ALLERGY, RESPIRATORY
Asthmatics Who Quit Smoking May Reverse Lung Damage
Molecule in Skin May Link Eczema and Asthma
Obesity May Raise Kids' Allergy Risk
ALTERNATIVE MEDICINE
Memory Loss Help from Brain Supplement Prevagen
Yoga May Bring Calm to Breast Cancer Treatment
Tai Chi: An Ideal Exercise for Many People with Diabetes
ANIMAL CARE
Rest Easy. When It Comes to Swine Flu, Your Pet Is Safe
Safe Toys for Dogs
Animals Respond to Acupuncture's Healing Touch
BONES & JOINTS
Stem Cells Might Treat Tough Fractures
Vitamin C Protects Some Elderly Men From Bone Loss
Bone Density Predicts Chances of Breast Cancer
CANCER
Omega-3 May Safely Treat Precancerous Bowel Polyps
Hypnosis Cuts Hot Flashes for Breast Cancer Survivors
Vitamin D Good for Breast Cancer Patients
CAREGIVING
Simpler Sleep Apnea Treatment Seems Effective, Affordable
Hispanic Children More Likely to Have Hearing Loss
High Rate of Rehospitalizations Costing Billions
CIRCULATORY SYSTEM
Potassium-Rich Foods May Cut Stroke, Heart Disease Risk
Night Shift Work Hard on the Heart
Support Network May Play Role in Benefits of Drinking
COSMETIC
Contact Lenses Boost Kids' Self-Image
Gum Chewing May Cut Craving for Snacks
Wrinkle Fillers Need Better Label Warnings: FDA Panel
DENTAL, ORAL
Scientists Find Gene for Tooth Enamel
Health Tip: At Risk for Gingivitis
Gummy Bears Join Cavity Fight
DIABETES
Fish Twice a Week Cuts Diabetics' Kidney Risks
Poor Blood Sugar Control After Heart Surgery Impacts Outcomes
Fructose-Sweetened Drinks Up Metabolic Syndrome Risk
DIET, NUTRITION
Antioxidants Abound in Cereals, Popcorn, Whole-Grain Snacks
Compound in Berries May Lessen Sun Damage
Iced Teas Pose High Risk of Kidney Stones
DISABILITIES
Review Finds Marijuana May Help MS Patients
Could Your Cell Phone Help Shield You From Alzheimer's?
ENVIRONMENTAL HEALTH
Gene Mutation May Cause Some Cases of Seasonal Affective Disorder
Exhaust From Railroad Diesel Linked to Lung Ailments
Walkable Neighborhoods Keep the Pounds Off
EYE CARE, VISION
It's a Whole New Outlook for Cataract Patients
Eye Disease, Cognitive Decline Linked in Study
Statin Drugs Cause Eye Disorders
FITNESS
After a Stroke, Light Exercise Gets Hands, Arms Working Again
Early Exercise Boosts Outcomes for ICU Patients
When It Comes to Lifting, the Pros Have Your Back
GASTROINTESTINAL PROBLEMS
Gum Chewing May Speed Colon Surgery Recovery
Soothing Imagery May Help Rid Some Kids of Stomach Pain
Intestinal Bacteria Trigger Immune Response
GENERAL HEALTH
A Little Alcohol May Stave Off Alzheimer's
8 Drugs Doctors Would Never Take
Workplace Wellness Seems to Really Work
HEAD & NECK
Zen May Thicken Brain, Thwart Pain
Ski Helmets Encouraged for All
Many Children Will Outgrow Headaches
HEALTH & TECHNOLOGY
Magnet Therapy May Ease Hard-to-Treat Depression
'Comfort Dogs' Come to Emotional Rescue
Airport Full Body Scanners Pose No Health Threat: Experts
HEARING
Summer Sounds Can Lead to Hearing Loss
Noise Hurts Men's Hearing More, Study Shows
HEART & CARDIOVASCULAR
Estrogen May Help Men's Hearts
Research Shows Genetic Activity of Antioxidants
A Little Alcohol May Help the Heart: Studies
INFECTIOUS DISEASE
Swine Flu Now Reported in All 50 States
Hand Washing 10 Times a Day May Help Keep Flu Away
Chinese 'Devil Dung' Plant Could Be a Swine Flu Fighter
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
School Phys. Ed. Injuries Up 150 Percent
Daily Exercise at School Yields Rewards
Wood Fires Can Harm the Youngest Lungs
MEN'S HEALTH
Drinking Green Tea May Slow Prostate Cancer
Noise Hurts Men's Hearing More, Study Shows
Vigorous Exercise Cuts Stroke Risk for Men, Not Women
MENTAL HEALTH
Consciousness Helps the Mind and Body Work Together
Psychotherapy Can Boost Happiness More Than Money
Shop 'Til You Drop: You May Feel Better
PAIN
Are We Exercising Pain Away? Not So Much.
Tai Chi May Help Ease Fibromyalgia
Acupuncture, Real or Fake, Eases Back Pain
PHYSICAL THERAPY
PREGNANCY
Alternative Treatments May Boost IVF Success
Woman in America Are Delaying Motherhood, Study Says
Exercise Boosts Bone Density in Breast-Feeding Moms
SENIORS
Rapid Weight Loss in Seniors Signals Higher Dementia Risk
Fitness Fades Fast After 45
For a Healthier Retirement, Work a Little
SEXUAL HEALTH
SLEEP DISORDERS
Better Sleep, Grades Seem to Go Up
Meditation May Help Put Primary Insomnia to Bed
6 to 8 Hours of Shut-Eye Is Optimal for Health
WOMEN'S HEALTH
Air Pollution Slows Women's Marathon Times
Exercise During Pregnancy Keeps Newborn Size Normal
Most Women With Osteoporosis Unaware of Raised Fracture Risk
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Grapefruit-Heavy Diet Helped Spur Dangerous Clot

THURSDAY, April 2 (HealthDay News) -- A rare set of interactions involving grapefruit juice, birth control pills and a genetic mutation almost cost a 42-year-old woman her leg, physicians report.

"It started when she was driving in the car one afternoon," said Dr. Lucinda Grande, a recent medical school graduate who is doing her residency in family medicine at the Providence Hospital of St. Peter Health Care in Olympia, the largest health-care provider in the state of Washington. "Her leg became extremely painful, from the lower back to the ankle. She didn't think much of it, but the next morning, it turned purple."

The woman was seen by Grande when she went to the hospital emergency room. She was also seen by Dr. Richard Krug, a surgeon who recognized a limb-threatening situation.

"He had an ultrasound done, which confirmed that she had a large blood clot in her leg," Grande said. "Dr. Evert-Jan Verschuyl, an interventional radiologist, did a procedure where he was able to bust up the clot."

Verschuyl injected the powerful clot-dissolving tissue plasminogen activator (tPA) into the leg, and then placed a stent to keep blood flowing through the reopened vein. It was a seemingly casual remark that the woman made as she was leaving the hospital that led to her story being published in this week's issue of The Lancet.

"She just happened to mention that she had started a diet that had her eating grapefruit for breakfast for three days," Grande said. "I wondered if that contributed to the blood clot, so I did a little bit of thinking and reading."

It's well known that grapefruit has interactions with a number of drugs, Grande said. A reference book she consulted showed that grapefruit juice magnifies the effects of the estrogen in the birth control pill the woman was taking; one effect of estrogen is to increase the likelihood of clotting. The patient was advised to stop taking the pill.

Dr. Raul Mendez, another physician involved in the case, recommended a series of follow-up tests. One of them showed that the woman had the factor V Leiden mutation, which also increases the risk of blood clots.

So it was the combination of grapefruit juice, the estrogen in the birth control pill, the clot-inducing mutation and just sitting in the car in a position that narrowed the blood vessel, that threatened amputation of the leg, Grande said.

This means there is no great lesson for people in general from the episode, she said. "Grapefruit juice is not a threat to society at large," she said. "It is very healthy in most cases. I believe this was a unique situation, and it should not discourage people from eating grapefruit."

Still, it's best for someone who intends to embark on an unusual diet, such as one that includes a lot of grapefruit, to consult a doctor about possible interactions with any medications that the person might be taking, Grande said.

"You should consult a physician about any major change in lifestyle," she said.

Its not fair to blame the grapefruit for the woman's problem, said Dr. Alan Blum, a professor of family medicine at the University of Alabama. The effects of the long auto trip she took and the oral contraceptive she was taking would be "far greater risks for a deep vein thrombosis than a total of three grapefruits over three days," Blum said.

"The bottom line is that grapefruit remains a healthful, I'd even call it essential, food for the vast majority of people," he said. "The scary message from this case report, if widely disseminated, will do far more harm than good to public health."

-Ed Edelson

More information

Interactions between grapefruit juice and medications are described by the University of Florida.



SOURCES: Lucinda Grande, M.D., resident, Providence St, Peter Hospital, Olympia, Wash.; April 2, 2009, The Lancet

Last Updated: April 03, 2009

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