ALLERGY, RESPIRATORY
Molecule in Skin May Link Eczema and Asthma
Overweight Moms More Likely to Have Asthmatic Kids
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ALTERNATIVE MEDICINE
Placebo Acupuncture Tied to Higher IVF Pregnancies
Spot light on Dani Antman New Lionheart teacher
Indian Spice May Thwart Liver Damage
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Animals Respond to Acupuncture's Healing Touch
Beware of Dog Bites
Safe Toys for Dogs
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Human Ancestors Put Best Foot Forward 1.5M Years Ago
Are We Exercising Pain Away? Not So Much.
Returning to the Road Tricky After Injury
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Smokeout '08: The Perfect Time to Quit
Where You Live May Affect Your Cancer Diagnosis
Quitting Smoking Doubles Survival in Early Stage Lung Cancer
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Study Links Pesticides to Birth Defects
Are Hospital Mobile Phones Dialing Up Superbugs?
Weekend Admission May Be Riskier for GI Bleeding
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Common Antioxidant Might Slow Parkinson's
Bye, Bye Back Fat?
Vitamins Do Older Women Little Good
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With Psoriasis, the Internet May Offer Hope
New Genetic Links to Baldness Discovered
Contact Lenses Boost Kids' Self-Image
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Health Tip: At Risk for Gingivitis
Acid Drinks Blamed for Increase in Tooth Erosion
Gum Care Helps Control Type 2 Diabetes and Its Complications
DIABETES
Red-Grape Compound May Improve Diabetes
Findings Challenge Tight Glucose Control for Critically Ill Patients
Formula Puts Doctor, Patient Glucose Readings on Same Page
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Eating Nuts May Help Cholesterol Levels
5 Reasons why you could gain weight while dieting
Coffee Beans May Be Newest Stress-Buster
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Could Your Cell Phone Help Shield You From Alzheimer's?
Review Finds Marijuana May Help MS Patients
ENVIRONMENTAL HEALTH
Main Ingredients in Household Dust Come From Outdoors
Air Quality Better in Northeast, Midwest
Gas Stove Emissions Boost Asthma in Inner-City Kids
EYE CARE, VISION
It's a Whole New Outlook for Cataract Patients
Ordinary Chores Cause Half of All Eye Injuries
Action-Filled Video Games Boost Adult Vision
FITNESS
Exercise Helps Reduce Falls in Young and Old
Higher Fitness Levels Tied to Lower Heart, Death Risks
Fall Cleanup Is a Prime Time for Accidents
GASTROINTESTINAL PROBLEMS
New Guidelines Issued for Management of IBS
Japanese Herbals May Ease Gastro Woes
Bowel Prep Harder on Women Than Men
GENERAL HEALTH
Coffee Cuts Liver Scarring in Hepatitis C
Deployment Takes Toll on Army Wives
Household Insecticides May Be Linked to Autoimmune Diseases
HEAD & NECK
Zen May Thicken Brain, Thwart Pain
Many Children Will Outgrow Headaches
Ski Helmets Encouraged for All
HEALTH & TECHNOLOGY
Save Your Aging Brain, Try Surfing The Web
Subway Defibrillators Save Lives
Using Light Therapy to Silence Harmful Brain Activity
HEARING
Noise Hurts Men's Hearing More, Study Shows
Summer Sounds Can Lead to Hearing Loss
HEART & CARDIOVASCULAR
Relaxation Tapes or Mozart Lower Blood Pressure
Exercise May Blunt Salt's Effect on Hypertension
Heart Disease May Be Prevented By Taking Fish Oils, Study Shows
INFECTIOUS DISEASE
Swine Flu Closes Three Schools in NYC
Viral Infection Might Trigger High Blood Pressure
Grapefruit Compound Inhibits Hepatitis C Virus
INFERTILITY
Obesity May Affect Fertility in Young Womene
KID'S HEALTH
Frequent Feedings May Be Making Babies Fat
Standard IQ Test May Underestimate People With Autism
6 Million U.S. Kids Lack Enough Vitamin D
MEN'S HEALTH
Lots of Sex May Prevent Erectile Dysfunction
Low Vitamin D Levels May Boost Men's Heart Attack Risk
Eating Fast Until Full Triples Overweight Risk
MENTAL HEALTH
Living Alone Increases Odds of Developing Dementia
Drink Away Dementia?
Heal Your Life® Tips for Living Well
PAIN
Are We Exercising Pain Away? Not So Much.
Acupuncture, Real or Fake, Eases Back Pain
'Cell Phone Elbow' -- A New Ill for the Wired Age
PHYSICAL THERAPY
PREGNANCY
For Baby and Mom Alike, Breast-Feeding May Be Best
Exercise Boosts Bone Density in Breast-Feeding Moms
Calcium Supplements Cut Blood Lead Levels During Pregnancy
SENIORS
A Little Alcohol May Stave Off Alzheimer's
Healthy Diet Could Cut Alzheimer's Disease Risk
More Whole Grains May Mean Less Fat
SEXUAL HEALTH
SLEEP DISORDERS
Sleeping Could Help Women Lose The Baby Fat
6 to 8 Hours of Shut-Eye Is Optimal for Health
Moderate Aerobics May Ease Insomnia Symptoms
WOMEN'S HEALTH
Prenatal Stress May Boost Baby's Asthma Risk
Being Active an Hour a Day Puts Brakes on Weight Gain
Green Tea May Help Treat Uterine Fibroids
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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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