Robinsons "Fruit & Barley" contains grapefruit

[flyhigher]

My wife bought the above as a change from the usual boring old Orange. Only by idle chance did I notice that one of the ingredients is grapefruit, along with apple and pineapple (which already sounds a bit bizarre). Acalabrutib is made ineffective by grapefruit (as are my statins), so does "Fruit & Barley" contain enough of the offending ingredient to be another proscribed foodstuff?

[mrsjsmith]

You should be safe as it is probably a minuscule amount, but to be sure you could write to the manufacturer’s. When I was checking what oranges were used in marmalade I found they were usually helpful.

Colette

[lankisterguy Volunteer]

Hi flyhigher,

-

The effect of grapefruit actually makes your Acalabrutinib stay in your body longer, so may make side effects stronger - see:

en.wikipedia.org/wiki/Grape...

SNIP: The effects are caused by furanocoumarins (and, to a lesser extent, flavonoids).[12] These chemicals inhibit key drug metabolizing enzymes, such as cytochrome P450 3A4 (CYP3A4). CYP3A4 is a metabolizing enzyme for almost 50% of drugs, and is found in the liver and small intestinal epithelial cells.[13] As a result, many drugs are affected. Inhibition of enzymes can have two different effects, depending on whether the drug is either

metabolized by the enzyme to an inactive metabolite, or

activated by the enzyme to an active metabolite.

In the first instance, inhibition of drug-metabolizing enzymes results in elevated concentrations of an active drug in the body, which may cause adverse effects.[11] Conversely, if the medication is a prodrug, it needs to be metabolised to be converted to the active drug. Compromising its metabolism lowers concentrations of the active drug, reducing its therapeutic effect, and risking therapeutic failure.

Low drug concentrations can also be caused when the fruit suppresses drug absorption from the intestine.[14]

-

Len

Grapefruit effect

[flyhigher in reply to lankisterguy]

Gosh - so many long words! Oddly, I checked the Calquence 'instructions' in my latest box, and they do not mention grapefruit - have I misremembered? But then I also checked my latest Atorvastatin instructions and they no longer prohibit grapefruit: instead they say "do not take more than one or two small glasses of grapefruit juice per day because large quantiies [have an effect]". Well, that's definitely not what was said when I last looked (probably some years ago now, but no misremembering here!), so clearly the rules of engagement have changed.

[LeoPa]

Best thing you can do is to avoid all food products. Stick to real food and problem solved 😉

[flyhigher in reply to LeoPa]

Lummy, I hope you didn't really mean to avoid all food products! I'd starve to death!

[LeoPa in reply to flyhigher]

Products - as in factory made consumable food like substances that masquerade as food,come in a packing with an ingredient list on it. As opposed to real food, single ingredient, not manufactured, as found in nature. Avoiding those fake foods is a good first step in the right direction 😉.

[lexie in reply to flyhigher]

The term most are familiar in this context is "processed" foods. If there was a way for me to be able to have fresh grapefruit on statins I would be thrilled!

[SofiaDeo in reply to lexie]

There could be a way. It depends on what statin you are taking, hydrophilic versus lipophilic. Also, you would have to commit to eating grapefruit consistently. Like a potential drug-drug interaction, where one has consistent doses of the medications. You couldn't just eat grapefruit randomly.

health.clevelandclinic.org/...

I am willing to no longer have grapefruit, because there is a possibility the *lipophilic* statins, that have this interaction, are the ones that possible help tamp down CLL. There's a study out to see if a lipophilic statin helps potentiate Venclexta. The statin I take, is lipophilic.

[lexie in reply to SofiaDeo]

I had read that statins might have a beneficial effect on CLL but didn't know that may only be specific to lipophilic statins, which are what I take, also. Another positive aspect to statins and worth foregoing grapefruit.

My nieces sell Florida citrus to raise money for their school marching band and each year, before statins, I bought several cases of grapefruit. But when I ran out I didn't buy any from the stores because those never measured up to the high quality of the band fruit. So, consistent intake is unfeasible.

[SofiaDeo in reply to lexie]

Early data suggests low potency lipophilic are the class that affect CLL.

aacrjournals.org/cebp/artic...

There's been discussion of potential mechanisms of how they induce apoptosis in CLL:

ehoonline.biomedcentral.com...

There's a study out looking at one lipophilc statins' ability to be synergistic with venetoclax

clinicaltrials.gov/ct2/show...

[lexie in reply to SofiaDeo]

Thanks for these links!

[LeoPa in reply to lexie]

Why do you take statins?

[LeoPa in reply to lexie]

Understood. Do you consider bread to be one of those? Whole grain bagels? Flour? Some don't. But these are food products too.