Orange You Glad I Warned Ya?

Warning! Apparently you’re not supposed to chase your allergy medication, most infamously the drug Allegra, with orange juice. Even more, grapefruit juice could prove to be lethal when taken with some medication.

I’m sorry, when did this happen? Does this mean that for the past 10 to 15 years I’ve been nullifying all of my medication by pairing it with a glass of freshly sqozen orange juice? (That’s right, I said sqozen; “The ice is ready to freeze, the ice is frozen / The oranges are ripe and have been sqozen”) (Didn’t think you were going to learn English today, did you?)

The scoop: According to a New York Times report in 2008, grapefruit juice lessened the absorption of fexofenadine (Allegra), and can produce a toxic effect when used with almost 50 other medications including popular names such as Zoloft (anti-depressant), Viagra (another anti-depressant *wink wink*), Valium (anti-anxiety), Lipitor (for lowering cholesterol), Aleve and Midol (Naproxen-containing pain relief and anti-inflammatory (analgesic) drugs). Grapefruit, orange, and apple juices were also found to decrease absorption of etoposide (an anticancer drug), some beta blockers (for high blood pressure), cyclosporine (to prevent organ rejection), and some antibiotics.

Drinking citrus juices and/or eating the entire fruit should be avoided while taking these medications and others because “chemicals in these fruits interfere with the specific enzymes that break down (metabolize) the medications. This can lead to much higher blood levels of these medications and can cause serious side effects.” Let’s find out more, shall we?

Cause/Mechanism of action:

The chemicals in grapefruits and its relatives are furanocoumarins that “affect the cytochrome p450 (CYP) system (especially at isoenzyme CYP3A4) by binding to the isoenzyme as a substrate and impairing” the first important step in the metabolic break down of medication in the small intestine and/or the liver “by direct inactivation or inhibition of the enzyme…The net effect on the CYP enzymes from this inhibition seems to be a selective down-regulation of CYP3A4 in the small intestine. For certain drugs which are known to be CYP 3A4 metabolized, less [of the] drug is metabolized prior to absorption, and greater amounts of these drugs reach the systemic circulation.” The resulting high blood concentration of circulating medication has toxic consequences, e.g. cardiac arrest and death. However, if the drug has a high “oral bioavailabilty,” i.e. most of it is released before it reaches the small intestine (located right after the stomach), then it will not be affected by citrus juices in the same way. In other words, grapefruit juice only affects drugs that first need to be metabolized by the small intestine/liver before becoming active, which explains why citrus juices affect some medications and not others. Also important to note is that the effects of grapefruit on this family of enzymes lasts up to 72 hours, meaning that within that time it is still not safe to eat/drink anything grapefruit-related (e.g. seville oranges, pomelos, sweeties, melogold grapefruits, limes, star fruit, pomegranates, pawpaws).

There is an easy way to avoid this: Take all of your medication with WATER.

Drug/Food interactions, as I’ve discovered, are numerous and difficult to keep track of—and if the internet accounts are true, these effects are not well-known (if at all) by physicians, yet much better known by pharmacologists (understandably, because they are knowledgeable and trained in drug physiology (“pharmacokinetics”) and interaction) (hopefully). To list a few notable and most likely commonly abused drug/food mistakes:  

1. Theophylline, an asthma medication containing a member of the xanthine family whose molecules resemble caffeine and are found in coffee, tea, cocoa beans (chocolate), should not be consumed with large servings of these same foods
2. Heparin, Warfarin and Coumadin, blood clot preventing (anticoagulant) medications, should not be taken when eating a heaping helping of broccoli, spinach, or leafy green vegetables because of their high concentrations of vitamin K that promotes the formation of blood clots (the opposite of what the medication is trying to do) and should not be consumed with garlic, also an anticoagulant and also commonly adds spice to leafy green vegetables
3. Fiber, soluble and insoluble, negatively affects drug absorption such as that of acetaminophen (i.e. Tylenol). Thus, this medication should not be taken with the likes of pectin containing fruits e.g. apples, oranges, grapefruits (sound familiar…) or bran
4. No orange juice with antacids due to the juice apparently increasing the absorption of the aluminum from the antacid
5. Wait to drink tea until a couple hours after taking iron supplements (or your multi-vitamin for that matter); tea contains tannates that halt iron absorption, instead take these aids with acidic juices like orange juice (Are you keeping up??)
6. Etc. etc. etc. Just drink water people.

Just to recap: a) Be aware of the medication(s) you are taking to make sure they don’t have any dietary no-no’s; b) Ask a pharmacist (or a smart doctor) about any fruits, herbs or veggies that shouldn’t be eaten with your medication(s); c) Go online like I did and look up your medication(s), and perhaps you’ll find out more information that you wanted to know…like I did…

P.S. Here are some common/popular medications that don’t have a reaction to grapefruit and the like: Xanax, Prevacid, Quinine, Coumadin (don’t take that one with leafy green veggies though! Do you remember that from like 5 minutes ago?)

To find out more about the effects of juices on medications: NYTimes.com,  EverydayHealth.com, HolisticOnline.com, Wikipedia (Theophylline, Anticoagulant, Furanocoumarin, Grapefruit-Drug Interactions Website

Obese or Not to Be?

Right mouse: You wanna go to da club tonight?

Left mouse: Yeah, I wanna club sandwich.

Right mouse: No, no, never mind...

The scoop: The mouse on the left is unable to produce leptin, an adipokine (hormone secreted by your fat cells (adipocytes)) that signals the changing level of fat storage in the body and modulates long-term appetite control and body weight management: less fat = eat more, store fat / more fat = eat less, burn fat. Two possibilities for obesity development, among many others, are: 1) a leptin deficiency or 2) leptin resistance. Leptin deficiency can be curbed by leptin therapy; but for those who are leptin resistant, leptin is already present in high levels in the blood; it just doesn't stimulate the metabolic system anymore because the body has gotten used to the stimulation, in a sense (either the leptin receptors on target cells have lessened in number in response due to over-stimulation by leptin, or they have diminished in sensitivity, yet overall the end result is the same).

If one is consuming more calories than what you're burning, the energy is stored in the body first in the liver as glycogen, a branched polymer made of individual glucose molecules, and then as fat (adipose tissue) when no more glycogen can be made. So, with the leptin targets overwhelmed and unable to keep up with the over-signaling --> the body's signal (leptin) for telling your brain (hypothalamus) that you have too much fat already can't keep up with how much fat is being made --> therefore, the amount of fat burned will less than the amount of fat being laid down in your body's architecture --> this cycle continues until one becomes obese and then it is very difficult to break the cycle, physiologically and psychologically.

There might be ways to rebound from leptin resistance. Both of the ones I will mention involve losing weight, so don't get too excited. For one, losing the amount of fat in your body will directly lessen the level of leptin in your system (remember, fat cells produce leptin, so the less fat cells you have = the less leptin); this will reduce the amount of leptin overwhelming your system and allow the body to catch up to its fat-burning potential. Also, losing fat will increase the amount of another adipokine, adiponectin, which similar to leptin serves to lessen appetite and stimulate the metabolic catabolism of fat, yet it has not been correlated to the same decrease in sensitivity in obese people that accompanies leptin. (Got it? Less fat = More adiponectin).

In the absence of food, adiponectin helps muscle cells (myocytes) take up more blood glucose, stimulates the breakdown of fat (fatty acid catabolism) for use as fuel in our muscles, decreases inflammation, stops generation of new glucose (gluconeogenesis) in the liver while also decreasing the deposition of fat in the liver , . However, it seems that the overweight and obese can often have deficiencies of this hormone which would curb their bodies' ability to lessen appetite and metabolize fat as well as the rest of us. And since adiponectin seems to be a mediator for decreasing the risk of developing Type II diabetes, then it would partially explain why overweight and obese citizens have a greater risk of developing this disease.

Dr. Philipp Scherer at UT Southwestern Medical Center, who discovered adiponectin in 1994, also performed a study in 2007 that showed high levels of adiponectin protected severely obese mice, which were also genetically altered to be leptin-deficient, from developing symptoms of Type II diabetes. This was contrary to the other group of leptin-defincient mice who ALL developed such symptoms. To me, that's sounds like a pretty good case, especially when they showed that the location of fat in adiponectin-heavy mice was most, if not all, subcutaneous rather than visceral, which means that it lies under the skin instead of around your vital organs (e.g. liver, heart).

Now onto foods: The Mediterranean diet, according to a 2006 study in The American Journal of Clinical Nutrition, is positively correlated to a higher observance of adiponectin in the plasma: women who closely adhered to the diet showed a 23% higher plasma adiponectin concentration than women who loosely adhered to the diet. An example of the Mediterranean food pyramid is shown below.

 

In particular, alcohol, fruits, nuts and whole grains showed statistically significant, positive associations to adiponectin concentrations (More eaten = Higher adiponectin levels). The authors of the study admit that the associations were modest, however it does support what decades of research and nutrition education has told us all along. Well, maybe except for the alcohol part...


Places to find out about leptin, adiponectin, the Mediterranean diet and their effects: Wikipedia (Obesity, Leptin, Adiponectin), Fat Resistance Diet, MedPageToday.com, Adipocyte.co.uk, Science and Reason, The American Journal of Clinical Nutrition, WebMD.com, and The Mayo Clinic.

Lunch Much?

The City Critic on School Lunches

A step in the right direction, even before the rest of the country had put on their sneakers. Thanks to NYC for having their finger on the pulse of what needs to be done to help kids learn and keep healthy appetites.

The scoop: Someone who's also making waves in New York cafeterias...Plattsburgh, New York that is...is Professor Brian Wansink of Cornell University. An expert in human eating behavior, an application of the studies of consumer behavior and behavioral economics, his strategy for getting kids to eat more fresh fruit is to "trick" them. Basically, to make the consumer (the child) choose the desired behavior (taking fresh fruit and vegetables) by strategically placing the product (fruits & veggies) in locations (by the cash register) or in attractive packaging that will end in seamless incorporation of the product into the consumer's cart. Has it worked? Yes, it most definitely has (phew!)

In January 2010, the school lunch manager instituted Dr. Wansink's plan and witnessed a surprising 4-fold increase in fruit sales by March! Even better news came from parents who reported their children talking about the fruit in the cafeteria. Did we just enter the twilight zone?

No, snap out of it, it actually happened. These cheap and simple changes are based on Wansink's theory of behavioral engineering. To avoid resistance, he believes (and, as far as I'm concerned, has proven) that making a consumer feel as though they have chosen the behavior/product themselves is crucial to curbing consumer behavior to the outcome you want. Big Brother anyone? At least he's using his powers for good and not evil. The author of best-selling book Mindless Eating believes people make about 250 eating decisions a day and that most of those are "'mindless' decisions triggered by his or her environment." Therefore, changing the environment can encourage people to change their eating behavior and this success of this centers on 4 concepts: 1) placement (e.g. broccoli at the beginning of the line, 2) marketing/advertisement (e.g. attractive packaging of veggie snacks or verbally offering salad to children), 3) convenience (e.g. putting chocolate milk behind the plain milk), and 4) visual cues (e.g. keeping ice cream in opaque freezers. 

Now housed in the just 1-year-old Cornell Center for Behavioral Economics in Child Nutrition Programs, the prospects of healthy changes in the lunchroom are looking good thanks to the team led by Prof. Brian Wansink.

So the next time you buy strawberries because you want them, think again, you might have just been hoodwinked!

The original article entitled "Meal Plan" that discusses Prof. Wansink's work was written by Edward Lewine and can be found in the March 2011 Hemispheres Inflight Magazine by Continental Airlines.

Biofilm, Oral Health & Your Diet

Could you prevent the creation of plaque with the things you eat?

Well, I don't know. That's what I'm asking.

A Listerine commercial informed me today of the term "biofilm" and promised that swishing a mouthful of Listerine would eradicate the bacterial coating and further protect the teeth for up to 12 hours. Is biofilm different or stronger than plaque? Is there something worse than bad breath that I have to worry about!?!

The scoop: Not a new notion, biofilm has apparently been studied for years. Dental plaque, with which we are all familiar, is a type of biofilm on our teeth. However, in the last 20 years the study of dental bacteria has changed. It is now studied as a biofilm, a working cohesive network of many microorganisms that behave differently as a community. Identification as a biofilm will affect how plaque will be treated medically and perhaps give more insight into its overall functions and structure, and more importantly how to overcome its stronghold in our mouths.

Bacteria form the biofilm by excreting extracellular DNA, proteins, and polysaccharides in various configurations that create the Extracellular Polymeric Substance (EPS). Microbes form biofilms in response to environmental factors, which includes changes in its nutritional sources. Notable is the fact that microbes' genetic expression also changes in response to building the biofilm, which then produces changes in the bacteria's behavior (phenotype) that surprisingly even includes a primitive mode of communication as well as resistance to antibiotics, antimicrobials, and host immune response. Sneaky little devils...

The biofilm isn't one big pool of bacteria swimming together in their self-made slime (sorry for the visual...); it's organized into microcolonies with differing pH's, oxygen concentrations, and nutrient availability. The microcolonies communicate with one another via chemical signals that travel in their intermicrobial matrix which spans across colonies. The microcolonies grow over a relatively short period of time; the first microbes adhere within minutes, colonize within about 2 hours, and then spread and colonize just after that. This is why your dentist ideally wants you to brush after every meal !!!

If this won't get you brushing, I don't know what will.....

Biofilm is present on the tooth surface, on top of and under the gums (gingitivis, periodontal disease), and unfortunately may travel into the bloodstream and damage other organs and increase internal inflammation. Different bacteria prefer different living quarters and have different colonizing practices. For instance, subgingival (under the gums) bacteria differ from ones that live on top of the gums (supragingival). The former includes the species Lactobacillus (found in gut flora, the vagina, and used for yogurt and cheese production) that produces lactic acid (what causes tooth decalcification), and the latter includes Streptococcus mutans (what causes tooth decay) and Candida albicans (yes, the same that causes vaginal yeast infections).

Suggestions to combat biofilms, due to watching antimicrobials and antibiotics fail to conquer the biowall of terror, include 1) interfering with microbial communication, 2) mimicking the natural defenses of ocean dwellers like whales and dolphins that don’t accumulate bacterial biofilms (LOL I know....give us fins while you're at it), 3) taking in base-generating nutrients to buffer the destructively acidic bacterial environment (possibly with arginine- and/or proline-rich foods), 4) eating sugar substitutes (e.g. sorbitol, xylitol, saccharin, aspartame, sucralose, but not fructose), and 5) using anti-inflammatory agents. 

Buffering the pH in the mouth is theorized to be a critical factor in controlling the environment of microflora, as low pH (acidic) environments favor the growth of pathogenic over non-pathogenic bacteria and shifts some normally non-pathogenic species to become pathogenic. pH buffering agents present in saliva are active while we're eating and such, but saliva is decreased for about 2 hours after a meal and while we're sleeping. That's why Trident gum, which also contains sugar-substitutes, proclaims that it helps to fight cavities--because it keeps salivary production, and therefore pH buffering capacity, active during the 2 hours right after a meal when our teeth are most vulnerable to the acidic, pathogenic environment.

The metabolism of sugars (glycolysis) in anaerobic bacteria produces lactic acid, which as you can understand lowers the environment's pH, which is why it's proclaimed that sugar causes cavities ! Well then, that's why it's proposed that eating base-generating foods (that will raise the pH) and eating sugar-substitutes are ways to buffer the mouth's pH and halt or slow the formation of caries (cavities) by literally neutralizing the cariogenic environment of pathogenic bacteria.

Arginine and Proline, both non-essential amino acids, are electron and proton acceptors (bases) involved in acid-base reactions in the mouth that raise the pH level. You can also find arginine bicarbonate and calcium carbonate in BasicMints, mints designed to increase the mouth's pH. One can also eat fats, like hard cheeses, that can coat the teeth and limit the surface-attaching ability of bacteria and also enhance the clearance of sugars from the mouth, most likely because the sugars aren't able to be caught and stored in the plaque due to the protective lipid coating. Foods containing linoleic and oleic fatty acids could limit the growth of Streptococcus mutans, as the fatty acids are shown to do so in lab. Sugar-substitutes are not normal substrates for glycolysis and bacteria have a hard time metabolizing these compounds, if they are able to at all. If they are able to, as is the case with sorbitol and some species of bacteria, the resulting products are not lactic acid but carbon dioxide and other non-destructive substances. 

So now onto foods...

However, as of now the most effective ways to destroy biofilm are by mechanical means: brushing, flossing, having your teeth cleaned by a dentist, and by using a WaterPik. I've had a WaterPik for 2 months now, recommended to me by my dentist because I hated to floss. I've only used it once because it's loud, awkward, and-as it turns out-even more obnoxious than regular flossing. Yet, as this video shows, it's highly effective at breaking through the biofilm barrier, which means I need to start pickin' with water again. Damn.

Sources to find information about biofilms are Wikipedia, The Journal of Contemporary Dental Practice, PLoS One, The Dental Tribune, Penn State, Montana State University, Colgate, The Dental Care of Stamford, WebMD, Buzzle.com, The California Dental Hygienists' Association, Advances in Dental Research Journal, The World's Healthiest Foods, Trident Oral Care, and Dentistry Today.

Bug Bouillabaisse Anyone?

The scoop: Everyone at some point has wondered what a bug tastes like. We've all seen those bug-centered lollipops at the checkout counter and wondered, does anyone really eat those? A few of us may have even tested our own hypothesis from time to time. Yep, nasty. But not everyone agrees that bugs are repulsive; in fact, those who don't agree strongly disagree and advocate that foodstuffs of the insect variety don't deserve their poor reputation, especially because some edible pests are packed with nutrients not in the least of which are calcium, iron and protein. (When I say packed, I mean packed) (And when I say edible, I mean don't just go out into your backyard with a fork, not all bugs are edible!)

Okay, okay they may be chock full of nutrition, but what do we do about the taste? That's really what we want to know isn't it? If you're not a purist, who insist they taste great with or without cocktail sauce, there are apparently a decent amount of bug recipes with which to creatively cook your critters, including Banana Worm Bread, Chocolate Chirpie Chip cookies, and what sounds like a classic Chocolate-covered Grasshoppers. Oh, what an Easter this year will be.....especially when I can buy these chocolatey goodies pre-made.

 

Edible insect advocate Daniella Martin of GirlMeetsBug.com attests to the main reasons people should start incorporating insects into their cuisine including: 1) easy preparation, 2) "they're cleaner than most meat," and 3) "they're already in most processed foods anyway." Touché, my dear, touché. But seriously, she says eating bugs might be able to save the world. Bug production produces immensely less greenhouse gases than livestock and raising them requires significantly less food and water according to advocates. Cricket...cow...cricket...cow....yeah, that makes sense.

Interested in getting started? Daniella suggests that beginners buy their bugs online, so break out that MasterCard and make room in your freezer because it's going to be a bug's life: (live) FlukerFarms, San Diego Waxworms (for waxworm tacos!), RainbowMealworms.net, GrubCo; (dried) Hotlix.

The full article is available at AolNews.