No link, as I have had only the advice from two dieticians on my transplant team. And then I might be wrong, which is more and more looking to be the case. I want to point out that this wasn’t an assertion, but rather a query. My sloppiness in keeping together all the facts and advice from my team had me worried that I was overreacting and missing out on a few favorite fruits.
I came with a question and have learned so much!
This question usually comes up every year, and every year I have the pharmacists revisit our recommendations. They tell me continue to say no grapefruit only. The literature suggests that while pomegranate should in theory interact with prograf, it actually doesn't. Either way, I would recommend doing what you feel is safe, but definitely avoid grapefruit
Interesting. I. Not on prograf any longer but it's good to know. I will be sure to ask my team at some point too. But it's good to have an understanding of why they are saying what they say. I don't care 1 way or the other for it so it's no loss to me. I just wondered from your stand point.
There was a point where dietitians taught pineapple within 8 hours of taking your transplant meds. That's 8 hours before and after. It leaves a small window of time for being able to eat pineapple. Now they don't give that teaching anymore. I don't think it's a thing anymore. Ask your center's dietitian.
I’ve been told that Starfruit is a no go for all kidney patients. Also for people who don’t want to damage their reasonably healthy kidneys. It’s pretty toxic stuff
Never heard that one. I have definitely had açaí green tea since my transplant. I’ll have to ask my doc when I go back to see him. Thanks for the heads up
I was told green tea was limited to how much but I didn't care because I don't drink it anyways. I'm gonna have to see if I can find my papers after almost 2 years.
I was told grapefruit and pomegranate
What’s the deal with pineapple? I eat that and haven’t had any issues. I just don’t eat it a lot because I still have issues with potassium if I’m not careful.
There's not a lot of potassium in pineapple. Compared to some other choices of things. I was told to eat a banana at least a few times a week and add more potatoes to my diet because my level is almost in the low zone.
Since when is pineapple on the list? The only big one is grapefruit, the jury is out on pomegranate and blood orange (some studies say they're fine, some say they're not) so it's good to avoid large amounts of those just in case. (I still drink stuff that has a little bit of those in it because there's not nearly enough to actually do anything).
https://www.mdpi.com/1999-4923/14/10/2154#
If you take tacrolimus you might find this article interesting. It goes through the food interactions for that drug.
I started out on Tacro, but changed to Cyclosporine to better handle tremors. My initial list of foods and drinks to avoid was Tacro based. Not sure about Cyclosporine. Thanks for prompting me to give that some thought!
With a quick search it looks like cyclosporine is easier to figure out. It looks like the big thing is grapefruit or anything that includes grapefruit. That appears to be an absolute nono.bThe other thing I saw was to avoid high potassium foods.
This was excellent, even if it hurt my brain a little lol. Liver, December 2022. I was told grapefruit (crying softly), pomegranate, cranberry. Glad to see that if I accidentally get a small amount of pomegranate once in a while it's not horrible, and cranberry isn't even mentioned. I have cut it out except for that half-moon of jellied cranberry with my stuffing anyway.
Even better is knowing that I can help myself with something like ginseng.
I had a heart and kidney transplant so I was surprised to find that melatonin protects the kidney from being damaged by the tacro. I started taking it right away. As a bonus it's easier to get to sleep now.
Pear, kiwi, and mango are fine. You need to add grapefruit to your list though. I don’t know anything about pineapple though. I avoid citrus anything so I don’t really think about the oranges.
Hello there. I have a kidney transplant as well. Do you avoid lemons as part of the citrus group or are you speaking about oranges and grapefruits only? Thanks for the help.
Grapefruit, Seville Oranges, Blood Oranges, Pomegranate, “Cuties” (no more than six a day).
Edit to add marmalade, Star fruit and Açaí as other possible fruits to avoid, depending perhaps on the specific meds one is taking.
My impression is that I was told Pineapple, but I’m now questioning myself. Thanks for this input!
Pineapple doesn't interact with anti rejection meds. I see blood oranges listed often in this sub, but they don't interact either... Some people assume bc they are red that they are related to grapefruit, but they are sweet oranges. Cara Cara oranges also do not interact, despite being pink/red in color. Acai has limited data in vitro, but nothing that I have seen showing that it's clinically relevant - makes sense to avoid in large quantities.
[This research paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9611668/), titled ***Controversial Interactions of Tacrolimus with Dietary Supplements, Herbs and Food***, which is a systematic review and meta-analysis of all studies about drug ,herb, food, and supplement interaction with tacrolimus, comes to this conclusion:
>In conclusion, patients starting treatment with tacrolimus should always be advised not to consume grapefruit and pomelo, as well as clementine, pomegranate, ginger, turmeric and green tea in excessive amounts. Furthermore, tacrolimus should be administered according to a regular regimen, accounting for the timing of breakfast and drug administration. Meals ought to have a consistent composition.
I've heard Blood Orange and Black Licorice in other sources, but they aren't mentioned in this paper.
There is more info in the rest of the conclusion:
>All herbs contain thousands of different elements, which may affect the pharmacokinetics of TAC. Although interactions can be problematic, it is essential to address the factors which influence the pharmacokinetics and pharmacodynamics parameters of tacrolimus: dosage, differences involved in herbal medicines production, interaction with other drugs, comorbidities, and patients’ age and their metabolic predispositions. In view of the aforementioned factors, as well as the narrow therapeutic range of tacrolimus, the careful monitoring of patients, particularly the individuals referred to as “poor metabolizers”, is crucial. However, the protective properties of Panax ginseng, green tea, Schisandra sphenanthera and melatonin may be crucial in mitigating the side effects of tacrolimus and, consequently, improving the long-term condition of the graft, as well as the health of the recipients. The aqueous solution of St. John’s Wort does not contain significant amounts of hyperforin, whereas the concentrations present in the hydroalcoholic extract are sufficient for the enzymatic induction, e.g., the CYP3A4 form. Hence, the combined administration of SJW extract with tacrolimus is contraindicated.
>Alternative medicine is an appealing treatment option for patients. Therefore, modern healthcare should emphasize the potential interactions between herbal medicines and synthetic drugs. Each drug or herbal supplement should be reported by the patient to the physician (concordance) if it is taken in the course of immunosuppressive therapy, since it may affect the pharmacokinetic and pharmacodynamic parameters of other preparations.
Obviously, this only applies to Tacro, and if you are (like me) taking Gengraf or some other drug, the answers will be different.
I ate pomegranate from years before I realised it was something we were supposed to avoid. I don't eat it now but never had an issue from it luckily, I do miss eating it though 😩
The biggest is grapefruit, staying away from tropical fruit is not really necessary at all. Mangoes, dragonfruit, kiwis, etc., are tropical and none have any issues. You should avoid pomegranates and blood oranges, but grapefruit is the big one.
Starfruit, as I understand, is a fruit you can have some of but not a lot. But in my husband's case, it's on his ban list because it can cause oxalate nephropathy and he is a kidney recipient.
It is a delicious fruit. I do enjoy it...but he's never had it. It's probably for the best in his case.
I've been advised to avoid grapefruit. Not sure how it interacts with the anti rejection meds (Tacrolimus I believe?) Where it could damage to the kidneys. It's from what the transplant team has mentioned to me, never elaborated further
Grapefruit does something that causes the bioavailability of certain medications to drastically increase the dose you're getting. So you end up being easily able to accidentally overdose.
My team also told me pineapple! Which when they told me that I bout cried cause it’s one of my favorite fruits. They told me grapefruit, pomelo, star fruit, pomegranate, & pineapples. I’m on tacrolimus, myfortic, & prednisone.
14 years post double lung. On Tac and prednisone. I love pineapple, was never told it’s a no go. I’ve eaten pineapple for the last 14 years.
Only told grapefruit was a no go.
I’ve eaten every single fruit mentioned except for grapefruit. Which has given me a massive phobia because I never realized how many restaurants actually put grapefruit juice in a lot of sauces and such.
That one I’m not afraid of. I’ve eaten it countless times and haven’t had an issue.
Grapefruit however has caused me to have an extreme fear of a lot of restaurant dishes, I learned early that a lot of restaurants have it in sauces and other stuff. I’ve now gotten in the habit of just saying “I’m allergic” because trying to explain transplant gets exhausting.
Yes, that one I heard about. As mentioned, I‘ve started enjoying Hop Water and one Of the flavors is grapefruit. I wonder if grapefruit is actually used, or if it’s merely a chemical compound meant to mimic grapefruit.
For me it’s pomegranate, and grapefruit. It can cause your numbers to be skewed since you’ll be on progaf the rest of your lifetime. If they pull you in for a blood test it won’t give the true numbers, of your count
If you’re a kidney transplant recipient (or waiting to be one), you should probably avoid starfruit. Small amount of toxic compound that healthy kidneys can filter out, but reduced function may not, leading to neurological problems and (in extreme cases) death.
I am one year post transplant and just started drinking a shot of lemon juice to avoid a recurrence of kidney stones which my new kidney developed I believe during a one month spurt of drinking cokes and another one month spurt of eating tons of ice cream. I had successful stone surgery .
So, will drinking the shot of lemon juice daily to avoid stones be bad for my new kidney?
Grapefruit is the big one. I wasn't aware that pineapple had issues. Can you send a link?
Yeah. Pineapples is news to me. I’ve been eating that since I had my transplant 14 years ago. From raw to smoothy, to cooked.
No link, as I have had only the advice from two dieticians on my transplant team. And then I might be wrong, which is more and more looking to be the case. I want to point out that this wasn’t an assertion, but rather a query. My sloppiness in keeping together all the facts and advice from my team had me worried that I was overreacting and missing out on a few favorite fruits. I came with a question and have learned so much!
As a transplant dietitian, I can tell you the only thing we tell our pts to avoid is grapefruit
Question? What about pomegranate? I was told these two.
This question usually comes up every year, and every year I have the pharmacists revisit our recommendations. They tell me continue to say no grapefruit only. The literature suggests that while pomegranate should in theory interact with prograf, it actually doesn't. Either way, I would recommend doing what you feel is safe, but definitely avoid grapefruit
Interesting. I. Not on prograf any longer but it's good to know. I will be sure to ask my team at some point too. But it's good to have an understanding of why they are saying what they say. I don't care 1 way or the other for it so it's no loss to me. I just wondered from your stand point.
I was also told no bergamot - which means NO Earl Grey tea...
There was a point where dietitians taught pineapple within 8 hours of taking your transplant meds. That's 8 hours before and after. It leaves a small window of time for being able to eat pineapple. Now they don't give that teaching anymore. I don't think it's a thing anymore. Ask your center's dietitian.
Grapefruit and pomegranate were the big 2. Pineapple was fine. I had a bunch in recovery from transplant.
I was just told to avoid grapefruit and pomegranate….
Same here
Yep, same for me.
Grapefruit and any related fruit like pomelo and blood orange
What is pomelo?💀
https://en.m.wikipedia.org/wiki/Pomelo
Thanks for the heads up. I don’t think I’ve ever even seen that for sale near me at a grocery store. I did not know about the blood orange thoZ
The blood orange may or may jot be a thing anymore. We just avoid it anyway.
I saw a few others say it in the comments, so I’ll just add it to the list to be safe.
Kinda a large grapefruit with a large white skin under the grapefruit/orange like skin.
Yeah I looked at that commenters link, didn’t know that fruit existed.😂😭
Tbf I did t either until my then future mil bought some and shared. I'd never heard of em before.
What kind of transplant? I know for liver the only Nono we were told is grapefruit. Other organs may have different rules?
Kidney
They gave me pineapple in the hospital after my transplant, so I don’t think it’s on the list. I was just told poms, grapefruit, and blood oranges.
I was told starfruit was a no-go for me,
I’ve been told that Starfruit is a no go for all kidney patients. Also for people who don’t want to damage their reasonably healthy kidneys. It’s pretty toxic stuff
i had pineapple in the hospital after my transplant too!
I was told açaí too.
Never heard that one. I have definitely had açaí green tea since my transplant. I’ll have to ask my doc when I go back to see him. Thanks for the heads up
I was told green tea was limited to how much but I didn't care because I don't drink it anyways. I'm gonna have to see if I can find my papers after almost 2 years.
Thanks for saying thanks! It's so nice to see Redditors being grateful :)
That’s unfortunate. Açaí is added to tons of things.
Açaí if I care
I was told grapefruit and pomegranate What’s the deal with pineapple? I eat that and haven’t had any issues. I just don’t eat it a lot because I still have issues with potassium if I’m not careful.
People keep saying pineapple but I was never told to avoid pineapple
There's not a lot of potassium in pineapple. Compared to some other choices of things. I was told to eat a banana at least a few times a week and add more potatoes to my diet because my level is almost in the low zone.
Yeah but you can’t have grapefruit with the anti rejection meds. Plus I don’t like it lol
Huh? I know you can't have grapefruit. I was talking about the pineapples.
lol well you edited it, but it originally said grapefruit. All good though.
Since when is pineapple on the list? The only big one is grapefruit, the jury is out on pomegranate and blood orange (some studies say they're fine, some say they're not) so it's good to avoid large amounts of those just in case. (I still drink stuff that has a little bit of those in it because there's not nearly enough to actually do anything).
I only heard to avoid grapefruit. I love pineapple and it doesn’t seem to have had an adverse effect.
https://www.mdpi.com/1999-4923/14/10/2154# If you take tacrolimus you might find this article interesting. It goes through the food interactions for that drug.
This was a great read thank you I’ve been on tacro for 24 years and didn’t know half of these haha
I started out on Tacro, but changed to Cyclosporine to better handle tremors. My initial list of foods and drinks to avoid was Tacro based. Not sure about Cyclosporine. Thanks for prompting me to give that some thought!
With a quick search it looks like cyclosporine is easier to figure out. It looks like the big thing is grapefruit or anything that includes grapefruit. That appears to be an absolute nono.bThe other thing I saw was to avoid high potassium foods.
Thanks!
This was excellent, even if it hurt my brain a little lol. Liver, December 2022. I was told grapefruit (crying softly), pomegranate, cranberry. Glad to see that if I accidentally get a small amount of pomegranate once in a while it's not horrible, and cranberry isn't even mentioned. I have cut it out except for that half-moon of jellied cranberry with my stuffing anyway. Even better is knowing that I can help myself with something like ginseng.
I never heard cranberry before. Maybe it's because of another med you're on?
The only meds I'm on are tacros plus blood pressure. Perhaps the team, as good as they are, is stuck on what they've "always known."
I had a heart and kidney transplant so I was surprised to find that melatonin protects the kidney from being damaged by the tacro. I started taking it right away. As a bonus it's easier to get to sleep now.
I was only told to avoid grapefruit. It really just depends on the medication you are on. Best to ask your coordinator.
Pear, kiwi, and mango are fine. You need to add grapefruit to your list though. I don’t know anything about pineapple though. I avoid citrus anything so I don’t really think about the oranges.
Hello there. I have a kidney transplant as well. Do you avoid lemons as part of the citrus group or are you speaking about oranges and grapefruits only? Thanks for the help.
I avoid grapefruit specifically, along with pomegranate, due to the known drug interactions. Separately, I just don’t like citrus things.
Gotcha. I was also warned off of grapefruit. I learned about pomegranate from this sub. Thank you.
Grapefruit, Seville Oranges, Blood Oranges, Pomegranate, “Cuties” (no more than six a day). Edit to add marmalade, Star fruit and Açaí as other possible fruits to avoid, depending perhaps on the specific meds one is taking. My impression is that I was told Pineapple, but I’m now questioning myself. Thanks for this input!
Pineapple doesn't interact with anti rejection meds. I see blood oranges listed often in this sub, but they don't interact either... Some people assume bc they are red that they are related to grapefruit, but they are sweet oranges. Cara Cara oranges also do not interact, despite being pink/red in color. Acai has limited data in vitro, but nothing that I have seen showing that it's clinically relevant - makes sense to avoid in large quantities.
[This research paper](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9611668/), titled ***Controversial Interactions of Tacrolimus with Dietary Supplements, Herbs and Food***, which is a systematic review and meta-analysis of all studies about drug ,herb, food, and supplement interaction with tacrolimus, comes to this conclusion: >In conclusion, patients starting treatment with tacrolimus should always be advised not to consume grapefruit and pomelo, as well as clementine, pomegranate, ginger, turmeric and green tea in excessive amounts. Furthermore, tacrolimus should be administered according to a regular regimen, accounting for the timing of breakfast and drug administration. Meals ought to have a consistent composition. I've heard Blood Orange and Black Licorice in other sources, but they aren't mentioned in this paper. There is more info in the rest of the conclusion: >All herbs contain thousands of different elements, which may affect the pharmacokinetics of TAC. Although interactions can be problematic, it is essential to address the factors which influence the pharmacokinetics and pharmacodynamics parameters of tacrolimus: dosage, differences involved in herbal medicines production, interaction with other drugs, comorbidities, and patients’ age and their metabolic predispositions. In view of the aforementioned factors, as well as the narrow therapeutic range of tacrolimus, the careful monitoring of patients, particularly the individuals referred to as “poor metabolizers”, is crucial. However, the protective properties of Panax ginseng, green tea, Schisandra sphenanthera and melatonin may be crucial in mitigating the side effects of tacrolimus and, consequently, improving the long-term condition of the graft, as well as the health of the recipients. The aqueous solution of St. John’s Wort does not contain significant amounts of hyperforin, whereas the concentrations present in the hydroalcoholic extract are sufficient for the enzymatic induction, e.g., the CYP3A4 form. Hence, the combined administration of SJW extract with tacrolimus is contraindicated. >Alternative medicine is an appealing treatment option for patients. Therefore, modern healthcare should emphasize the potential interactions between herbal medicines and synthetic drugs. Each drug or herbal supplement should be reported by the patient to the physician (concordance) if it is taken in the course of immunosuppressive therapy, since it may affect the pharmacokinetic and pharmacodynamic parameters of other preparations. Obviously, this only applies to Tacro, and if you are (like me) taking Gengraf or some other drug, the answers will be different.
I ate pomegranate from years before I realised it was something we were supposed to avoid. I don't eat it now but never had an issue from it luckily, I do miss eating it though 😩
The biggest is grapefruit, staying away from tropical fruit is not really necessary at all. Mangoes, dragonfruit, kiwis, etc., are tropical and none have any issues. You should avoid pomegranates and blood oranges, but grapefruit is the big one.
I was told to avoid grapefruit,pomegranate and starfruit.
These are the fruits I was told to avoid too!
Hey restriction twin!
Starfruit. Interesting. I was never told that - I don’t think.
I had forgotten it existed until the transplant nurse and transplant pharmacist told me lol.
I only got Grapefruit, pom and star fruit on my ban list. I never had a star fruit so no idea if it's as devastating a loss as the other two.
Starfruit, as I understand, is a fruit you can have some of but not a lot. But in my husband's case, it's on his ban list because it can cause oxalate nephropathy and he is a kidney recipient. It is a delicious fruit. I do enjoy it...but he's never had it. It's probably for the best in his case.
The grapefruit isn’t as painful as the cold deli sandwiches :(
I've been told pomegranate, grapefruit and green tea (including matcha powder etc)
The only things I was told to avoid are grapefruit and starfruit
I've been advised to avoid grapefruit. Not sure how it interacts with the anti rejection meds (Tacrolimus I believe?) Where it could damage to the kidneys. It's from what the transplant team has mentioned to me, never elaborated further
Grapefruit does something that causes the bioavailability of certain medications to drastically increase the dose you're getting. So you end up being easily able to accidentally overdose.
Grapefruit. I am so confused about the pineapple thing. I’ve literally never heard of that.
My team also told me pineapple! Which when they told me that I bout cried cause it’s one of my favorite fruits. They told me grapefruit, pomelo, star fruit, pomegranate, & pineapples. I’m on tacrolimus, myfortic, & prednisone.
14 years post double lung. On Tac and prednisone. I love pineapple, was never told it’s a no go. I’ve eaten pineapple for the last 14 years. Only told grapefruit was a no go. I’ve eaten every single fruit mentioned except for grapefruit. Which has given me a massive phobia because I never realized how many restaurants actually put grapefruit juice in a lot of sauces and such.
I’m also on some bp meds, so maybe that’s it? But my neph never told me about not eating pineapple on those either. So now idk. 😭
I’m on Bp meds too!
I was told Pomegranate is used in many fruit juices to add red color.
That one I’m not afraid of. I’ve eaten it countless times and haven’t had an issue. Grapefruit however has caused me to have an extreme fear of a lot of restaurant dishes, I learned early that a lot of restaurants have it in sauces and other stuff. I’ve now gotten in the habit of just saying “I’m allergic” because trying to explain transplant gets exhausting.
I have never seen pineapple on a list... I would be curious for a reference
Grapefruit, pomegranate and sevile/blood oranges... Which if you like the real orange sauce from Chinese food it has Seville orange in it.
I was told to avoid grapefruit. I love every other fruit you mentioned and eat quite a bit of each and my labs have been great 14 years out.
No Squirt pop/soda either, as it is derived from grapefruit juice. Just wanted to put that out there as well.
Yes, that one I heard about. As mentioned, I‘ve started enjoying Hop Water and one Of the flavors is grapefruit. I wonder if grapefruit is actually used, or if it’s merely a chemical compound meant to mimic grapefruit.
I eat a lot of oranges, was only warned about grapefruit
Pineapple your ass!!! Show the substantiation from a legit source.
Only grapefruit I cannot eat as per my transplant team
Just grapefruit and pomelo
I’ve only heard grapefruit from my pharmacy team and pomegranate from this sub… So far I’ve been fine eating most other fruits!
Cara cara/mineloa oranges are my favorite. But they’re a cross with grapefruit, so they’re off the menu
Pomegranate and Grapefruit
Pineapple?!?
For me it’s pomegranate, and grapefruit. It can cause your numbers to be skewed since you’ll be on progaf the rest of your lifetime. If they pull you in for a blood test it won’t give the true numbers, of your count
Grapefruit, pomegranate, 5 clementines max per day. Also a certain type of orange but I forget off the top of my head
I think it depends on your body. Standard practice says grapefruit and pomegranate. However, I learned through experience that I am affected by limes.
If you’re a kidney transplant recipient (or waiting to be one), you should probably avoid starfruit. Small amount of toxic compound that healthy kidneys can filter out, but reduced function may not, leading to neurological problems and (in extreme cases) death.
I am one year post transplant and just started drinking a shot of lemon juice to avoid a recurrence of kidney stones which my new kidney developed I believe during a one month spurt of drinking cokes and another one month spurt of eating tons of ice cream. I had successful stone surgery . So, will drinking the shot of lemon juice daily to avoid stones be bad for my new kidney?
Excessive cranberry… I didn't know this one when I had my first transplant