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Update: What You Need to Know About Grapefruit and Hepatitis C

Nicole Cutler L.Ac.

February 28, 2008

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Even though there are more reasons than ever for those with chronic Hepatitis C to have a daily glass of grapefruit juice, there is a catch. Unfortunately, there is a long list of medications that can be dangerous when combined with this fruit.

In the aftermath of recent research from Massachusetts, those with Hepatitis C are likely consuming more grapefruit than ever. By concluding that a compound in grapefruit likely prevents the Hepatitis C virus (HCV) from proliferating, this citrus fruit may accompany antiviral medication prescriptions in the future. However, anyone with a chronic illness considering adding grapefruit or its juice to their shopping list must be aware of the danger it could potentially inflict.

The Research

An investigative team from the Massachusetts General Hospital Center for Engineering in Medicine recently announced details about HCV propagation and the role grapefruit may have in hindering it. Apparently, Hepatitis C virus binds to a very low-density lipoprotein (vLDL) before it is secreted from liver cells to re-infect additional liver cells. Otherwise referred to as the bad cholesterol, vLDL functions as the body’s internal transport mechanism for lipids. According to lead author Yaakov Nahmias, Ph.D., “By finding that HCV is secreted from infected cells by latching onto vLDL, we have identified a key pathway in the viral lifecycle.”

Since HCV does not integrate its genetic material into the DNA of infected cells the way HIV does, totally clearing the virus is possible if new cells were not being infected. Therefore, interfering with the transport of HCV out of cells holds a great deal of therapeutic promise.

Scientists found that by blocking vLDL with a compound in grapefruit, Hepatitis C lost its vehicle and thus was stopped from expansion. Grapefruit’s bitter taste is caused by the presence of the flavonoid naringin, which is metabolized into naringenin, an antioxidant known to reduce the secretion of vLDL from liver cells. The Massachusetts investigators confirmed that naringenin reduces the secretion of Hepatitis C from infected cells.

Another Grapefruit Advantage

Although focusing on a different component of the grapefruit, previous research supports the hepatic potential of grapefruit. Phytonutrients in grapefruit, called limonoids, inhibit tumor formation by promoting the formation of glutathione-S-transferase, a detoxifying enzyme. This enzyme sparks a reaction in the liver that helps to make toxic compounds more water soluble for excretion from the body.

Since those with chronic Hepatitis C are at a greater risk for developing cancer of the liver, inhibiting tumor formation is especially important. By helping the liver clear out cancer-causing toxins, limonoids’ promotion of detoxification enzymes is a simple way to ward off the development of cancer.

Grapefruit Warning

While just a few of grapefruit’s many health benefits are described above, there is a bittersweet side to this popular fruit. Grapefruit and its juice can be dangerous to people who take certain medications.

Amy Karch, RN, MS, of the School of Nursing at the University of Rochester Medical Center, an expert on drug interactions, explains that grapefruit juice is one of the foods most likely to cause problems with medications. The cytochrome P-450 3A4 enzyme breaks down grapefruit juice into useful components for the body, just like it breaks down dozens of medications. Grapefruit juice can block this enzyme, making it easier for medications metabolized by the same pathway to pass rapidly from the digestive system to the bloodstream. The result is blood levels of the drug rising faster and higher than normal. In some cases the abnormally high medication levels can be dangerous.

Consisting of more than 50 medications, interactions with grapefruit juice are well-known among researchers and clearly documented on warning labels. However, people commonly fail to comprehensively read the warning labels about drug-food interactions. In addition, it doesn’t take much grapefruit juice to boost the levels of drugs that are susceptible. A single glass can produce a 47 percent reduction of the intestinal enzyme that regulates absorption. Since the effect of grapefruit juice wears off slowly, a third of its impact is still evident after 24 hours.

While this list is not complete, some of the drugs interacting with grapefruit include:

  • Anxiety: Xanax, Buspar, Versed, Halcion
  • Depression: Luvox, Zoloft
  • Allergies: Allegra
  • Abnormal heart rhythm: Cordarone, quinidine
  • Heart disease/stroke/blood clots: Coumadin
  • Epilepsy: Tegretol
  • Cancer: Cyclophosphamide, etoposide, ifosfamide, tamoxifen, vinblastine, vincristine
  • Cough: Dextromethorphan (found in many over-the-counter cold medicines)
  • HIV: Agenerase, Crixivan, Viracept, Norvir, Fortovase
  • Prostate enlargement: Proscar
  • Heart disease/High blood pressure: Coreg, Cardizem, Plendil, Cardene, Adalat, Procardia, Nimotop, Sular, Covera, Calan, Verelan
  • Erectile dysfunction: Viagra, Cialis
  • Asthma/Emphysema: Theophylline
  • High cholesterol: Lipitor, Lescol, Mevacor, Zocor
  • Pain: Alfenta, Duragesic, Actiq, Sufenta
  • Infection: Biaxin, Sporanox, erythromycin, troleandomycin

As a person living with a chronic disease, those with HCV may have additional health issues warranting the use of medication. If unsure of a medication’s food interaction data, always contact a pharmacist to be sure.

The new evidence supporting the use of grapefruit in the fight against HCV is exciting, both because it may lead to viral elimination and because it can be done with an all-natural, well-known food source. However, before ordering your next case of grapefruit, make certain you don’t put yourself in jeopardy. If indulging in this sweet, tart member of the citrus family, be certain that any medications you take will not interact with your grapefruit.

References:

http://en.wikipedia.org, Very low density lipoprotein, Wikimedia Foundation, Inc., 2008.

www.health.harvard.edu, Grapefruit and medication: A cautionary note, President & Fellows of Harvard College, 2008.

www.peacehealth.org, Grapefruit Juice and Medication, Healthwise, 2008.

www.sciencedaily.com, Grapefruit Compound May Help Combat Hepatitis C Infection, ScienceDaily LLC, 2008.

www.sciencedaily.com, Grapefruit Juice And Medication Can Be A Dangerous Mix, ScienceDaily LLC, 2008.

www.whfoods.com, Grapefruit, The George Mateljan Foundation, 2008.

Posted by Nicole Cutler L.Ac. on February 28, 2008

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