Saturday, April 4, 2009

Warning: Grapefruit Diet Plus Contraceptive Pill Led To Dangerous Blood Clot In Woman's Leg

We are being warned that Grapefruit Diets can increase the risk of blood clots, especially in women taking contraceptive pills.

In the Daily Mail we read that "Doctors are warning of the dangers of the grapefruit diet after a woman almost lost a leg three days into the eating regime. The 42-year-old developed a blood clot in her left leg after the fruit interacted with the contraceptive Pill she was taking."

"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.

It's 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.

For some years now grapefruits have been singled out from among the citrus fruits as being inadvisable to eat when taking certain medications. As well as oestrogen-containing pills, these medications include statins and calcium channel blockers. Further explanation and a longer list of drugs that have potentially serious interactions with grapefruit products is given on this Mayo Clinic webpage.

Quite apart from the harmful effect of the grapefruits as such to this particular woman, there is a strong case to be made against extreme diets of all kinds. These diets tend to contain far too few calories and this in itself leads to hunger, tiredness and feeling cold and unwell. Coupled with the inadequacy of calorie content there is the inadequacy and lack of variety of nutrient intake.

The grapefruit diet for instance provides scarcely any protein or fat and only a limited vitamin and mineral content. Similarly with other extreme diets. A moment's thought tells you what the banana diet lacks, what the egg diet lacks, etc.

A healthy diet for human beings is low in salt/sodium and consists of a wide variety of foods which provide a comprehensive range of nutrients in adequate amounts. The woman in the story was trying to lose a little excess weight, and as far as losing excess weight is concerned, extreme low calorie diets are neither appropriate nor necessary.

Overweight is caused not by eating too many calories as we have been encouraged to believe. It is caused by fluid retention/salt sensitivity and is easily, swiftly and safely reduced by cutting down on salt and salty food. This means in practice avoiding convenience foods to which manufacturers have routinely added lots of salt. These include ready meals, bread, cheese, bacon and ham, sausages, most breakfast cereals, etc. You will find that if you give up dieting and counting calories, cook 'from scratch'/from fresh, and eat good hearty meals with plenty of fruit and fresh vegetables you will lose excess weight as if by magic. Why not try it? Reducing salt intake, unlike extreme diets, is completely safe and has many other health benefits as well as reducing excess weight.