This is apparently due to substances in grapefruit that interact with an enzyme used to metabolize some medicines.
Warning labels in the leaflet seems like a very inefficient solution. Why isn't the warning placed on products containing grapefruit?
We can't put billboards up for everything. It is your health, and therefore your responsibility, to read the provided literature and raise any questions to your doctor. It's not obscured or hidden knowledge. In fact, it's usually one of the first things mentioned in big, bold text. In addition every pharmacy I've been to offers consulting on medications for free and in general doctors will always go over major interactions with medication (though I've had less luck with this).
I eat thousands of different things every week and I don't ask questions about any of them weekly. Do you? And would you think it's realistic to question everything all the time?
Where did I say that? We're in a topic about medicine interacting with grapefruit. I suggest putting the warning on the medicine is a reasonable approach for this issue.
>Maybe you eat thousands of things and some interact with each other.
Whats your point here? Should every food list every possible interaction with every other existing food and medicine? Will I need to a read a 1400 page book before I can buy an orange?
Sure, you eat thousands of things. But surely you're consuming less prescribed medicine. The onus is on you to read the material given to you when prescribed potentially life threatening medication. It's prescribed and not over-the-counter for a reason. There's extra precaution placed on the medicine itself, and so you should pay attention to that and read up.
More seriously, it is easy to overlook the extreme spectrum of knowledge and ignorance in our society. There are other factors too, such as cognitive impairment, state of mind, etc. Ignorance may be a poor defence under law, but in a more ideal world, ignorance of grapefruits shouldn't result in capital punishment.
With the extreme liberalness we accept advertisements everywhere, it doesn't seem unreasonable to dedicate an extra amount of space here and there for friendly warnings.
Edit: I see several comments stating that such warnings are printed on labels. If so, discard my comment. Other than verbal warning, that's probably adequate for our imperfect world.
Maybe you eat thousands of things and some interact with each other. You don't know, you're just hoping it will be fine, because learning everything about everything is not feasible, which was my point.
My secondary point is that everyone on this thread is blaming the victim for not doing enough research, while at the same time everyone on this thread is only marginally better - maybe you do enough research in this specific topic, but surely not for everything in life.
I see no reason why prescription drugs shouldn't work the same way (which is, in fact, the way they work now). If you start taking a new prescription drug, find out what foods you can't eat and avoid them. There's no need to add a specific warning to every food that might interact with any given drug.
Dogs can eat garlic. You'd have to be feeding them multiple powdered garlic packets to cause harm, if its even possible.
So you've failed at risk management. This is why we have to have these dumbed down labels.
The American Kennel Club [1] and [2] the Pet Poison Help Line (among others) would disagree with your certainty, sir. In this case it is you who have "failed at risk management". You did not bother to consider the risks of posting false / incorrect information on a public forum. This is why we have to have these dumbed down labels. Because people cannot bother to do (literally) ten seconds of research on their favorite search engine before "speaking with authority" on public forums / social media about a topic which they are clearly not nearly as sure of as they believe themselves to be. That's how misinformation spreads so readily these days.
[1] https://www.akc.org/expert-advice/nutrition/can-dogs-eat-gar...
Studies have found it takes approximately 15 to 30 grams of garlic per kilograms of body weight to produce harmful changes in a dog’s blood. To put that into perspective, the average clove of supermarket garlic weighs between 3 and 7 grams, so your dog would have to eat a lot to get really sick. However, some dogs are more sensitive to garlic toxicity than others, and consumption of a toxic dose spread out over a few days could also cause problems.
This means that if your dog accidentally eats something containing a little garlic, they will probably be okay, but intentionally feeding it to your dog is a bad idea.
You wanna risk it with your dog, that's on you… Also, "Dogs can eat garlic." and then ridiculing the person who actually did research about what's safe for their dog, when this person couldn't be bothered to even do a ten second web search to determine if their harshness was even justifiable? And it's worth taking into account that dogs come in a pretty wide variety of sizes and body mass. Larger or more massive dog can obviously tolerate more of a toxic substance before it's a serious issue. Still shouldn't just take this person at their word and start feeding your dog garlic just because some Internet rando says "dogs can eat garlic".
Do you know that it is true? Pretty sure they read the same/similar info from a web search and determined that foods that contain a bit of garlic aren't a big danger to dogs. The context is important (although it's fair to point out that the quote can be taken out of context) -- the discussion was about food that incidentally contained garlic as ingredient (which realistically wouldn't contain a whole lot of it), not feeding whole cloves of garlic to dogs.
If you'd prefer, feel free to insert "grapes" instead. The point remains.
My burden taking a medication is on a percentage basis an edge case for the general "eating stuff" problem. So the onus is on me to resolve this edge case.
If you really desire some sort of campaign to stop this there are ways that don't impede on businesses and other's lives. You could run commercials about pharmaceutical pamphlets, you could fund a website where people could find their drug and learn quickly about interactions, you could make it a legal obligation of doctors and pharmacists to both tell you the necessary precautions with your medication. All of these would be better solutions than some safety theater like a warning label on an unambiguously safe product except to people taking certain medications. To exemplify this most diet soda contains a required notice "caution phenylketonurics: contains phenylalanine." Did you know this? Do you think the average person finds utility in this? If you are a phenylketonuric you most likely already know about the risks and what to avoid with your condition. Not only that it's incredibly rare on a population basis (~1/15,000). It's not the onus of a business to put this theater on their foods unless the chemical is dangerous to a majority (such as tar in tobacco).
Plus, knowing that grapefruit helps metabolize different things helpful and cheapens your bartab. You'll get drunk faster after eating a grapefruit or two. Animal derived fats help slow down the inebriation process, like butter and a really greasy beef patty.
Would you want grocery stores to label grapefruits in the produce section?
Pharmacists will generally warn you about known major drug interactions, when you should take the medication, etc... when you're getting a new medication that you've not had before. Now, if you've had this medication before, they may not warn you. But they will ask if this is the first time you're taking this medication.
At least, that's always been my experience.
It's surprising that people would take any medication without reading the leaflet anyway, given that grapefruit is not the only thing that can interact with them, and it's usually pretty clearly written.
The important thing is for your doctor to be aware, and notify you.
Also, grapefruit is nowhere near the only food that can have terrible interactions with certain drugs.
I was entirely ignorant about them while buying grapefruits and juice for decades.
Perhaps because of a life too inundated by data, or because they’re busy, or for whatever reason, they ignore all of these opportunities to understand the medicine they’ve been asked to take.
I can’t judge a person for doing that, as I’m sure I’ve done the same thing, but I certainly wouldn’t expect a new label on a jug of grapefruit juice that they barely glance at to finally make it across the finish line!
There are problems in the world that are just going to exist, and efforts to eradicate them can become costly and fruitless nuisances rather than further solutions. This feels like one of those to me.
I don’t know what the healthcare system is like where you live but based on my experience in the UK, the only reliable one of these three sources that I’ve experienced is the printed material. Doctors and pharmacists, for whatever reason, have not proved to be a good source for anything but the most basic of information (if any) about prescribed medicine.
And that printed material is so broad that they list every possible side effect and contraindication under the sun. Presumably for sufficient legal cover for the pharmaceutical company.
I got no shortage of warning about from the medication side (doctor and pharmacist directly and verbally, plus in written form in the paperwork and labeling).
It seems far more reasonable and feasible to put the warnings on the medicine than on the food.
I remember no such warning for either of us.
If you take medications regularly, I'd recommend checking out https://www.fda.gov/consumers/consumer-updates/grapefruit-ju....
Warning about interactions with pregnancy, grapefruit/grapefruit juice, alcohol, all other medications, and a description of the physical appearance of the pills.
By the time someone has killed themselves by eating grapefruit, it means they've already plunged through two safety barriers:
1) The medical professional that prescribed failed in their duty to inform of interactions (which then begs the question as to whether they also failed to screen for interactions before prescribing).
2) You know, those little bits of magically folded paper that come in every single packet of pills. They're not just there for decoration. And if you can't read, then there's always the Pharmacist (or friends or family).
The risks that come with grapefruit juice is much less obvious than the example with broken glass from the wine bottle.
There's so many warnings and small print already. Just like terms of services and cookie banners on websites, nobody is reading them any more because we have warning fatigue.
Whoa there. Do you know about how impact to glass can create a crater on the inside of the bottle without shattering? Then you can end up eating or drinking the glass fragments that are in the food/drink. That's something that's not very obvious.
True, but you can fix bad design.
I have a chronic ailment and take medication for it. Every single box comes with that strip of paper with important information.
The problem? It's tiny, extremely dry and technical, and is barely readable even by someone who wants to understand it (me).
There's absolutely a need for making more readable pamphlets. Until anybody cares the manufacturers will just put in the bare legal effort, and patients may suffer.
It seems that the most deadly things should be pointed out in bold and in as simple language as possible. Like in (human friendly) UX design, what is important should look important.
I suspect that the reason they don't want to put it on the boxes is largely because brands don't want medication to look dangerous in any way. The excuse that might be made about is that "pamphlet must be read too, and if we print something on the box people won't read pamphlets", but it does not seem very convincing.
Packaging is all approved by the FDA. Grapefruit interactions are a concern but so are a dozen other pieces of info.
When I’ve gotten a prescription with a grapefruit interaction the medicine had a colorful sticker with a picture of grapefruit on it.
That certainly caught my attention.
https://shop.gohcl.com/default.aspx?page=item+detail&itemcod...
Not common sense that grapefruit interacts with many meds. Signal to noise is important, but grapefruit interacts with enough to be notable. Someone would become aware that would've otherwise been ignorant:
https://en.wikipedia.org/wiki/Defence_in_depth_(disambiguati...
Even this thread itself raised some awareness, so thanks
Medicine, especially prescription medicine, often has terrible interactions with many commonly used substances.
On the other hand, warning are useless when they are unspecific and appear on something you regularly consume. You will at best notice a warning label on a package 2-3 times in your entire life, assuming you use that regularly, and even then you will immediately forget unless it is very specific to you (such as a peanut warning for someone with a peanut allergy).
Or, when we soon switch to a CBDC with programmable credits, people who purchase prescription products could be prohibited from purchasing grapefruit products.
Edit: I'm in favor of advancing awareness of the dangers of fresh and pasteurized fruit, not as proposed above, but in some effective way.
And because I know I have never read the packaging of an item I buy more than once, with the exception of medication.
I also know that this fact doesn't change when I do take medication.
I don't suddenly start re-reading packaging on my milk to see if they have any warning about interacting with medications. Especially given how many different food items I buy every month that could have a generic warning.
Medications have all kinds of complex interactions.
The vitamin K from any number of leafy greens in conjunction with prescription meds can kill you too.
If you are tuned within an inch of your life on prescription meds maybe you should read the leaflets.
Warnings on citrus fruit. What.
this has killed people before - someone will be on a carefully titrated dose of heart meds, stop consuming grapefruit, and die from their body suddenly having 3x more/less of their med.
This is complicated by the fact that other citrus fruits may have similar interactions and, at least according to Wikipedia, the full set of problematic citrus fruits is not well characterized.
But there is a limitation for HN thread titles, I had to keep the question simple.
Now, that's partially on me for not scrutinizing the ingredients, but also *beer doesn't have to list ingredients*. So it's entirely possible to have a beer containing a significant amount of grapefruit without any indication of it on the label. And that can be life-threatening, depending on the medication in question.
So that's something where I'd definitely appreciate a standard of noting grapefruit if it's in a food. Activated charcoal similarly.
That's more likely to prompt someone who's medicated into looking up if their drugs are affected by the fruit.
At worst, it causes a few companies to have to print an extra line of text and it gets disregarded by users.
Eventually this argument will move on to putting big bold warnings on the front of food, and then giant warning stickers like we do for cigarettes. At some point we have to allow people to have responsibility over their condition. Not only is the number of people affected by this small its also asinine. If it is a problem, make it a legal requirement to get drug counseling at the pharmacy before you can pick up your prescription. Otherwise it's a solution looking for a problem.
Especially if the same warning appears on every common food that interacts with some common medication (for example, tea has potential bad interactions with SSRIs and other anti-depressants).
This is 100% on your doctor, pharmacist, medicine producer, and yourself to check. Vague warnings on common foods would have 0 effect.
You can be in liver failure (See https://www.mayoclinic.org/diseases-conditions/acute-liver-f... ) after one very large dose of acetaminophen, or after higher than recommended doses every day for several days.
From https://www.ucihealth.org/blog/2018/03/acetaminophen-liver-f... About 1,600 U.S. cases of acute liver failure occur each year due to acetaminophen overuse. And some 500 people die each year from overdosing on the drug.
The question is what additional measures would reduce--for example, cut in half--the current level of unintentional overdoses and drug interactions that cause liver failure.
What the doctors call polypharmacy and regular people call "grandma has a big bag of pills to take each day" is a serious problem for folks over 65 to pick a different aspect of the same challenge.
In my experience you will get nowhere if you will only explore interventions that "eliminate problems." Reduction in harm for effort and money invested is a better standard.
Imagine you have a peanut allergy and have to check the labels on everything to see if it contains peanut or processed in a plant with peanuts.
Then you walk into the drinks aisle and see grapefruit juice box with a big red banner WARNING THIS PRODUCT CONTAINS GRAPEFRUIT JUICE.
Beyond that, it's really on the consumer of food to make sure they are not ingesting anything that can cause harm to them. Ascertaining grapefruit presence in the food falls squarely in this category. If you can not be sure that grapefruit is absent in a juice, do not drink it. It's that simple. And if something says grapefruit prominently on the packaging (I imagine grapefruit juice in its original packaging would certainly fit the bill), then it's really the individual's responsibility.
You can of course, but you obviously need to print it on grapefruit too, no ?
Too much noise is bad even today. Try to about solutions which provide clarity and personalization.
Medical professional should be responsible for your care, so he should provide you with link/printed brochure with comprehensive list of interactions for YOUR exact condition. it is more efficient and if something happens to you have piece of paper near you in your house with all interactions. You need personalization of everything.
The medicine comes with a warning label.
You can’t avoid what isn’t on the packaging.
They should.
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My grandmother was an ER nurse her whole life (a candy-striper, etc, malpractice insurance investigations etc...)
she was on some medications and grapefruit was a staple morning breakfast for my grandmother and grandfather... Grapefruit, a small sprinkle of either sugar or salt and a glass of O.J. - every morning for like 40 years....
Nearly killed her after she was on some medication that had a poor interaction with grapefruit.
and these were medical experts!
So, _YES_
EDIT: The point is: that even if youre a medical expert, you're still susceptible to this problem, and SHE WAS AWARE but the thing was that a medication she took at like 75 years old, was NOT properly warned about...
Jeasus folks, even brilliant people miss shit like this at times.
Or do you think the warning would be kept up to date with the brand names (since many people don't know the substance names, of course) of the hundreds or thousands of medications that interact with grapefruit, and that people would periodically read that list?
This is 100% on the doctor that prescribed the medication, a label on the juice or the fruit would do less than nothing, especially for people who consume it regularly.
It's your body, your health ultimately, in hand with the doctors support.
How would you even mark fresh fruit? Force supermarkets, farmers, why stop there?
(Source: watching my partner do online professional competency tests. Definitely expert level knowledge required.)
There is no such thing as a “medical expert” as the term is over broad and eg ER nurses are not required to advise patients on interactions of prescription medications.
That falls to the doctor and likely pharmacist.
It does not surprise me at all that a former ER nurse doesn’t know that some medication she got prescribed interacts with grapefruit juice.
My aunt is the head NICU nurse at El Camino Hospital in Mountain View Ca, (the hospital of the future) one of the many hospitals I built... (el Camino, UCSF, SFGH, Sequoia, Nome, Methodist) yeah im a little closer to this subject than you may have assumed.
And if you think an ER nurse "just does what a doctor says"
You know absolutely nothing of top nurses. They wear the pants.
I'm comfortable with my statement. So, thankfully you don't know what to say.
However they are medical experts in the same way that a plumber is a construction expert. I would not be surprised if a plumber was caught off guard by lighting codes.
The term is so broad as to be meaningless in practical application.
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Please share this joke with them, this is from Dr. Francis Stutzman, Cardiologist and mayor of Saratoga Ca..
--
>"I've got good news!!! and bad news"
>>You're _heart_ is going to last you the rest of your life!!
>>>"Sadly, thats going to be about a week."