Diet for CML patient

Thank you very much David.
What about red meat?
Some one was telling me that red meat is a no no no.

Hi Justina and David
It was helpful reading your feedback on the forum as I to get a bit confused as to what I can can't eat I understand not to have grapefruit are savillie oranges
So is it ok to eat pineapple and tangerines as I use to enjoy theses fruits
I take imatinib 400mg daily
Mike Ashcroft

Hi David
Thank you for swift feedback it's very much appreciated
Mike Ashcroft

Sometimes one has to break the rules set by doctors who neither have CML or ever have taken a TKI.

I eat anything I want - including ruby red grapefruit, citrus of all kinds and pomegranate seeds. All so-called no-no's ...

Food - especially food high in vitamin C is vital for good health. Vitamin C absorbs pretty quickly and the effect of the "no-no" foods are short lasted.

So - to avoid any conflict - take your TKI a few hours before or a few hours after eating these great foods. I take Sprycel late in the evening for overnight. The last food is usually 4 or so hours earlier.

And yet - I have had pomegranate seeds as a midnight snack right at the same time as Sprycel (unintentional). Nothing happens. I am PCRU on 20 mg Sprycel.

I do recommend supplementing with vitamin D3, K2 and magnesium as these vitamins and minerals are hard to come by with food alone. D3 and K2 are fat soluble and need to be taken with food that has fat in it otherwise these supplements will just pass through your gut and not get absorbed (fat causes bile to be released and it is the bile that "digests" the D3 and K2 supplements for easy absorption). Magnesium is a mineral that absorbs best when in the citrate or taurate form - so opt for those. The oxide form does not absorb well - so if you take it, you have to take a lot of it and deal with its side affects (laxative).

Most important, in my mind - is to eat healthy food that is natural and includes citrus. Just keep it separate in time from when you take your TKI.

snowman - you are fine. Sprycel has a half-life in the blood of 5 hours. It is metabolized quickly.

I take my sprycel at the end of the day before bed - roughly 4 hours or so after eating. By morning, sprycel is long gone.

Here is the recommendation from the professionals:

https://www.webmd.com/drugs/2/drug-144641/sprycel-oral/details/list-inte...

"While you are taking this medicine, you should not eat grapefruit or drink grapefruit juice or eat Seville oranges (often found in marmalades) at any time."

Here is what I do: I eat grapefruit and oranges any time I want. My sprcyel dose is 1/5th normal (20 mg). I have no concern regarding grapefruit. Adding the fact I don't take sprycel at the same time as eating grapefruit is just added so-called 'security' although that would not be a concern of mine. I have no side effects from sprycel that I can feel.

I tend to take my sprycel with wine - another no-no. I have been doing this for years. I am "undetected".

What dose sprycel do you take? if you are taking 1/2 full dose (i.e. which would be 50 mg or less), I would not be concerned about grapefruit.

You can easily do online searches for dasatnib, grapefruit, etc. or any other combination of key words to get started.

I tend to go to the biochemistry journals directly and read the authors research. I have access to medical libraries. Also - over the years, I have had many conversations with medical professionals mostly Ph.D's (not MD's) who understand drug pharmocokinetics. I form my own conclusions and don't rely on the "news" press for insight. And that includes "WebMD".

There is no reason why you should be taking full dose 100 mg sprycel given that you are undetected for two years. I take 20 mg and I am undetected for just shy two years. You are opening yourself up to potential pleural effusion and other toxic effects. You should discuss with your doctor cutting dose to a maintenance level. If your doctor expresses worry about "resistance" get a new doctor. He is badly misinformed.

I would add that the grapefruit effect is well known. It interacts with CYP4A3 that is used to absorb and metabolize a big number of drugs. The effect could go either way, increasing or decreasing the circulating amount depending on the drugs and the individuals. The amount of the CYP3A4 enzyme in the intestine varies from person to person. Some people have a lot of enzymes and others just a little. So grapefruit juice may affect people differently even when they take the same drug. Also, the effect might last for days. Personally, I had my pcr go dangerously up when I was taking cranberry extract for probably the same reason.

Your doctor is right.  It's way too soon to reduce dosage.  The people who have the best chance at TFR (treatment-free remission) someday are the ones who have been at MR4 or undetectable for at least a year, and on TKI treatment for over 5 years.  Don't mess up your future chances by hasty moves now!  Unless and until you have unbearable side effects (like SEVERE myelosuppression, not mild) you should continue your course, which is right on target.

They want me to take omeprazole for my esophagus issues.   Can I take this in between 12 hours apart. I am on 50 mg sprycel

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