Don't Eat This If You're Taking That: The Hidden Risks of Mixing Food and Medicine

Don't Eat This If You're Taking That: The Hidden Risks of Mixing Food and Medicine

by Madelyn Fernstrom, John Fernstrom
Don't Eat This If You're Taking That: The Hidden Risks of Mixing Food and Medicine

Don't Eat This If You're Taking That: The Hidden Risks of Mixing Food and Medicine

by Madelyn Fernstrom, John Fernstrom



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NBC Today show nutrition and diet guru Madelyn Fernstrom and award-winning neuroscientist and pharmacologist John Fernstrom —partnering with AARP— present the ultimate guide to food and medicine interaction.

Millions of Americans take prescription drugs to treat diabetes, high blood pressure, heart disease, or other conditions. But beware: The foods you eat and the medications you take could be working against each other.

Don’t Eat This If You’re Taking That takes the mystery out of food and medication interactions. This easy-to-use guide details foods that can interfere with the action of the medication—whether taken for the short or long term. In this book, readers can easily find a medication, see what foods to avoid, and make smart swaps.

We all believe a diet rich in colorful fruits and vegetables, lean proteins, whole grains, and low-fat dairy products is part of healthy eating—right? Not always. Dr. Fernstrom explains exactly what foods to avoid when and why. For instance,

If you’re taking cholesterol medicine, you should cut out—or cut down on—grapefruit.
On a blood thinner? Avoid dark green veggies.
If you’re on thyroid medication, nix the soy.
And more small diet changes with big health payoffs!
As an added bonus, each chapter offers a “Dietary Supplements Alert” box, providing the most up-to-date information on interactions with vitamins, minerals, and other dietary supplements.

With this concise, scientifically based guide, consumers can easily personalize their eating plan to work with, not against, their medications.

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Product Details

ISBN-13: 9781510721517
Publisher: Skyhorse
Publication date: 05/02/2017
Format: eBook
Pages: 232
File size: 2 MB

About the Author

Madelyn Fernstrom, PhD, CNS, is a national health expert, neuroscientist, and nutritionist. She is the on-air NBC News and Today Show health and nutrition editor. She is also a contributor to An award-winning clinician, she has published more than one hundred research papers and several books, including The Real You Diet and The Runner’s Diet.

John Fernstrom, PhD, is a nationally renowned and award-winning neuroscientist and pharmacologist. He is a world expert on the effects of foods and drugs on brain function. He is professor of psychiatry, pharmacology, and chemical biology at the University of Pittsburgh School of Medicine. He is the author of more than two hundred scientific papers and the editor of several books.

Read an Excerpt

Don't Eat this If You're Taking That

The Hidden Risks of Mixing Food and Medicine

By Madelyn Fernstrom, John Fernstrom

Skyhorse Publishing

Copyright © 2015 Madelyn Fernstrom and John Fernstrom
All rights reserved.
ISBN: 978-1-63220-925-2



While antidepressant medicines are well-known options for millions of people, it wasn't too long ago that the symptoms of depression were thought to be "all in your head" — and just a matter of willing yourself to feel better. Whether called "the blues" or melancholia, in the old days, the response to people reaching out for help was "life is tough, learn to cope." But science has shown that nothing could be further from the truth. The treatment of depression and anxiety has been documented for decades to be a combination of biology and behavior that can be helped by medicine.

The role of the brain in controlling mood is connected to actual abnormalities in brain chemistry. Small changes in brain chemistry in one or more neurotransmitters (brain chemicals) can produce large changes in mood. For many people, depression is a medical illness that benefits from medical treatment and the use of medicines, along with psychological treatment to help make necessary behavioral changes. It's that one-two punch of treatment that studies show is very effective in treating depression.

Beginning in the 1950s, the first generation of antidepressants — tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) — was discovered and quickly entered the marketplace. More than 50 years later, these medications are still used to treat certain types of depression. As interest in the connection between brain chemistry and depression continued to develop, a new class of antidepressants was introduced, the result of years of scientific research.

New to the market nearly 30 years after the first medications were introduced, these drugs were named serotonin-selective reuptake inhibitors (SSRIs), to resemble the action they had on brain chemistry. They became widely used because they worked well and had fewer side effects when compared with the earlier medicines. SSRIs are used primarily to treat major depression, but many are very useful for the long-term treatment of anxiety disorders and panic disorders. All are presently in clinical use.

Even more medications have been developed for the treatment of depression. A variation of the SSRIs (which only act on serotonin nerve cells), serotonin-norepinephrine reuptake inhibitors (SNRIs) is a group of drugs that act on two brain chemicals: serotonin and norepinephrine. This next generation of medicines has been shown to be a useful addition to antidepressant treatment options.

Still other antidepressants have been identified that don't fit neatly into one of the broad drug categories above. This is because their action on the brain is somewhat mixed, or not well understood, but they have proven to be good treatment options for some patients.

Everyone's brain is different, so it is a modern medical miracle to have so many drug options to help treat depression. The long-term treatment can be challenging, but the right combination of medication and talk therapy has provided relief for millions of people.

We'll take a look at each of these drug classes separately because of the important differences in how foods and supplements affect their actions.

Tricyclic Antidepressants

Eight different tricyclic antidepressants are available in the United States: amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil). While in the same medication class, very small differences in their chemical makeup have different effects. That's a great thing when it comes to antidepressants, because individual responses to medication can vary widely. What is a miracle drug for one depressed person might not work for another.

If you begin taking one of these drugs, the daily dose will usually be divided into smaller doses taken throughout the day. After several weeks, once you and your physician have determined whether the medication is working, your doctor may suggest that you take the entire daily dose at one time. The general recommendation is usually shortly before bedtime, because these drugs can make you sleepy soon after you take them.

Foods to Avoid

Alcohol use can interfere with the delicate balance of choosing a dose of an antidepressant to optimize beneficial effects while minimizing side effects. For example, one of the most common side effects of these medications — drowsiness and dizziness — can be enhanced by alcohol. If you are a heavy drinker, alcohol can affect how the body breaks down these drugs, sometimes causing drug levels to be too high in the body and sometimes too low. Heavy alcohol use can make it quite difficult to determine the proper dose for maximizing beneficial effects, while also minimizing side effects. If you take a tricyclic antidepressant, it is wise to avoid alcohol altogether. Check with your doctor for guidance if you are a heavy alcohol user.

Limit the use of grapefruit and grapefruit juice. Grapefruit blocks the body's ability to break down tricyclic antidepressants, resulting in your body "seeing" too much of the medication — essentially, a higher dose. So, limit your intake of grapefruit products to a single serving each clay, such as one-half grapefruit or a small glass of grapefruit juice (6–8 ounces), if you are a grapefruit lover. You can also choose to avoid it altogether. If you don't already consume grapefruit products and take a tricyclic antidepressant, check with your doctor before adding any grapefruit products to your diet.

Dietary Supplements to Avoid

When it comes to dietary supplements, the list of compounds to avoid is long. That's because many of these supplements act on the brain, and antidepressants have multiple actions at different brain sites.

Kava and valerian can increase the drowsiness and sleepiness that occurs when taking these medicines. Kava can also interfere with your liver's ability to break down many of these antidepressants, increasing their concentration in the body, and thus potentially increasing side effects. Kava use should be avoided while you are taking a tricyclic antidepressant. If you already use kava or valerian, and a tricyclic antidepressant is recommended for you by your doctor, be sure to discuss your current use of these supplements with him.

St. John's wort increases the breakdown of several tricyclic antidepressants, reducing their levels in the body and potentially reducing their ability to treat your depression. It's as if your body is seeing a lower dose than intended. If you currently use or are thinking about using St.John's wort and are already taking a tricyclic antidepressant, you should discuss this plan with your physician.

Herbal supplements containing bitter orange or ma huang (ephedra) extracts may increase the risk of high blood pressure and abnormal heartbeat when taken with a tricyclic antidepressant. Ma huang contains ephedrine, while bitter orange contains synephrine — both of which increase blood pressure by stimulating the action of a compound, norepinephrine, on the heart and blood vessels. This occurs because the antidepressant itself stimulates norepinephrine action, which may be increased in the presence of ma huang or bitter orange.

Ma huang is no longer permitted to be sold in the United States because it has been linked to a number of deaths related to abnormal heart function and stroke. But ma huang is readily available online — sourced from different countries, or with undocumented claims that the version being sold is not the same plant as that which was removed from the market. Avoid all sources of ma huang if you are taking a tricyclic antidepressant.

Bitter orange extracts are found in many products and are often used in place of ma huang, since the two herbal supplements have similar actions in the body. The use of bitter orange has not yet been linked to the same effects on the heart as ma huang, but has been shown to have an effect on the heart. Its effects may be greater if you are taking a tricyclic antidepressant, so the use of products containing bitter orange should be avoided.

Tryptophan and 5-hydroxvtryptophan supplements should be avoided because they raise serotonin levels in the body. This effect will enhance one of the same actions of several of the tricyclic antidepressants, which is to increase the action of serotonin in the brain and elsewhere. It is very important never to mix medications and supplements that each raise serotonin in the body. This excess of serotonin can trigger the "serotonin syndrome," which is potentially life threatening. Common symptoms include confusion, restlessness, spontaneous muscle contractions, tremor, shivering, and excessive sweating. Always discuss your use of these supplements with your doctor when a tricyclic antidepressant is under consideration as a treatment.

Monoamine Oxidase Inhibitors

The monoamine oxidase inhibitors (MAOIs) currently in use in the United States for the treatment of depression are phenelzine (Nardil), isocarboxazid (Marplan) and tranylcypromine (Parnate), which are all taken orally. Another MAO I is selegiline (Emsam), which is administered through a skin patch.

Remember to make a full evaluation of your daily diet and herbal and nutrient supplement use if you are going to take an MAOI. MAOIs have many food and supplement interactions that can produce potentially dangerous effects. All of these drugs can be taken with or without food, but use the guidelines below to help you identify the specific foods that are important to avoid.

Foods to Avoid

Fermented foods:Do not consume fermented foods. While the term "fermented" might not be familiar, the foods in this group certainly are. These are foods that are purposefully or accidentally allowed to be partially digested by microorganisms. These might sound unsafe to consume under any circumstance, but a fungus (like yeast) or bacterium (like lactobacillus) is undoubtedly involved in the creation of some of the foods you love to eat or drink. The most familiar examples are beer and wine, where yeast is used to create the alcohol in them. Many other foods and condiments gain their distinctive flavors through fermentation, including many flavorful cheeses, aged and cured meats, and soy sauce. For a list of the commonly consumed fermented foods, please see the box on page 14.

These "healthy" microorganisms in food have several natural biological actions. They cause fermentation, turning sugars into alcohol products (like wine and beer) or acid foods (like sour cream and yogurt), but they also break down food proteins and convert some of the amino acids that are released in the process into biologically active chemicals called "biogenic amines." When fermented foods are consumed and digested, and their constituents enter the bloodstream, some of these biogenic amines cause blood pressure to rise. Normally, your body (especially your digestive tract, lungs, and liver) contains large amounts of an enzyme, monoamine oxidase, that rapidly destroys these amines, making these foods safe to eat. But if you take a monoamine oxidase inhibitor, this defense mechanism has been turned off, and these biogenic amines are free to enter the body and ultimately produce potentially dangerous effects.

Alcohol, caffeine, and natural licorice: Limit your intake of these items to minimize potential side effects of the MAOIs. Alcohol can enhance the sleepiness and loss of concentration that these drugs can cause as a side effect. Limit your daily intake of all caffeine-containing beverages to moderate amounts — no more than 300 milligrams (mg) per day, about two cups of brewed coffee. Excessive intake of caffeine can boost the blood pressure-raising side effect occasionally seen with this group of drugs. And if you eat natural licorice regularly, even in moderate amounts, cut back on your intake. Natural licorice raises blood pressure by causing salt and water retention in the body. When taking a monoamine oxidase inhibitor, you always want to avoid any foods or supplements that have the potential to raise your blood pressure.

Dietary supplements:Do not take dietary supplements containing the amino acids phenylalanine, tyrosine, dopa, tryptophan or 5-hydroxytryptophan. Tryptophan, phenylalanine, and tyrosine are converted to transmitter molecules in neurons that normally use them. Dopa and 5-hydroxytryptophan are converted to transmitter molecules as well, but show up in parts of the body that normally do not see them. When they do, they are quickly eliminated by monoamine oxidase. All of these amino acids can also be converted to small amounts of other biogenic amines that the body normally eliminates very quickly, because they produce adverse effects (such as raisingblood pressure). The biogenic amines produced from phenylalanine and tyrosine are phenylethylamine, tvramine, and octopamine, while the one produced from tryptophan is tryptamine.

The enzyme responsible for quickly clearing these biogenic amines is monoamine oxidase. While you are taking a monoamine oxidase inhibitor, this defense mechanism is turned off, and when these amino acid supplements are turned into these amines, your body cannot destroy them. Their levels build up in your blood and in some tissues, raise blood pressure, and produce many other undesirable effects. If you take one or more of these amino acids, you should discuss this practice with your doctor before contemplating taking a monoamine oxidase inhibitor. If you are already taking a monoamine oxidase inhibitor, don't start taking any of these amino acids without first talking to your doctor.

Herbal supplements:Do not take herbal supplements containing ma huang or bitter orange. Ma huang and bitter orange naturally contain biogenic amines that raise blood pressure. Ma huang contains ephedrine, while bitter orange contains synephrine and octopamine. These biogenic amines can raise blood pressure and produce other undesirable effects.

Although ma huang is no longer permitted to be sold as a dietary supplement in the United States, it is still available for purchase online, in multiple forms. Bitter orange is available in several forms as a supplement, and its current use has not yet been linked to adverse effects. But the compounds present in bitter orange have the same actions as ma huang. Monoamine oxidase destroys the bioactive amines present in ma huang and bitter orange when they enter the body. But, if you are taking a monoamine oxidase inhibitor, your body is unable to eliminate them, and they can build up and cause dangerous effects. If you use herbal products containing ma huang or bitter orange, it is very important that you tell your physician, and stop using them while taking a monoamine oxidase inhibitor.

St.John's wort:Do not take St John's wort, tryptophan, or 5-hydroxytryplophan. Never combine supplements that raise serotonin in the body along with medications that act the same way. MAOIs raise serotonin levels in the brain, which contributes to improvement in your mood. IF you combine MAOIs with these supplements, you may develop "serotonin syndrome," a life-threatening condition. Symptoms include confusion, restlessness, spontaneous muscle contractions, tremor, shivering, and excessive sweating. If you are taking an MAOI, you need to be especially careful to avoid these compounds, which are all sold as herbal and dietary supplements.


Excerpted from Don't Eat this If You're Taking That by Madelyn Fernstrom, John Fernstrom. Copyright © 2015 Madelyn Fernstrom and John Fernstrom. Excerpted by permission of Skyhorse Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Table of Contents

Introduction xi

1 Antidepressants 1

2 Pain Relief (Analgesic) Medicines 31

3 Blood Thinners (Anticoagulants) 57

4 Diabetes Medicines 77

5 Heartburn (Acid Reflux) Medicines 97

6 Blood Pressure (Antihypertensive) Medicines 117

7 Cholesterol-Lowering Medicines 157

8 Heart (Cardiovascular) Medicines 177

Resources 199

Acknowledgments 201

Index 203

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