ALIVE - Canadian Journal of Health and Nutrition,
June 2000
Common Drugs Deplete Nutrients
by Daniel T. Wagner, RPh, MBA
The growing fusion of natural medi-cines with nutrition and allopathic medicine
has spawned a new area of specialization called drug/nutrient depletion.
Current estimates are that 62 to 68 per cent of North Americans take "alternative"
medicines and therapies (including herbs, botanicals, vitamins, minerals and
homeopathy). The growth in this industry has increased unabated for over a decade.
Although the media is full of reports on nutri-tional supplements, many consumers
(and unfortunately many physicians and other health professionals) don't understand
that some medications can reduce absorption (and even cause depletion) of vitamins,
minerals and electrolytes crucial for good health. Pharmacists can play an important
role in educating customers about this potentially serious problem.
Many pharmacists, widely regarded as the "drug experts" in American medicine,
feel compelled to "catch-up" and learn as much as possible about integrative
pharmacy practice.
The concerns that a patient may have interactions with nutrients versus drugs,
nutrient versus nutrient or drug versus food, adds volume and credi-bility to
the role of the pharmacist in role as a counselor. A health profes-sional (particularly
a pharmacist) who can have a foot in both worlds (of allo-pathic and complementary
medicine) is in a unique position to counsel patients in this emerging area
of expertise.
There are numerous problematic interactions that can take place between drugs
and nutrients. Some involve similar structures and meta-bolic pathways that
may affect vitamin depletion. A common example is aspirin's negative effect
on the body's depletion of vitamin C and iron.
Other times, depletions may impair system metabolism. An example would be a
diuretic drug's effect on potassium loss, or an oral contracep-tive's depletion
of folic acid and vitamin C. Sometimes depletions can cause another disorder
to arise. An example of this may be how statin drugs deplete co-enzyme Q10 levels
or how antibiotics eradicate intestinal flora, spurring Candida outbreaks. Lastly,
certain nutrients may interfere with the accuracy of lab results, resulting
in false (positive or negative) readings. A common example of this is concurrent
use of ginkgo biloba and warfarin, and other anti-coagulate medicines. This
misreading could prove extremely dangerous, or even fatal, to the patient.
The following list is a concise, but accurate measure of common drug/nutrient
depletions.
Antibiotcs
Intestinal Bacterial Flora - A healthy physiological intestinal flora
is very important for a healthy organism. Although antibiotics are quite effec-tive
in eradicating the body of harmful "bad" bacteria, they unfortunately also rob
the body of beneficial "good" bacteria, located in the gut. Research shows that
the absence of good gut flora can cause problems with digestion. This also leads
to a malab-sorption of nutrients (especially from your food) and symptoms such
as bloating, gas, diarrhea, belching, con-stipation, pressure and sometimes
rebound acidity. To ensure that your bowel flora is intact, supplement with:
Acidophilus: To replenish and repli-cate the friendly bacteria. It is
suggested to take lactobacillus aci-dophilus each time you take the antibiotic,
and possibly take it for five to seven days after the course of antibiotics
is finished to ensure nor-malization. (Yogurt is a good natural source of acidophilus,
but it may be a problem for people sensitive to lactose intolerance).
Fructo-oligosaccharides (FOS) and Other Probiotic Support: To help restore
other gastrointestinal prob-lems that the antibiotics may induce (especially
the stronger, third-genera-tion type) and help offset the imbalance or the GI
flora.
Antidepressant Drugs
Includes drugs used to stimulate the mood of a depressed patient. Some are used
in eating disorders, treating obesity, and panic disorders. Drugs include tricyclic
and SSRI medicines such as Amitriptyline, Elavil, Tra-zodone, Desipramine, Pamelor,
Nortriptyline, Serzone, Paxil, Prozac, Zoloft and Imipramine.
B-Complex Vitamins: Additional B--vitamins are critical when taking antidepressants
for short or extended periods. Vitamin B12 and folic acid are especially necessary.
There may also be an additional need for riboflavin (B2).
Selenium: Stores of selenium are com-promised with extended use of these
drugs. A suggested supplementation dose would be 50 to 100 micrograms daily.
Zinc: Depletion of this antioxidant can slow wound healing and reduce
the sense of taste. Supplement with a dose of 10--35 mg per day.
L-Gluthathione: An important amino acid that decreases free radicals
and helps to protect your liver.
Calcium/Magnesium: Take for nutri-tional support, along with additional
minerals.
Vitamin C
Diabetic Medications
Includes sulfonylurea drugs such as Diabinese and Tolinase; second gener-ation
drugs Glynase and Diabeta; and miscellaneous diabetes drugs such as Metformin
and Acarbose.
Chromium: This mineral is essential for the body's metabolism of glucose.
Low levels may lead to insulin insensi-tivity and abnormal insulin usage.
Vitamin C: Vitamin C improves all aspects of diabetes, and is often depleted
due to free-radical destruc-tion and increased urinary excretion.
Magnesium: There is a direct relation-ship between magnesium deficiency
and insulin resistance. Magnesium also improves all aspects of diabetes aiding
in arterial strength, normalizing blood pressure, and aiding in glycolysis.
Most diabetics have an 80 to 85 percent deficiency.
Vitamins B6 and B12: B6 may aid in healthy eye support and proper vision.
Bilberry, lutein and other bioflavonoids may be supplemented when vision problems,
diabetic retinopathy or macular degeneration are present. (Note: these herbs
would be contraindicated with warfarin use.)
Folic Acid: A deficiency is especially noted with Metformin use.
Estrogen and Progesterone
Includes oral contraceptives agents and estrogen compounds (Premarin, Estratest)
and estrogen-progesterone combinations (Prem-pro).
B-Complex Vitamins: B vitamins are important to maintain healthy skin,
nails, nerves, hair and cells. They are also critical in the production of energy.
An increased requirement for vitamin B6 may be even more acute. Folic acid may
be required, especially with oral contraceptives.
Calcium/Magnesium: Perhaps there are no two more important minerals for
women (especially menopausal or post-menopausal). Calcium supple-ment with vitamin
D are especially recommended.
Vitamin C, E and Beta Carotene: These three essential anti-oxidants are
valuable in reducing a woman's risk of post-menopausal breast cancer. They help
to reverse free-radical destruction and boost the immune system. Addi-tional
supplementation with vitamin E may ease hot flashes and other menopausal symptoms.
Essential Fatty Acids: The omega-3 and omega-6 essential oils aid in
anti-inflammatory and immunoregulatory properties. They can be depleted in a
typical North American diet of high saturated fatty foods.
Arthritis Medications
Includes non-steroidal anti-inflamma-tory (NSAID) drugs such as Aspirin, Ibuprofen
and Advil.
Calcium/Magnesium: These two crit-ical minerals are essential when taking
arthritis medicines. Both are needed to build bone, muscles and nerves all through
life, especially in your senior years. Long term depletion can lead to high
blood pressure, heart irregulari-ties, muscle cramps and asthma-like symptoms.
Since bone loss can ensue with continued steroid use, vitamin D should be supplemented
to prevent osteoporosis.
Vitamin C: NSAID medicines can cause increased urinary excretion of Vitamin
C. This vitamin is essential for maintaining connective tissue, reducing the
levels of free radicals that weaken the immune system and syn-thesizing collagen
to strengthen bones.
Folic Acid: Lower levels of this impor-tant nutrient, aiding in the inhibition
of uric acid.
Glucosamine: Although not an anti-inflammatory, glucosamine and chondroitin
play a role in stimulating cartilage cells, regenerating cartilage and binding
with collagen so that carti-lage can be strong. It relieves the pain of arthritis
and may decrease the need for NSAIDs.
Essential Fatty Acids: The omega-3 and omega-6 essential oils aid in
anti-inflammatory and immunoregulatory properties. They "lubricate" the joints.
Corticosterolds
Steroid drugs are used as anti-inflam-matories and for a wide range of diseases,
including dermatitis, autoim-mune diseases, asthma and allergic disorders. Drugs
include costisone, hydrocortisone, prednisone, triamci-nolone, dexamathasone
and azulfidine.
Vitamin C: Steroid overuse can deplete vitamin C stores, leading to easy
bruising, lower immunity, asthma and allergy-like symptoms, and poor wound healing.
B-Complex Vitamins: Folic acid deple-tion can lead to anemia and cardiovascular
disease. Steroid use can also raise blood sugar; chromium might be needed as
an additional supplement.
Potassium: Loss leads to edema, irreg-ular heartbeat and muscle weakness.
Supplementation amounts are determined by blood levels.
Zinc
Selenium
Calcium/Magnesimn
Diuretics
Includes all drugs used in the manage-ment of edema associated with congestive
heart failure and renal or liver disease, including furosemide, Lasix, hydrochlorothiazide,
Dyazide, bumetanide, Bumex, spironolactone and chlorthalidone.
Potassium: All of the loop diuretics and the thiazides can contribute
to severe potassium deficiency that can lead to defects in the kidneys, skeletal
muscle, central nervous system, gas-trointestinal tract and heart muscle. Excessive
loss leads to edema, irreg-ular heartbeats and muscle weakness.
Calcium/Magnesium: Long term use of diuretics can eliminate these essen-tial
minerals vital for cardiac function, along with potassium.
B-Complex Vitamins: Diuretics can especially deplete thiamin (vitamin
B1) and pyridoxine (vitamin B6). This depletion can elevate homocysteine levels,
leading to harm to the heart.
Zinc
Vitamin C