Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Grapefruits

Episode Date: January 31, 2023

Dr. Sydnee and Justin don't actually like grapefruits, so it's irrelevant to them, but grapefruit juice is known to interact poorly with many medications. Given the wide variety of fruits and their juices, it seems strange this is such an outlier. How was this anomaly discovered, and why exactly does it do what it does?Atlas Obscura article, "Grapefruit is One of the Weirdest Fruits on the Planet" by Dan Nosowitz: atlasobscura.com/articles/grapefruit-history-and-drug-interactionsMusic: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/ 

Saw bones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, Tommy is about to books. One, a myrtle tour of Miss Guided Medicine. I'm your co-host Justin McAroy. And I'm Sydney McAroy. And I'm so excited to be with you today, Sid.

I'm excited to be with you today. No, on. Oh, thank you. I feel bad for our listeners. They only get a half hour with you. Or, you know, an hour if their listening is still buffering and Saul Bones. Or, if I guess if they're one of your clients that you work with, they could see you there

at Harmony House, I guess. That's true. Or at the store they could run into you at the store. Yeah, that's true. I think you'd love to have more of them. I'm not a mother. I can't do more of them. I don't want to further talk to you.

I don't want to further dox you. I was good to say. Do you want to name like where are Dennis's and where I get my hair done? Well, we're at it. Dennis just retired. Shout out to Judy. She's fine.

She just retired. I think I said she retired. Oh, well, the way it's a shout out. Shout out. That's not like in the world. I don't know. It was something weird about it. I by the way, I didn't know I was messing with the sound board before we started.

Is that right? Oh, that's good to hear. They're all up. No, it's not right. I'll learn. Okay. Is that better? Okay, that sounds good.

I don't know. No, it's fine. Yeah. I mean, I'm just in the room. I can't hear anything. I'm just talking. Justin. Sydney.

Can't get the heater to turn off. Please turn off. No, I'm cold. We got an email from it is loud though. We got an email from, it is loud though. We got an email from one of our listeners, Isabel. Thank you Isabel. Asking about grapefruit. Oh, okay.

And I realize we have definitely referenced grapefruit. I believe in like a weird medical questions episode. But we've never done a whole thing on grapefruit juice and it's interaction with medicine specifically. That medical part of the grapefruit. And I also realized that in terms of the history, like when did we, how did we, why do we know that grapefruit juice interacts with medicines?

And that question really intrigued me. I mean, think about it. There's lots of foods and juices. There's lots of juices. How did we figure out specifically that grapefruit juice was a problem? You're in a hotel continental breakfast and they have like a wide range of juices.

And in that context, even though you don't drink juice ever, in that context when they have a little glasses, you're like, God, that'd be good. God, I love a glass of grape juice right now. That go down so smooth. Not me. I've never been a big juice drinker. And then as I've gotten older,

I've developed acid reflux. So I definitely stay away from juice. Right, right. I prefer my fruits in their original fruit form, personally, as opposed to fiber and the gunk. Yeah, I like to bite into an apple. I don't want to drink its juice. Oh, well, I mean, I am drinking it,

but like, I'm gonna eat its flesh and drink its juice all at once. I like fruit that way, but that's fine. If you're into juice, I'm not, I'm not gonna give you hard time. There's no shame if you're into juice. But if you are into great fruit juice, which was the name of Randy Moss's juice chain that he opened at the Charleston Town Center. I don't think it was that. It was. It was. Oh, in the juice. I don't even know. There's no shame if you're into juice. No, it's just into juice. Maybe

the full, full out of abbreviated title is there's no shame if you're into juice. But no, it's just into juice. But I will say that if you were into grapefruit juice, there are some things you should know. Okay. Uh... It's better. Not very good to drink. Is that part of your work?

Well, I feel like we should put the disclaimer out there because this is just and I don't have a lot of the same food preferences, but we agree on two things. We don't like olives. And this is no again, no shade if you do, that's great. We're all for you because we're not. That's right. And we don't like grapefruit. Sorry guys, I've tried. That grapefruit is one that I've tried many times. I like bitter. I drink IPAs. I like the bitter flavor profile. You'd think I would like grapefruit, just don't like it, don't like it. Anyway, and boy, my mom was of the generation where grapefruit was huge.

You know, a half a grapefruit for breakfast in the morning was like, the thing. Now, I remember that being a big 80's thing, my mom did it too. I learned about grapefruit a lot more in medical school in the context of the way that it can interfere with certain medications. And you may know this because you may have been told

at some point by a doctor or a pharmacist or somebody prescribing you a medication that, hey, FII, don't drink grapefruit juice while you're taking this. And if you're like me, you're like, no worries there. I, yeah, I remember I found out about it from you because I was, I don't know, I was into some health thing

and I had read that grapefruit juice would like help with, I don't know, but I don't know what it is. You probably know, metabolism or something. And you told me not that I should be careful with it because it can mess up my brain pills. And it's like, I don't like grapefruit juice anyway. And I'm gonna be sad about eating grapefruit juice. And also, my brain pills won't work.

So I'll be even sadder about this grapefruit juice. I could get pretty despondent about the grapefruit juice, I don't know. It's actually the other way around. Oh, so I'd get like. It'd be too high. Too anxious about grapefruit juice. So this is the thing.

When I learned about grapefruit juice, you learn about lots of interactions and one-soffs and things that can happen in medicine. And then as you start practicing, sometimes you learn that almost never happens. Like 99% of the time, the patient's gonna do that thing and everything will be fine. And it's pretty rare.

Grapefruit was one of the things that I thought was like this esoteric kind of board question fact. And then I knew someone, actually wasn't my patient, but I knew someone who actually had this problem and was discussing with me. They were on well-buterin, they were taking their well-buterin, and all of a sudden they just started having these weird symptoms. They were tired and out of it and dizzy, and they didn't know what was going on. We were going through all these different things.

They were just kind of talking to me like, you're a doctor, you know things. And finally, they said, the only thing I've been doing different is I started drinking a glass of grapefruit juice every morning because I read a book that said I should. And I was like, oh my gosh. It's like a board question. They laid it out like that. It's like a very easy house mystery.

It was. And then they stopped it and a couple days later, one to three days is usually how long it takes to do it better. So anyway. I bet they were really, to have an excuse to not drink grape juice anymore. It's great when you can solve something like that. I had somebody who was worried

because their armpits had turned brown, and it was their deodorant, and I told them to change deodorants and tell me what happened, and it changed. Yeah. It's always very exciting when these things are easy to solve. So what's the deal?

We take medications, but obviously they don't stay in our bodies forever, right? Right. That's why you take a pill daily, twice a day, three times a day, whatever. Like you take them in different dosing intervals, some are weekly month process. I'm always just processing them and it's my-

You break them down. Otherwise, you would just continue to add to that medication in your body. Eventually, it would be toxic. Something in your body is breaking them down. One of the enzymes responsible for breaking down medications, a lot of medications, a lot of different drugs that can be prescribed, is called CYP3A4. It's part of the Cytchrome P450 family of proteins.

These are enzymes that will oxidize for molecules. They live in your liver and in your intestine. And collectively, the P450 family metabolizes 60% of all the prescribed drugs. And specifically, this one, CIP384. CYP384, I'm'm gonna say tip 3a4. Yeah, for simplicity. Like a cool nickname. Tip 3a4 is responsible for half of that.

So it's the one. It's the reason that you have to keep taking pills and also that stuff doesn't just accumulate in your body forever. Could, what if we could take a pill that would get rid of those? Would that be nice? You just have to take one pill and everything about it again? Well, you're kind of bumping up against what happens.

By the way, enzymes, in case I realize I was talking about enzymes, do you know enzymes are, do you have an idea, a concept of what an enzyme is? Honey, look at me in the eyes. Not a single inkling of what an enzyme is. Honey, look at me in the eyes. Not. Not a single inkling of what an enzyme is. I could guess for a hundred years and not get anywhere close. It is something in your body, usually a protein. Typically, these are proteins.

And they catalyze reactions. They make things happen faster. They make their tons of chemical reactions constantly happening in your body all the time, right? That's what keeps you alive, all of these reactions shifting back and forth, if they all reached equilibrium at once, you'd die. Okay, so good. So we're...

Anyway, they catalyzed reactions. Or hot on reactions. We like reactions. Lots of things are involved in chemical reactions. There are lots of cofactors and things that are in there. But the thing that characterizes an enzyme is that it will be used over and over again and it's not destroyed. So it's like, it's just something that lives in there and its job is to be like,

oh, look, there's something to break down that I'm here due to do. So I'm kind of, and I'm like an enzyme of the podcasting world. You bring me on the show. I sparkle instantly. Glitter shoots out my fingertips. And the whole show is Caledisized. Catalyzed.

If I may, yeah, catalyzed, catalyzed, catalyzed, catalyzed. And I can't be destroyed. I can, I can, uh, um, I'm, I'm, I'm an enzyme. It's a heck of a thing. Or podcasting. I can't be destroyed. So this enzyme breaks down, that's its job. It's to catalyze, break down a lot of drugs. Okay, for the most part.

The thing is, so there are stuff that is broken down, that is metabolized. True. By this enzyme. But there's also stuff that can change the activity of the enzyme, kind of like you said, what if something could stop it, what if something could block it? So if you put something in the body... My internet drops, for example, and I can't be on the podcast anymore, to the enzyme of

me. There we go. This is going to be a rough to just continue this. I actually think it... I actually think it... It felt like I was closing the book on it right there. It felt like a nice, a nice closure point. So if you put something in the body that will block CIP 304, it's not going to break down the drugs. So they'll just stay in there.

And if you keep taking them, instead of, you know, you take something, the amount of it in your bloodstream peaks, and then start dropping off as it's broken down, right? Well, if it's not broken down, and then you put more on top of it, and then you put more on top of it, and then you put more on top of it, you see where I'm going. You can get sick, okay? So there's stuff that you can put in your body that will either block that enzyme, or there are other things that will turn it up and make it work faster

and more. So, instead of you building up really high levels, no, no, no, really high levels. For me. For me. Of the drug, you would actually decrease the amount of drug in your body. That's working. Because it's breaking it down so much faster. Okay.

So. You're burning through it. Yes. There are a lot of things that inhibit this enzyme. There are a lot of things that inhibit this enzyme. There are a lot of things that activate this enzyme. And this is at the root of a lot of like when we start talking about how two drugs can interact, this isn't the only thing that can cause that. But this is at the root of some of those interactions. If I tell you like, oh, since you're on this medication, it wouldn't be safe to start this one. This might be why because of the way those two drugs interact with this system.

If one of them is broken down by that and the other one inhibits or activates the enzyme that does it, you can see how all that would. Does that make sense? I know there's a lot of different substances at play here that are doing different things that all interact with each other. This is also what the root of things we worry about outside of drugs because like if we're talking about prescription drugs, ideally the same person, or at least people who are communicating with each other would be prescribing all the medicines you're on, right? So nobody would be prescribing you something without knowing other things that you're taking.

And so they would be able to, you know, account for this and not make those mistakes. But they may not know if it's something that's just random out in the world. A food, a supplement. This is why it's so important. A juice, perhaps. This is why it's so important to tell your provider if you're taking like herbs or supplements or anything like that over the counter meds or if you have a major change in like your dietary habits because it might interact with

a medicine you're on. Doctors do not have time for me to sit there and be like, so I hit up teriyaki express. I don't need everything. Anyway, where's that from? Teriyaki Express. I don't need everything. Anyway, where's that from? Okay, Tuesday at 3 p.m. I actually don't need to be like, yeah, and it was like, I went to the sneaky trip to the Long John Silver and got some cringies and chicken tenders. I don't need that.

So, here's the thing. What we have covered here are that there are a huge list of drugs and supplements and foods that can inhibit CIP-304. There's a huge list, and when I say huge, I don't, I shouldn't say huge. There is a, it's not something I can list on the show, that would be the whole show. If I list it all of these, there's three different lists. There's a list of blockers, there's a list of activators, and then there's the list of drugs that are broken down by CIP-304, so the blockers and the activators will have an impact on.

All of these lists are available easily online. If you Google, what inhibits this, what does grapefruit interact with? These are easily, and if you're not sure, this is always why when it comes to prescription medicines or any other supplements, whatever that you're putting in your body, talk to your provider. No, talk to your provider about all these things so that you aren't in a situation where you're getting sick and you don't know why, and it's easily fixable by just stopping one of the things that you're taking.

It's all available. I'm not going to read every single medicine. There's tons of them. This isn't the only reason why you might have, like an interaction, for instance. So great fruit juice can block this enzyme, which will increase the blood levels of medicines you take that are broken down by the enzyme. Well, great fruit juice also can interact

with certain proteins called drug transporters, which you can imagine what they do. Transport drugs. They transport drugs specifically into your cells so that you use them. Well, if it interferes with them, it may actually decrease the effect of the medicine in your body. So, great for juice is going to increase the effect of some medicines and decrease the effect of other medicines.

We know what one's that. So it's really easy to ask the question, is grapefruit, can I have grapefruit? Just grapefruit and a fruit with anything I'm taking. We're talking a lot about grapefruit juice, but do we also mean just grape, straight grapefruit? Yeah, I mean, it's just grapefruit. Yeah, grapefruit. I know there's the same thing.

I just meant like, I didn't know, I guess now that I feel a little a little bit. You just need to be careful, careful, bowl. One more time. About the ingestion of grapefruit. I always am. I knew that instinctively. My body was saying like, this isn't good for you, Justin.

Be careful. Be careful with this better juice. And on top of all that, it's different in different people depending on how much inside you have. So for some people, a little grape juice wouldn't hurt them, but a lot would. For some people who tell me more, yeah, grapefruit juice. You said grape juice. I didn't know I was doing a grapefruit juice. Oh, sorry, grapefruit juice.

No, not grapefruit. Okay. We're all over the place here. Your age, whatever, you know, again, medicines you take, what comorbidities you might have, all of that comes into play. And in some cases, it can take a very small amount. A very small amount of grapefruit juice can throw off the medicines you're taking. So it can have a huge impact. How did we figure this out? So that's the story. That's why we tell you. That's what you

need to know about. If you're on meds and you've never bothered to ask or to look it up or if you have concerns, please ask about the medicines you may be on. But how do we figure this all out? I want to tell you that, but first, we got to go to the billing department. Let's go. The medicines were medicines that escalate my car before the mouth. They can be anywhere at your office in your car,

and they are wrong. My mom says that the Greyhouse didn't exist, but she's wrong. He just does it wrong. Someone in your life is wrong about something. Something small, something weird, something vitally important. Only one person has the courage to tell them just how wrong they are. You know what you did was wrong, but your daughter is a liar who eats garbage. They call me Judge John Hodgman.

Listen to me on the Judge John Hodgman podcast. If someone in your life is doing you wrong, don't just take it. Take it to court. Submit your case at MaximumFund.org slash J.J.H.O. Hi, I'm Alex Schmitt. And I'm Katie Golden. And we make secretly and incredibly fascinating. A podcast about why seemingly ordinary stuff is actually the title of the podcast.

Using tons of research, we take a joyful look at history, and science, and stories, and jokes about the ordinary stuff in your life, Because that's what makes those things amazing. Also jokes. So get excited about paper clips. Get thrilled about pigeons. Get all psyched up and running around the room about the Imperial system of weights and measurements. For real, there's a whole episodes about this stuff. Hear them anytime and hear new episodes Mondays at MaximumFun.org.

and hear new episodes Mondays at MaximumFun.org. So, said, how did we start to unravel this grapefruit mystery? Okay, I found a great article from Atlas Obscura that interviewed the guy who figured this out. And I thought that was a great source. It's by Dianna Sowitz from 2020. And it's a great article just about how like weird grapefruit is, because grapefruit's weird, right? Just and why is it called grapefruit? That's a great question that I have no idea.

Yeah, I thought that was a great place to start. So, okay, first of all, it's part of the citrus family, right? We know that. Yes, it's that orange lemon lime. Do you know there were probably originally three, like primary citrus that all citrus have been derived from. No, I didn't know that. There was probably a citron, a pomello, and a mandron.

And all other citrus fruits are just mixtures of various varieties of that, right? Great fruit is a pomello and a sweet orange. A sweet orange is a mixture of a pomello and a mandarin. So work all that out. It was probably originally found in Barbados back in the 1600s. It wasn't called Great Fruit until like the 1830s. It's the first mention of it as a great fruit. Before that, it was called the Shadduck,

the golden orange or the forbidden fruit. Oh my. The forbidden fruit. Before that, it was called the Shadduck, the Golden Orange, or the Furbidden Fruit. Oh, my. The Furbidden Fruit. It's weird that we cultivated this. You know, that we've used for ages. We've used genetic engineering to make our fruit more delicious and make our fruit sweeter and more scrumptious to us, like we've genetically modified it to do that. It's weird that we kept chasing after this grapefruit thing,

just thinking that it would get better eventually. Like, it's weird that we didn't say like, let's give up on grapefruit. It's not working. It still tastes bad. There's other fruits. Like, hey, everybody, we had a good run. Let's go home.

There are a lot of people who like grapefruit. It's a complex flavor profile. It's not just sweet, and then There are a lot of people who like grapefruit. It's a complex flavor profile. It's not just sweet and then there are a lot of citrus fruits that are sweet and tart, of course. It's not just sweet and sour, there's the bitter. So it's all of that in there. But there are people who like that. So it's not wild to think people cultivate it

because some people probably enjoy it. In fact, I know people enjoy it. My mom very much loves grapefruit. Why is it called grapefruit? Does it grow in a bunch? Well, that's what a lot of people thought. For a long time, they were like, well, probably it was named that

because it grows in bunches like grapes. So grapefruit, no, that's probably not why it was called that. Others have suggested like, well, maybe it's because it's tastes like a grape. Which is a problem for a couple reasons. Let me say the first one. It doesn't. Yeah, that's the first one. At all.

Is it it does not taste like a grape? No. Also, it's kind of weird in that the grape is also a fruit. And so it would be weird to be like, well, that's a grape. It's like the grape. And that one tastes, even if it didn't taste like a grape was a fruit. Yeah. It's a grapefruit. Yeah. Well, grape is a grape. Fruit. Grape is a grapefruit already. So it's not a good name. But no, it's not that either. It also doesn't make geographic sense because the people, when it was first named a grapefruit,

the people who would have had access to it would not have also easily had access to grapes. So they wouldn't have had something to compare it to that tasted like grape. Mm-mm, mm-mm. The plot thickens. It may be because it tastes like something called sea grapes. Sea grapes. So what are this?

They're not grapes. God, God. They're part of the buckwheat family. They do look like grapes, and they are sour and bitter. So maybe grapefruit tasted like seed grapes, and that's why it was so great. Are those stolen production? I've never encountered them. Those don't grow around here, like in parts of the Caribbean, those grapes.

You won't find those in honey to my Virginia. I don't even think you can get them at the fancy crogr. Really? Not even at cha-cha-crogr? No, not even at Gucci Cro get them at the fancy crogr. Really? Not even at Cha Cha Crogr. No, not even at Gucci Crogr. Wow. That's amazing. The many names for the...

Every town has a good crogr and a bad crogr and a between-crogr. Right? It's just the thing. We have three levels of crogr in the town. Yeah. And the best crogr is usually either called the fancy crogr, the Gucci crogr, or my mom calls it the Cha Cha Croager, which I don't know where Cha Cha...

I don't know why, but I started getting into Cha Cha Croager. I started calling it that. I like that one. I did too. I have a lot of people that I work with that call the Buzzy Croager. I'll say. Buzzy Croager is judgmental to me.

I feel like that's like, you know, it's like, I'm not gonna turn my nose about it. Sometimes I wanna treat myself to some sushi made right in front of me at Gucci Croager. Do you know the funny's like, I'm not gonna turn my nose about it. Sometimes I want to treat myself to some sushi made right in front of me at Gucci Kroger. Do you know the funny thing that I noticed? Actually, I'm gonna tell you this and I should have told you off the podcast, but the lady who does the, one of the ladies,

there's a couple of different ladies that do the sushi at the Cha Cha Kroger. I saw her at Fifth Avenue Kroger, but she was like in the back, like in the in the deli section, like backward behind the butcher's counter, like doing her thing, just not on the split. They've like scrolled her away back there. She's still making the sushi at Fifth Avenue.

Do they have sushi at Fifth Avenue? Yeah, they have sushi at Fifth Avenue Croger. Why didn't know that? But apparently she's just going there, but they don't have her on the split. She's an artisan. Put her out there. You know, you do that? But apparently she's just going there, but they don't have her on the spoon. She's an artisan. Put her out there. You know what? No, that's a whole point.

You can watch people make sushi. And then you can get the sushi, which is, I mean, I'm gonna say, like, I know what you're thinking, Kroger, no, it's good. It's good sushi. She knows what you're doing. I'm sorry, the sushi's good. They've got fancy cheeses and they let you make your own

like beer pack and like a six pack. They got like a whole olive bar. If you got like a whole, they got a whole olive bar if you're some sort of olive pervert and you love olives that much. You're not, you're not an olive pervert if you love olives. Anyway, we're talking about crogres and we're supposed to be talking about grapefruit.

For many years, you're welcome for the free promo by the way, Crogre, get at us, you feel guilty and you wouldn't give us some money. No. Great, for many years grapefruit was thought of as a health food. It's a good question why. I mean, it does have like vitamin C in it. You know, there are other things that do too.

I'm not saying grapefruit's outside of all these medication interactions, of course, we're talking about. Grapefruit inherently is not bad for you in any way. There are things in it that are good for you. Certainly, not that it's the only source of these things, but it is a source of vitamin C. To answer like, why would it be considered medicine?

I know why. Why? Taste bad. Oh, actually a theory is that it kind of tastes, like there's always been this thought of something sort of tastes like sharp or bitter or acidic or something that's unpleasant, that that's a medicinal quality

and that maybe it's better for you because you don't like it as much. I don't know. Anyway, it took, and obviously there were like the great fruit diet, back in the 1930s became popularized. And for years, great fruit had the association of like, this is what you eat if you want to lose weight. Specifically, that's where.

Remember being a big thing. Like, as a health food generally, but then it really was like taken over by the weight loss industry to say like, grapefruit is what you eat. And if you look at those diets by the way, they tell you to eat grapefruit, yeah, whatever. They also tell you to eat 500 calories a day. So.

Yeah. Not not great. So like I'm not good would not recommend. And also it's not the great fruit there that's doing something bud. If you watch serial commercials from the 80s as much as I do, which is to say every night as I am wind with my bull cereal, uh, it's hilarious how many are like part of this complete breakfast since like a bull cereal and just this huge half grapefruit. Yeah, it's like yeah, it's a complete,

it's a complete healthy breakfast. All that grapefruit. Okay, so here we think grapefruit is this, you know, health food. At least that's what's the popular conception. A lot of people are eating it. We're into the 80s now, session 1989. So we've gone through the 80s. And I feel like the 80s were still the heyday of grapefruit. I mean, at least in my house, my mom loved grapefruit. But David Bailey, who was a researcher working in a lab in London, Ontario, and clinical pharmacology, figured out that grapefruit, there's a problem.

There's an issue with great fruit. He's the guy who discovered this. And it was a hard, when he, I'm gonna describe how he figured this out, but it was hard for him to sell this idea at first because people weren't like the idea that a food would cause problems with drug like this, was not well accepted.

Obviously, we knew drugs could interact with each other. But we didn't yet understand that food could play a role in that too. So this was ground breaking. That's fairly late. I mean, all things considered. Well, it would be a hard thing to tease out. Especially like, at this point, we're in 1989,

think about how varied the human diet has become. We all have access to so many more foods, all times of the year. Like by the time we have the technology to start understanding all this stuff, it's the same time where like the average person is eating such a wide variety of foods in any given day, it's such a hard thing to tease out.

Remember when we, for a little bit, people were eating those like freeze dried, they're not freeze dried, but like big chunks of cereal frozen in nitrous that would make your like dragon's breath I think they called it or something like that I don't remember that anyway. I remember seeing those at things. It's like or dip in dots Dip in dots is a good example That seems like like nobody would have accounted for that though. We'd start doing that It's got to be something you know, that's a huge writ.

Who knows? That's true. I mean, just did that and started eating it. We just did that and started eating it. We didn't even start to think about it. It would take us a long time to figure out there was a problem there. Yeah.

I love humans. And I hate different dots. Every time I say that, it sounds like I'm not one. I am a human. We're just a cool, we're just a great species. That only does good stuff. I am a human. I too. He was, we're just a great species. That only does good. I am a human. I too.

He was, anyway, so he was working. I swear on my blood moving device inside my thorax, but I too, of your human tissue. Of which I only have one. Just the one heart for me, thank you. Just the one, not two. Anyway, so he was studying different medicines and he was working on something called phallodipine. That's a blood pressure medicine.

And specifically, he was working on the connection between that and alcohol. What happens if you drink alcohol while you're on this blood pressure medicine, okay? So you've got, think about how you would set up that test. You've got two groups of people, they're both taking the medicine, and you wanna know how alcohol will affect them.

Well, what's the tricky part about that? That you gotta give an alcohol? Well, one group's gotta have alcohol, and the other group doesn't have to have alcohol, but you gotta make sure that they don't know if they're getting alcohol or not. Which, I mean, if you get a buzz or whatever off of it, yeah, you might know them,

but in that moment when you're drinking it, you've got to not know. Yeah. And alcohol has a taste, right? It's easier to do today. We've got a lot of great imitation liquors on the market. That's true. It's available, probably easier to do.

Back in 1989, it was harder because you got to figure out like, what can we use to hide the booze? Grenadine. You think Grenadine is str- no, Grenadine's not going to hide the booze. No, probably not. So it was actually, he worked on this on a Saturday night. This is according to this interview from Alice Obscura, with his wife, Barbara. The two of them sat down to figure out what can we hide the alcohol in so that the subjects the test subjects won't know if they're drinking alcohol or not

And so they tried all kinds of different things and at the very end they they thought about they had a can of grapefruit juice and they thought well Let's try that. Yeah, let's see if the grapefruit can hide because it is such a strong flavor. Maybe it will hide the alcohol and it did. So he gave his subjects either alcohol and grapefruit juice and his control group just got grapefruit juice. And? And it worked. People didn't know, which was which. First of all, the first goal, it did work like They couldn't tell if they were drinking alcohol or not. There was a little bit of difference in blood pressure. But the strange thing is that he was taking blood levels of the medication.

So looking for how much of the blood pressure medicine is still in their blood after taking the pill and drinking the drink. And what he found is that the levels were four times higher than he would have expected in the patients overall. Because all of them were drinking grapefruit juice. I don't think it's random. These random things freak you out sometimes. But like, like these like, oh, I don't know, I just kind of,

and so he figures this out and he's like, okay, the only thing that's off is the grapefruit juice. That's the only thing that makes sense. It's the grapefruit juice because the alcohol was different. Everything else was accounted for. So could it be grapefruit juice? So he tried it out on himself. He drank grapefruit juice and took the phyloedopean,

the blood pressure medicine himself, and checked it in his own blood and saw that his levels were very, very high. And he knew that it had to be the grapefruit juice. And it took a while to isolate exactly what it was in the grapefruit juice, right? So we know something in grapefruit juice is messing with the blood levels of this medication. It took him a while to figure out that there is something in grapefruit called furano cumurines. Ferano cumurines.

These are the compounds that specifically stop that P450 enzyme, that CIP 3A4 that we talked about from working, like just really, you know, finishes them off. And we just happened upon this. You know what I mean? It's wild. How much of innovations just happen, Sans? So he published... Do you know that chocolate chip cookies were an accident? Did you know they were created by accident?

Did somebody spill the chocolate chips and the... No, the woman who owned the toll house in broke up a chocolate bar because she thought it would make the cookies chocolate. She thought it would melt in the oven and make them chocolatey and they didn't melt. And she was like, this is good. Better even. Better even. Dippin' dots too.

Speaking of, created by accident. That's unfortunate. That's unfortunate. That's a bad accident. So, accidents are good. Regularizing is better. So, he published in the Lancet in 1991. And it's funny because the original study

is like literally there are six men who took a full Odapean five milligrams with water, grapefruit juice, or orange juice. I mean, just six people. And then they checked like the bioavailability with the grapefruit juice. And it looked at the levels and how did it affect the amount of sugar. It's really strong of sugar. Yeah, it's very small. And then they, um, yeah, and I mean, they, it was really just like six

people, but they saw a significant change. It would have to be significant. I would think for that, if you're having that small, the sample size, it seems like you would need it to be pretty impactful for it to register. Yep. So, so a 164 to 469 percent by availability like higher levels with the great fruit juice and with water. That is wild. Yeah, 469 percent. So that shows the range too. That shows like even in the six people, the six test subjects, some of them had a much stronger effect from the same amount of grapefruit juice than others, because it has to do with how much of the enzyme you have in your body and a lot of other factors play into it, which is why it's really unpredictable.

So you may be thinking, I take a medicine, you've probably Googled this by now, does my medicine interact with grapefruit juice, and you may think, well, sometimes I eat grapefruit. And I don't think I've ever had a problem. And it may be that the small amount you ingested wasn't enough to interfere with your med and your body. But maybe in somebody else, that exact same amount

would cause a huge effect. And the trickier part are meds that don't always immediately show you that there's an effect. If you have symptoms of toxicity of high levels, it's easy to know something's going wrong, but sometimes like you won't realize that your blood pressure medicine is way too high or something. And some of these drugs, it really doesn't matter as much.

I mean, it always matters, dosing always matters. I'm not saying dosing doesn't matter, but for some drugs, if you got higher levels in your bloodstream, it's probably not going to do much to you. Like, it's just there. You got more than you need. That's not a huge deal. But other things like let's say it has to do with regulating your heart rhythm. That's a huge deal. So this just highlights that I think it's it's wild. How this researcher figured that out. Yeah. David Bailey is his name, who stumbled upon this, making, I guess the name of this cocktail, if you mix vodka and grapefruit juice is a gray hound.

I didn't know that. But anyway, it's a fat, and there's a whole more, if you're interested in that article from Alice Obscura, like I said, it was from 2020, Dan Nosowitz wrote it, and it tells the whole history of gray, oh, a ton of stuff I didn't talk about but and it interviews him more about his his wild serendipitous discovery that we now know and and I guess in some countries like it's really widely like on all pill

bottles and things that says don't drink grapefruit juice don't take grapefruit don't eat grapefruit um it's something that I think we forget to talk about sometimes in the US. And you again, you may be listening and thinking, my doctor never said, I think that we learn about it along with like 50,000 other things that might happen. But I didn't until I researched this episode realized like how easily it can happen, how little great fruit it takes to cause this. I knew the lists were huge, but I think it's a good reminder to let your doctor know or your provider if you make major changes in your activities, behaviors, things you put in your body, because if you're on medicines, it may interfere.

And it may be something you want to take a quick look at. There are tons of resources that list the meds, the inhibit the meds that activate and the meds that are broken down and the other substances too, obviously not just meds. Great for juice, it's not a med. I think juice have this on the label. It feels like it should, right? Oh, that's a good question. I don't know if grapefruit juice actually has it on the label. Seems like it should. I mean, we don't have any grapefruits to test that on, but... Yeah, I don't know. I don't know if it... I've never had grapefruits in that. All right.

I don't know if it... I don't like grapefruits. I don't know if it's on the label. I know that, like I said, that some medications have it on the bottle. And I've seen some here, but I think that it's something we could all do a better job of, is just reminding people that I am sorry there are certain medicines that if you're on, you probably just should stay away from grapefruit altogether. I know that's a bummer. Miss that delicious bitter juice. There's lots of other good juices you could try. Come join us and enjoy lots of other citrus fruits that aren't grapefruit. What's your favorite juice right now? My favorite juice. What's your favorite juice right now? My favorite juice.

What's your favorite juice? I really don't like juice very much. Okay. I mean, I guess if I had to pick, it would be orange. What's your favorite juice? Oh my God. Power rankings number one is going to be Guava juice. Oh, outrageous.

Number two with a bullet weight group juice coming in strong. Number three, bringing up the rear. Not going to count Pog juice that would be cheating. Yeah, Pog juice would be high for me, but I think number three is going to have to be a cran apple. That could be cheating too. It's a blend, but still that's where I'm at. But Orange, you can mix with champagne. That is also cheating. So I'm sorry, Sydney, your juice opinions are invalid. You know what, I'll take it. That's fine. Thank you so much for listening to our show. We hope you have dumped out all your grapefruit juice. Because it's poison, basically, is what's saying. Sydney says. No, I'm saying that if you take any prescription medications or any of the counter herbal, any supplements, anything like that regularly.

Oh, just check. Just check. On a serious note, we love all of our listeners and we really do care about the people that listen to the show and we love hearing from you and love your feedback, your ideas, all of it. If you like grapefruit, please don't tell me about it. I love you. I don't want to get a bunch of emails that are like, but I like grapefruit. I understand.

You have just guaranteed that our inbox is going to be full of emails titled, I like grapefruit. I'm going to set up a filter. I'm going to set up a grapefruit filter. Hey, and I would like to say I got a couple of emails from people last week who felt left out when I talked about how sometimes that there are a lot of blood tests that are automated that we do, but that some need to be read, actually looked at by humans and not read by a machine. And that I said pathologists do that

and did not acknowledge the fact that lab techs do that as well. Lab technicians also look at slides. And I did not in any way mean to undermine the contributions of lab techs or insinuate that they don't do that. Sometimes I'm talking fast and I say one thing I move on but thank you lab techs for all you do and I'm sorry for how many times we call you from the call room and say I really need this result. I really need this result and you you're sitting there going, they haven't even collected it yet. I'm sorry.

Oh, medical, Huber, you're everyone can enjoy these. My lab texts know what I'm talking about. Oh, everyone can enjoy these great gigs. I know. Thanks to taxpayers for using their song medicines as the intro and outro program. And thanks to you for listening. That's going to do it for us until next time.

And it was just a Macaroi. I'm Sydney Macaro listening. That's going to do it for us until next time. I'm in his Justin McAroy. I'm Sydney McAroy. And as always, don't draw a hole in your head. All right. Maximumfun.org. Alright!