Second Helping

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Meet Margaret

Margaret is a fictional older woman. She loves Italian and Greek food. She takes a statin (simvastatin), a blood-pressure tablet and warfarin.

Taste ranking by Qloo. Restaurants are real businesses; people are fictional.

Safety: By medicine

Pick a medicine group to see which foods the rules look at.

Not medical advice. Fictional demo. Ask your pharmacist or doctor about any real medicine.

Statins affected by grapefruit (1 rule)

Includes: simvastatin, lovastatin, atorvastatin

  • Rule 1 Dish is left out
    Food: grapefruit; grapefruit juice; pomelo; Seville (bitter) orange, e.g. in marmalade
    Grapefruit can raise statin levels in the blood and increase the risk of muscle side effects.
Dihydropyridine calcium-channel blockers (1 rule)

Includes: felodipine, nifedipine

  • Rule 2 Dish is left out
    Food: grapefruit; grapefruit juice; pomelo; Seville (bitter) orange
    Grapefruit can raise levels of these blood-pressure medicines and cause low blood pressure, dizziness or swelling.
Other grapefruit-sensitive medicines (1 rule)

Includes: ciclosporin, tacrolimus, amiodarone, buspirone, carbamazepine

  • Rule 3 Dish shown with a caution
    Food: grapefruit; grapefruit juice; pomelo; Seville (bitter) orange
    This medicine may interact with grapefruit. Ask your pharmacist or doctor before including it.
Warfarin (3 rules)

Includes: warfarin

  • Rule 4 Dish shown with a caution
    Food: large portions of spinach, kale, broccoli, Brussels sprouts, cabbage, collard or turnip greens, parsley; green-vegetable-heavy dishes such as saag
    Warfarin does not mean avoiding green vegetables. The aim is to keep vitamin K intake steady from week to week. Large changes can affect the INR. Keep the clinic informed of diet changes.
  • Rule 5 Dish shown with a caution
    Food: cranberry juice in large amounts; cranberry products taken daily
    Some reports link large amounts of cranberry to INR changes. The evidence is mixed, so treat this as a caution only.
  • Rule 23 Dish shown with a caution
    Food: alcoholic drinks; dishes served with wine, beer or spirits; dishes cooked with wine, beer or spirits (e.g. risotto with white wine); desserts containing liqueur or marsala (e.g. tiramisu); flambeed dishes
    Alcohol can change how warfarin works and affect the INR. Small amounts used in cooking are usually less of a concern, but drinks and desserts with liqueur should be discussed. Ask your pharmacist or doctor.
Sedating medicines (2 rules)

Includes: diazepam, lorazepam, temazepam, zopiclone, zolpidem, chlorphenamine, promethazine, codeine, morphine, tramadol, oxycodone, amitriptyline, mirtazapine, quetiapine, gabapentin, pregabalin

  • Rule 6 Dish is left out
    Food: alcoholic drinks; dishes served with wine, beer or spirits; flambeed dishes; tiramisu and other alcohol-soaked desserts
    Alcohol adds to drowsiness and can raise the risk of falls and breathing problems in older adults.
  • Rule 8 Dish shown with a caution
    Food: dishes cooked with wine, beer or spirits where most of the alcohol is cooked off
    Cooking removes only part of the alcohol. Low risk for most people, but mention it for people on sedatives.
Metformin (2 rules)

Includes: metformin

  • Rule 7 Dish shown with a caution
    Food: alcoholic drinks; large amounts of alcohol in dishes
    Heavy alcohol use with metformin raises the risk of lactic acidosis. Alcohol can also cause low blood sugar in people with diabetes.
  • Rule 8 Dish shown with a caution
    Food: dishes cooked with wine, beer or spirits where most of the alcohol is cooked off
    Cooking removes only part of the alcohol. Low risk for most people, but mention it for people on sedatives.
Blood-pressure and water tablets (2 rules)

Includes: ramipril, lisinopril, enalapril, perindopril, losartan, candesartan, valsartan, irbesartan, amlodipine, felodipine, nifedipine, bisoprolol, atenolol, furosemide, bendroflumethiazide, indapamide, spironolactone

  • Rule 9 Dish shown with a caution
    Food: salty or cured dishes: ham, bacon, salami, smoked fish, canned soup, stock cubes, soy sauce, pickles, olives, many takeaway dishes
    High salt intake can raise blood pressure and cause fluid build-up.
  • Rule 13 Dish shown with a caution
    Food: real liquorice sweets and tea
    Real liquorice can raise blood pressure and lower potassium, which matters with water tablets and digoxin.
ACE inhibitors, sartans and potassium-sparing medicines (2 rules)

Includes: ramipril, lisinopril, enalapril, perindopril, losartan, candesartan, valsartan, irbesartan, spironolactone, eplerenone

  • Rule 10 Dish is left out
    Food: potassium-based salt substitutes (e.g. 'LoSalt')
    Potassium salt substitutes can push potassium too high with these medicines.
  • Rule 11 Dish shown with a caution
    Food: large servings of potassium-rich foods: bananas, dried fruit, potatoes, tomato sauce, spinach, avocado, coconut water
    Ordinary servings are usually fine. Very large or frequent servings may raise potassium in some people.
MAO inhibitors (1 rule)

Includes: phenelzine, tranylcypromine, isocarboxazid, moclobemide

  • Rule 12 Dish shown with a caution
    Food: aged cheese (mature cheddar, blue cheese, parmesan); cured or fermented meats; soy sauce, miso, tempeh, fermented tofu; sauerkraut, kimchi; yeast extract spreads; broad bean pods; tap beer
    High tyramine foods can cause a sharp rise in blood pressure with MAOIs.
Digoxin (1 rule)

Includes: digoxin

  • Rule 13 Dish shown with a caution
    Food: real liquorice sweets and tea
    Real liquorice can raise blood pressure and lower potassium, which matters with water tablets and digoxin.
Levothyroxine (1 rule)

Includes: levothyroxine

  • Rule 22 Dish shown with a caution
    Food: breakfast; coffee
    Levothyroxine should be taken on an empty stomach, 30 to 60 minutes before breakfast and before coffee.
Tetracycline and quinolone antibiotics (1 rule)

Includes: doxycycline, tetracycline, lymecycline, oxytetracycline, minocycline, ciprofloxacin, levofloxacin, ofloxacin, moxifloxacin

  • Rule 21 Dish shown with a caution
    Food: milk; yoghurt; cheese; calcium supplements and calcium-fortified drinks
    Milk, yoghurt, cheese and calcium supplements can stop these antibiotics being absorbed properly. Take the antibiotic and these foods at least 2 hours apart.
Insulin and sulfonylureas (1 rule)

Includes: insulin, gliclazide, glimepiride, glibenclamide

  • Rule 15 Dish shown with a caution
    Food: sugary drinks, sweet desserts, large portions of white rice, white bread or sugary sauces
    Sugary or very starchy meals can push blood sugar up. Skipped or irregular meals can cause lows for people on insulin or sulfonylureas.

By condition or eating need

High blood pressure (1 rule)
  • Rule 9 Dish shown with a caution
    Food: salty or cured dishes: ham, bacon, salami, smoked fish, canned soup, stock cubes, soy sauce, pickles, olives, many takeaway dishes
    High salt intake can raise blood pressure and cause fluid build-up.
Heart failure (1 rule)
  • Rule 9 Dish shown with a caution
    Food: salty or cured dishes: ham, bacon, salami, smoked fish, canned soup, stock cubes, soy sauce, pickles, olives, many takeaway dishes
    High salt intake can raise blood pressure and cause fluid build-up.
Kidney disease (2 rules)
  • Rule 10 Dish is left out
    Food: potassium-based salt substitutes (e.g. 'LoSalt')
    Potassium salt substitutes can push potassium too high with these medicines.
  • Rule 11 Dish shown with a caution
    Food: large servings of potassium-rich foods: bananas, dried fruit, potatoes, tomato sauce, spinach, avocado, coconut water
    Ordinary servings are usually fine. Very large or frequent servings may raise potassium in some people.
Diabetes (1 rule)
  • Rule 15 Dish shown with a caution
    Food: sugary drinks, sweet desserts, large portions of white rice, white bread or sugary sauces
    Sugary or very starchy meals can push blood sugar up. Skipped or irregular meals can cause lows for people on insulin or sulfonylureas.
Chewing problems (3 rules)
  • Rule 16 Dish is left out
    Food: nuts and seeds; raw hard vegetables (raw carrot, celery); crusty bread, hard biscuits, crackers; crisps and popcorn; hard sweets
    Hard or crunchy foods are difficult to chew and can be a choking risk.
  • Rule 17 A swap is suggested
    Food: steak; chops; chewy or gristly meat; tough cuts without sauce; dry roast meat
    Tough meat is hard to chew.
  • Rule 18 Dish is left out
    Food: fish with small bones; shellfish in shells; whole grapes; fruit with pips or stones; chicken on the bone; skins on beans or sweetcorn
    Small hard pieces can cause choking.
Swallowing difficulty (3 rules)
  • Rule 18 Dish is left out
    Food: fish with small bones; shellfish in shells; whole grapes; fruit with pips or stones; chicken on the bone; skins on beans or sweetcorn
    Small hard pieces can cause choking.
  • Rule 19 Dish shown with a caution
    Food: very sticky foods: peanut butter on its own, soft white bread that forms a ball, sticky rice cakes, marshmallow, caramel, toffee; dry crumbly foods: dry cake, dry rice
    Sticky or dry foods can stick in the mouth or throat.
  • Rule 20 Dish shown with a caution
    Food: soup with lumps; cereal in milk; any food that mixes thin liquid and solid pieces
    Mixed thin liquid and solids are hard to control when swallowing. Whether thin drinks are allowed is for the person's speech and language therapist to say.
Dry mouth (1 rule)
  • Rule 19 Dish shown with a caution
    Food: very sticky foods: peanut butter on its own, soft white bread that forms a ball, sticky rice cakes, marshmallow, caramel, toffee; dry crumbly foods: dry cake, dry rice
    Sticky or dry foods can stick in the mouth or throat.