Away From the Bench

The world outside of the lab

Archive for the month “September, 2012”

Juicing the Most out of Your Medication

Many of your medications may have warnings of TAKE WITH FOOD or DO NOT EAT 30 MINUTES BEFORE OR AFTER THIS MEDICATION because oral drugs may upset the stomach or not be absorbed as well depending on food intake.  Some foods, like the grapefruit, can act like a drug themselves.

Grapefruit juice contains a chemical called  bergamottin (and 6’,7’-dihydroxybergamottin, which were first found in bergamot oranges).  This chemical is a specific inhibitor of an enzyme in your liver and small intestine called cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) that usually metabolizes macromolecules (lipids, proteins), but also drugs and toxins.  Depending on the drug, CYP enzymes can either increase or decrease the amount of active drug in your circulation (called bioavailability).  There are warnings not to drink grapefruit juice with some statin medications because that would increase the bioavailability of the statin and could cause side effects and organ damage.

Creative Commons Copyright John Steven Fernandez

Some researchers are actually using the power of the grapefruit to benefit patients.  They are investigating whether grapefruit juice could be used as a ‘drug booster’ –  the drug dosage could be lowered, but the resulting bioavailability would be the same.  Using less drug would translate to a lower cost to the consumer.  During Phase I trials in humans, researchers determined that an 8-oz. daily glass of grapefruit juice increased the bioavailability of 25 mg of sirolimus (a possible anti-cancer drug that is currently used as an immunosuppressant) to that of 90 mg of sirolimus alone.  That translates into taking 25% of the usual drug dose but seeing the same effects of the drug on cancer cells.

There are a couple of drawbacks to using grapefruit as a prescription.  The concentration of bergamottin can vary between grapefruit juice batches.  The authors of the Phase I study contacted the Florida Department of Citrus to obtain a frozen concentrate that was tested for bergamottin levels before they used it.  The other inconsistency is the variation between individuals.  Some people have higher levels of CYP3A4 enzyme in their small intestine (as much as 40-fold), and those people see the greatest effect from grapefruit juice.

Grapefruit could be a powerful medical tool because it is a natural, easily available, low-cost food that has a specific and well-known molecular mechanism.  Who said money doesn’t grow on trees?

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McCalories

The next time you go to McDonald’s, don’t just automatically order your #4 Extra Value Meal, take a look at the menu board.  McDonald’s just announced they will post the calories on all of their in-store and drive-thru menus this month.

I think this is a step towards educating the general consumer.  Some people who go to McDonald’s frequently may not care about this information, but for people who go to McDonald’s when they just don’t have time or are on the road and want to make smarter choices, this will be a welcome change.  In July, McDonald’s began their Favorites Under 400 Calories program, which lists menu items in 100-calorie sections.  This is a great way to attract attention to healthier options, even though some of those items are fairly small and would need other items to make a filling meal (looking at you, side salad without dressing).

For any restaurant, having nutrition information available online is necessary to make better choices (especially for people with diabetes or food allergies), but having nutrition information quickly available when you order is even better.  However, calories are not everything.  Maybe you want a cheeseburger but think to yourself, “I should really just get a salad and be healthier”.  You look at the menu board and see that a cheeseburger is 300 calories (12 grams of fat) and a Southwest salad with grilled chicken and Southwest dressing is 390 calories (14 grams of fat).  The salad may have more calories, but when other nutrient data is factored in, the salad is actually healthier with more fiber and vitamins and less saturated fat.  It might even satiate your appetite longer than the cheeseburger, which could lower your total daily calorie intake.  Even so, the calorie information on the board will probably be more useful to people who usually get a large Extra Value Meal and are shocked by how many calories they are actually eating and cause them to order something less calorie-laden.  And for this reason, I support the calorie information on the menu.

All of this, of course, comes four years after New York City required restaurants (or, technically, food service establishments) to post calories on their menu boards.  Studies (based on surveys) suggest reduced calorie choices were made at some establishments (McDonald’s, KFC, Au Bon Pain) but not others (Subway) after this law was enacted.  In one study, only a subset of people who were surveyed (15%) knowingly made lower calorie choices after calories were posted on the menu.  Socioeconomic factors seem to have a large impact on menu choices and calorie-posting did not seem to affect a majority of adolescents.  However, these studies must be looked at with caution, because they do not consider food choices in the same people before and after the calorie-posting.  When a regression model was used to control for restaurant chain, store location, sex of customers, type of purchase, and inflation-adjusted cost, there was a statistically significant decrease in average calories before and after the regulations, which was masked when all the data was pooled together.  In addition, some people may have stopped patronizing certain restaurants altogether after the calorie regulations but these surveys don’t control for that type of information.

But hey, even if posting calories on the menu only affects 15% of consumers (although I think more-controlled studies would show a higher percentage), that is still 15% of consumers making healthier food choices when eating away from home.  So thank you McDonald’s, for at least attempting to assist customers nationwide in making healthier decisions.  The fast-food chain’s 2012 nutrition progress report also introduces their plan to include more fruits and vegetables on their menu; reduce sodium across the board; and reformulate some items to reduce sugar, saturated fat, and calories.  And don’t worry, a packet of low-fat balsamic vinaigrette is only 35 calories…and you probably wouldn’t use the whole thing on your side salad anyway.  Morgan Spurlock would be proud.

Courtesy of McDonalds USA

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