For those of you on Ibrutinib- what foods have you been avoiding?

[steve_canada]

When I started on IB I was advised to omit

grapefruit and Seville oranges from my diet ( as all of you also have).

Are there any other foods we should be avoiding?

Cheers Steve

[cajunjeff]

I don’t eat cauliflower since I started ibrutinib. But I didn’t eat it before either, I just don’t like it.😎

Seriously, there are no foods I avoid because of ibrutinib other than the ones you mention. I suppose depending on one’s neutrophil counts, we might want to avoid things like sushi and undercooked meats. I am on ibrutinib and since I never ate grapefruit or Seville oranges (maybe I ate SeVille oranges and didn’t know, I never paid attention to the variety of oranges I ate) I have not made any changes to my diet.

[fapumpkin]

I am on a clinical trial for Ibrutinib and have been advised to not eat:

Seville Oranges, (used in marmalade) grapefruit, Pomegranate and Star Fruit.

I also avoid unpasteurised products.

[Hidden]

Grapefruit, seville oranges and starfruit are indeed highly contraindicated/dangerous. Pomegranate is not always included but does have at least some similar effect. These are P450 CYP3A4-5 inhibitors which in effect inhibit the clearance of Ibrutinib through elimination pathways from the body. This means the drug can build up to toxic levels and cause very serious problems.

Other things to avoid are any foods/supplements that act as blood thinners, like large quantities if turmeric/curcumin, fish oil etc. Ibrutinib increases risk of bleeding.

[steve_canada]

My naturopath has me taking a product called curcum-evail which is a highly concentrated curcumin.

This is for inflammation.

Curious as to why you avoid it?

[Hidden in reply to steve_canada]

Blood thinner. Just do a google search, this is well documented. To my knowledge, you should not be taking curcumin with ibrutinib due to life threatening bleeding risk.

I was taking curcumin as well prior to cancer treatment. My CLL specialist expressly forbids it.

[lankisterguy Volunteer]

Hi Steve-Canada,

There have been several previous discussions about foods that inhibit CYP3A4 the digestive enzyme that allows the removal of Ibrutinib from your body in a predictable way.

See healthunlocked.com/cllsuppo...

Be sure to look for the box labeled "Related Posts" on this page and any other pages.

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If you eat grapefruit, bitter oranges or pomegranet then the Ibrutinib will stay in your body much longer and possibly cause more side effects, but the effect is not consistent or predictable.

Here is a Wikipedia article that lists many of the drugs and a few of the foods to avoid:

en.wikipedia.org/wiki/CYP3A4

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SNIP: Inhibition through fruit ingestion

In 1998, various researchers showed that grapefruit juice, and grapefruit in general, is a potent inhibitor of CYP3A4, which can affect the metabolism of a variety of drugs, increasing their bioavailability.[18][19][20][21][22] In some cases, this can lead to a fatal interaction with drugs like astemizole or terfenadine.[19] The effect of grapefruit juice with regard to drug absorption was originally discovered in 1989. The first published report on grapefruit drug interactions was in 1991 in the Lancet entitled "Interactions of Citrus Juices with Felodipine and Nifedipine", and was the first reported food-drug interaction clinically. The effects of grapefruit last from 3–7 days, with the greatest effects when juice is taken an hour previous to administration of the drug.[23]

In addition to grapefruit, other fruits have similar effects. Noni (M. citrifolia), for example, is a dietary supplement typically consumed as a juice and also inhibits CYP3A4;[24] pomegranate juice has this effect as well.[25]

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also: medsafe.govt.nz/profs/puart...

And a SNIP from the above site page: Herb and Food Interactions

Popular dietary supplements and foods that have a high risk for interaction with medicines metabolised by CYP3A4 include (but are not limited to) the following.

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Goldenseal

Goldenseal (Hydrastis Canadensis) is often taken to try to prevent common colds and upper respiratory tract infections. It has been reported to reduce CYP3A mediated activity by 88%, equivalent to that seen with clarithromycin12.

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Black pepper

Black pepper (Piper nigrum) has been used as a flavouring agent and medicine. When used for flavouring food it is not likely to affect the metabolism of most medicines12. However, excessive use or use in dietary supplements (piperine or piperamides greater than 10 mg) may produce clinically significant interactions, including CYP3A4 inhibition12.

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Schisandra

Preparations of fruits from woody vines of Schisandra species are used in traditional Chinese, Japanese and Russian medicine, often as hepatoprotective agents12. Currently available clinical data strongly suggest that Schisandra extracts pose a significant risk for elevating blood levels of medicines that are CYP3A substrates12.

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St John’s Wort

This is used for its antidepressant activity. The active substance is hyperforin, the most potent known activator of PXR12. Clinical studies have demonstrated that products containing less than 1% hyperforin are less likely to produce interactions12. However, most products contain 3% hyperforin12.

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Grapefruit

Grapefruit (all sources) is a potent inhibitor of intestinal CYP3A4 that has been proposed to interact with more than 44 medicines and result in serious adverse effects13.

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Healthcare professionals should ask patients about their use of complementary and alternative medicines when considering the use of a medicine that is altered by CYP3A4.

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Len

[steve_canada in reply to lankisterguy]

Thanks for your insight into the curcumin - looks like I will definitely stop taking it.

The metabolism of ibrutinib is mainly performed by CYP3A5 and CYP3A4.

Curcumin inhibits CYP3A4 and CYP1A2 but enhances CYP2A6.

Foods that affect CYP enzymes:

The best known foods that affect the CYP enzymes are grapefruit and Seville oranges. This includes their juice and other products that are mostly made from these for example marmalade.

Some of the foods that are known to affect CYP enzymes include:

* grapefruit and grapefruit juice

* Seville oranges

* pomegranate

* star fruit

* vegetables such as cabbage, Brussel sprouts and onion

* turmeric

[Ngtinfu in reply to steve_canada]

Really? Those vegetables (cabbage, brussels sprouts, onions) should not be eaten? This is the first I've heard - I love those veggies. Please confirm where you saw this.

[steve_canada in reply to Ngtinfu]

cancerresearchuk.org/about-...

[Ngtinfu in reply to steve_canada]

Thank you. I love cabbage and onions!

[Sepsur]

I was told to avoid limes but lemons are ok, star fruit, grapefruit, pomelo and Seville oranges are a no no - I was told to avoid turmeric, ginger & galangal ( all the same family of roots) too.

[morepork]

This is very timely as I have just acquired but not yet touched a 1 litre carton of Beetroot, Raspberry and Pomegranate juice which sounded delicious and very healthy .

Not so while on Ibrutinib I now learn. Phew.

[Big_Dee in reply to morepork]

Hello morepork

Yes it is wise to learn these no-no items as the hype to sell supplements to general population does not require warnings about possible health risks to those with CLL and other health conditions.

[DelrayDave]

I have cut back on alcohol. Instead of 2 a day it's now less than 1. Other than that I have not changed my diet.

[country76]

One not included is licorice. We love licorice. Woke up at 1AM with edema inflamed joints. I could't hardly walk for 3 days, Arms hands legs feet severe edema. It was terrible. Cyp3A4 licorice uses the same pathway and was high on the list. I was taken off Ibrutinib for a week and then 1/2 a dose for a week. Also given prednisone and antibiotic. they didn't know what was wrong. Someone else on this website had the same experience and was sent to Cyp3A4 list. I haven't had licorice since.

[Miller1960]

Just wondering about gingerroot. I've been making lemon ginger water with honey for years. I'm on Ibrutinib , almost a year now hmmmm.

I'll research that,thanks for the heads up.

[Pinhead1]

Ibrutinib thins the blood so my husband stopped eating anything with flax seeds. He was having trouble with blood shot eyes.

[Lawand1]

Same as you but see some folks were told not to take curcummin....I’ve been taking it, to reduce inflammation as a side effect of Ib, for three years with my oncologists full knowledge. Works well I believe.

[Charredswiss]

How about grapefruit seed extract?