drop is relatively small. But if you already have a low blood sugar level, and eat a lot of lychee it can maybe even kill you. So don’t eat them for an empty stomach just to stay on the safe side. That is my other “tasty fruit with a weirdly dangerous rare side-effect” fact.
- krisoft 2y ago
  I heard this before. (Perhaps even on hacker news.) The way i stored it in my brain is “grapefruit is weird, don’t eat or drink grapefruit juice when on medication. Why? It might make you ill or even kill you.” Obviously that form is ovesimplified. But since I’m not a pharmacist, nor a doctor I can allow this simplification for myself because it “fails-safe”. That is it might make me refrain from eating grapefruit in a situation where I could safely do so, but it will save me from eating grapefruit in situations where it is not safe. It would be harder if I would need to remember that I must eat grapefruit in some situations and can’t eat in other situations. The reason why I’m saying this is because this is how I would approach explaining this to someone. By oversimplifying to the point where the safe story is easy to remember. People already understand that they can’t mix alcohol and certain medications. So it is just one more thing you can’t mix with medication.
  - AbstractH24 2y ago
    Grapefruit is a bad example, because it has a clear impact on the way certain medications are metabolized. That’s chemistry more than anything else. But your overall point makes sense because so many of these claims are based on studies that boil down to “playing the carefully controlled odds.”
- neom 2y ago
  "The intensity comes down to how grapefruit's compounds mainly furanocoumarins inhibit CYP3A4. Normally, this enzyme would help break down psilocybin into psilocin and metabolize it out of your system. When CYP3A4 is inhibited, more psilocybin remains in your bloodstream longer, allowing for a higher concentration of psilocin to flood your brain at once. This rapid spike in active compound could overwhelm your serotonin receptors, particularly the 5-HT2A receptors, which are the primary target of psilocin." - Found that on erowid years ago, always thought it sounded silly (yet I copied it down ha) - maybe worth giving a go.
robwwilliams 2y ago
Here is a great review by Bailey and colleagues who discovered the risks of grapefruit in drug metabolism. It is from 2013. This is a GREAT example if genotype-by-drug interaction and why knowing your genotype can be extremely useful. https://pmc.ncbi.nlm.nih.gov/articles/PMC3589309/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3589309/ >Our research group discovered the interaction between grapefruit and certain medications more than 20 years ago [1990s].1–3 Currently, more than 85 drugs, most of which are available in Canada, are known or predicted to interact with grapefruit. This interaction enhances systemic drug concentration through impaired drug metabolism. Many of the drugs that interact with grapefruit are highly prescribed and are essential for the treatment of important or common medical conditions. Recently, however, a disturbing trend has been seen. Between 2008 and 2012, the number of medications with the potential to interact with grapefruit and cause serious adverse effects (i.e., torsade de pointes, rhabdomyolysis, myelotoxicity, respiratory depression, gastrointestinal bleeding, nephrotoxicity) has increased from 17 to 43, representing an average rate of increase exceeding 6 drugs per year. This increase is a result of the introduction of new chemical entities and formulations.

xp84 2y ago

It can potentially double or triple the effective dose you’ll absorb of many medications, so weird doesn’t adequately describe it. “Potentially life-threatening” is better.

mattgreenrocks 2y ago
This is the first time I've heard of that. Glad I stumbled across this, even though I hate the taste.
- krisoft 2y ago
  Have you heard the one about lychee? There is some compound in them which can lower your blood glucose levels. The sugar from digesting the fruit will eventually push up your sugar levels, so it all ends up okay eventually, and the drop is relatively small. But if you already have a low blood sugar level, and eat a lot of lychee it can maybe even kill you. So don’t eat them for an empty stomach just to stay on the safe side. That is my other “tasty fruit with a weirdly dangerous rare side-effect” fact.
krisoft 2y ago
I heard this before. (Perhaps even on hacker news.) The way i stored it in my brain is “grapefruit is weird, don’t eat or drink grapefruit juice when on medication. Why? It might make you ill or even kill you.” Obviously that form is ovesimplified. But since I’m not a pharmacist, nor a doctor I can allow this simplification for myself because it “fails-safe”. That is it might make me refrain from eating grapefruit in a situation where I could safely do so, but it will save me from eating grapefruit in situations where it is not safe. It would be harder if I would need to remember that I must eat grapefruit in some situations and can’t eat in other situations. The reason why I’m saying this is because this is how I would approach explaining this to someone. By oversimplifying to the point where the safe story is easy to remember. People already understand that they can’t mix alcohol and certain medications. So it is just one more thing you can’t mix with medication.
- AbstractH24 2y ago
  Grapefruit is a bad example, because it has a clear impact on the way certain medications are metabolized. That’s chemistry more than anything else. But your overall point makes sense because so many of these claims are based on studies that boil down to “playing the carefully controlled odds.”
neom 2y ago
"The intensity comes down to how grapefruit's compounds mainly furanocoumarins inhibit CYP3A4. Normally, this enzyme would help break down psilocybin into psilocin and metabolize it out of your system. When CYP3A4 is inhibited, more psilocybin remains in your bloodstream longer, allowing for a higher concentration of psilocin to flood your brain at once. This rapid spike in active compound could overwhelm your serotonin receptors, particularly the 5-HT2A receptors, which are the primary target of psilocin." - Found that on erowid years ago, always thought it sounded silly (yet I copied it down ha) - maybe worth giving a go.

robwwilliams 2y ago

Here is a great review by Bailey and colleagues who discovered the risks of grapefruit in drug metabolism. It is from 2013. This is a GREAT example if genotype-by-drug interaction and why knowing your genotype can be extremely useful. https://pmc.ncbi.nlm.nih.gov/articles/PMC3589309/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3589309/ >Our research group discovered the interaction between grapefruit and certain medications more than 20 years ago [1990s].1–3 Currently, more than 85 drugs, most of which are available in Canada, are known or predicted to interact with grapefruit. This interaction enhances systemic drug concentration through impaired drug metabolism. Many of the drugs that interact with grapefruit are highly prescribed and are essential for the treatment of important or common medical conditions. Recently, however, a disturbing trend has been seen. Between 2008 and 2012, the number of medications with the potential to interact with grapefruit and cause serious adverse effects (i.e., torsade de pointes, rhabdomyolysis, myelotoxicity, respiratory depression, gastrointestinal bleeding, nephrotoxicity) has increased from 17 to 43, representing an average rate of increase exceeding 6 drugs per year. This increase is a result of the introduction of new chemical entities and formulations.