Transcript Understanding Nutrition, Herbs and Drug Interactions

Understanding Nutrition,
Herbs, and Drug Interactions
Michael Davidson, Pharm.D., ACN
Integrative Pharmacist
Clinical Nutritionist
Phytotherapist
Disclaimer
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The information provided in this lecture
should not be construed as a claim or
representation that any formula, procedure,
or product mentioned constitutes a specific
cure, palliative, or ameliorative for any
condition.
The material contained in this lecture has
not been reviewed by the FDA and is not for
the diagnosis or treatment of any disease.
Disclaimer
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This lecture and the information it contains
is for educational purposes only; it is not a
substitute for individualized guidance from a
qualified healthcare professional.
Audiences are cautioned not to use any
substance or product mentioned herein
without reviewing it with their qualified
healthcare professional to determine if it is
appropriate for them.
What is an Herbal Product?
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It is a mixture of organic chemicals that are made
from raw or processed plant parts, that may include
leaves, stems, flowers, roots, and seeds of plants.
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Different Forms: Extracts, Juices, Teas, Lozenges,
Inhalants, Oils, Salves, Capsules, and Herbal Baths
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In the US, under current law, they are categorized
as Dietary Supplements.
Herbal Products and
Medications
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1/3 to 1/2 of drugs commonly prescribed
today contain at least one active ingredient
derived from plants.
Examples:
Aspirin: Botanical origin from white willow
bark and acid meadow sweet plant.
Codeine and Morphine: Botanical original
from opium/poppy.
Digoxin: Botanical origin from foxglove.
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Source: Barrett B, Kiefer D, Rabago D. Assessing the risks and benefits of herbal medicine: an
overview of scientific evidence. Altern Ther Health Med. 1999;5:40–9.
Consumer Education
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Use of dietary
supplements is
increasing in the US.
Supplement use in
adults (20 years and
above):
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1988–1994: over 40%
2003–2006: over 50%
Standardization of Active
Ingredients
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The potency of
herbs depends on:
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geographic location
soil
sunlight
rainfall
altitude
harvesting
drying process
storage
Standardization of Active
Ingredients
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Therefore, necessary for manufacturers to
test their products to ensure standardized
amounts of suspected active ingredients
Most companies do not do perform these
tests.
Some research is required to ascertain the
quality of supplements and/or of the
supplement company
Quality Problems
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Many of the purported side effects and drug
interactions of herbs are not due to the herb
itself.
Actually due to:
Chemicals added in the manufacturing
process (eg. solvents, preservatives, etc.)
Wrong species or wrong part of plant used
Contaminants
Possibility of Contamination
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Herbal products imported from Asia may
have a high risk of containing contaminants.
A study examining the contents of 260 Asian
patent medicines found that 25% of
products contained high levels of heavy
metals and another 7% contained
undeclared drugs, purposefully and illegally
added to elicit a desired effect.
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Source: Bent, Stephen. “Herbal Medicine in the United States: Review of Efficacy, Safety,and Regulation”. 2004.
Regulations of Herbal
Products in the U.S.
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Regulation is currently the predominant factor
affecting the reliability of herbal products that are
manufactured in the U.S.
The Dietary Supplement Health and Education Act
(DSHEA) of 1994 classifies herbs as dietary
supplements.
Supplement manufacturers are required to fulfill the
FDA’s Good Manufacturing Practices (GMPs) for
foods, which describe conditions under which
products must be prepared, packed, and stored.
Regulations of Herbal
Products in the U.S.
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GMPs do not address all issues influencing
supplement quality. This raises concerns regarding
the quality of herbal supplements.
Remember, quality and potency of herbal products
is affected by: geographic location, soil, sunlight,
rainfall, altitude, the methods used to grow,
harvest, dry, and store the herbs.
DSHEA Restricts regulation of herbal products by
the FDA, enabling supplements to be produced,
and marketed without having to undergo rigorous
evaluations for safety and efficacy.
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Source: Bent, Stephen. “Herbal Medicine in the United States: Review of Efficacy, Safety,and Regulation”. 2004.
Regulations of Herbal
Products in other Countries
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In contrast, some other countries have
government regulatory bodies
responsible for ensuring safety and
efficacy of herbal products on the
market
Eg. Australia, Germany
Regulations of Herbal
Products in Australia
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The Therapeutic Goods Administration was
established in 1990 to “safeguard and
enhance the health of the Australian
community through effective and timely
regulation of therapeutic goods”
TGA “provides a national system of controls
relating to the quality, safety, efficacy and
timely availability of therapeutic goods used
in, or exported from, Australia”
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Source: Australian Government Department of Health: Therapeutic Goods Administration
http://www.tga.gov.au/pdf/presentations/tga-education-introduction.pdf
Regulations of Herbal
Products in Germany
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In Germany herbs are routinely prescribed
by physicians and sold in pharmacies.
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The German Commission E gives scientific
expertise for the approval of substances and
products previously used in traditional, folk
and herbal medicine.
Regulations of Herbal
Products in Germany
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The commission became known beyond Germany
in the 1990s for compiling and publishing 380
monographs evaluating the safety and efficacy of
herbs for licensed medical prescribing in Germany
These monographs serve as the basis for the
medical usage of herbs within the German health
care system
Outline acceptable manufacturing processes on the
basis of available scientific and clinical evidence.
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Source: Mark Blumenthal. The German Commission E Monograph System for Phytomedicines: A Model for
Regulatory Reform in the United States. American Botanical Council, P.O. Box 201660, Austin, TX 78720.
Herb-Drug Interactions
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Other herb-drug interactions are due to an
actual interaction between the plant and
drug ingredients
In general, 2 different types:
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PK: interaction causes a change in the amount
of herb or drug in the body
PD: interaction causes a change in the degree
of effect of the herb or drug on the body
These can be beneficial or harmful
ST. JOHN’S WORT
(Hypericum Perforatum)
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Percentage use in US: 2.1%
Main Actions: Antidepressant, nervine tonic,
antiviral (against enveloped viruses),
vulnerary, antimicrobial (topically)
Scientific evidence for efficacy: Likely
effective for mild-moderate depression
Safety: Numerous Amounts of Drug
Interaction. Not recommended for pregnant
or lactating women.
ST. JOHN’S WORT
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Most interactive herbal product
Interaction with drugs metabolized by
liver
Increases the rate of metabolism of
certain pharmaceutical agents,
causing a reduction in blood levels.
ST JOHN’S WORT
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May reduce levels of the following drug types:
certain antivirals
chemotherapeutic agents
oral contraceptives
warfarin
Anti-seizure medications,
cardiovascular meds (eg. digoxin)
transplant rejection drugs
many others
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Source: Hammerness P, Basch E, Ulbricht C, et al. St John’s wort: a systematic
review of adverse effects and drug interactions for the consultation
psychiatrist. Psychosomatics. 2003;44:271–82.
GINKGO BILOBA
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Commune Use: Improvement of Memory and
Concentration, and treatment of dementia and
peripheral vascular disease, reduce the incidence
of plaque formation associated with atherosclerosis,
Antioxidant, Glaucoma, Menopausal symptoms,
Multiple Sclerosis, Sexual Dysfunction
Main Actions: Antioxidant, anti-PAF activity, tissue
perfusion enhancing, circulatory stimulant, cognition
enhancing, neuroprotective
Percentage use in U.S.: 3.7%
Scientific Evidence for Efficacy: Likely Effective for
Alzheimer’s Prevention
Side Effects: generally mild and may include
headache, GI upset, nausea/vomiting
GINKGO BILOBA
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Some possible Drug Interactions with:
anticonvulsants (may reduce effects)
antipsychotics (may increase effects)
hypoglycemic meds (may increase effects)
certain acid lowering drugs (may reduce
effects)
certain anxiolytic/sleep meds (may increase
or decrease effects)
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Ernst, Edzard. “The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John’s Wort, Ginseng,
Echinacea, Saw Palmetto, and Kava” 2002.
GINSENG (PANAX GINSENG):
Background Information
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Historically, ginseng has been used to
improve endurance, concentration,
alertness, and general well-being.
P. ginseng has a range of pharmacological
activities, including CNS stimulation,
immune system modulation, and anabolic
effects.
Main Actions: adaptogenic, tonic, immune
modulating, cardiotonic, chemopreventive,
cognition enhancing
GINSENG (PANAX GINSENG):
Efficacy
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recent epidemiological study of a ginseng
growing region in Korea:
the risk for cancer of persons who
consumed fresh Korean ginseng on a
regular basis was reduced to about 30% of
those who did not consume it.
a dose-response correlation between
regular ginseng consumption and risk for
cancer was observed.
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Source: Ernst, Edzard. “The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John’s Wort,
Ginseng, Echinacea, Saw Palmetto, and Kava” 2002.
GINSENG (PANAX GINSENG):
Safety
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Some possible Drug Interactions with:
warfarin (may decrease effect)
digoxin (may increase digoxin levels)
anti-diabetic meds (may increase effect)
blood pressure lowering meds (may decrease or
increase effects depending on drug)
MAO inhibitors like phenelzine (CI: may cause HA,
tremor, mania)
moreover, since the quality of numerous
commercial ginseng products sold in the US is
unknown, adverse effects / drug interactions might
be caused by contaminants.
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Ernst, Edzard. “The Risk-Benefit Profile of Commonly Used Herbal Therapies: Ginkgo, St. John’s Wort, Ginseng,
Echinacea, Saw Palmetto, and Kava” 2002.
Standardization of Active
Ingredients: Ginseng
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A number of recent studies have documented
significantly different levels of suspected active
ingredients in the same types of herbal products.
For instance, a recent analysis of 25 available
ginseng products found a 15- to 200-fold variation
in the concentration of 2 ingredients (ginsenosides
and eleuthrosides) believed to have biological
activity.
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Source: Harkey MR, Henderson GL, Gershwin ME, Stern JS, Hackman RM. Variability in
commercial ginseng products: an analysis of 25 preparations. Am J Clin Nutr.2001;73:1101–6.
Standardization of Active
Ingredients: Echinacea
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Three species of echinacea are used to prepare
commercially available herbal supplements:
Echinacea angustifolia, E. pallida, and E. purpurea.
Main actions: immune enhancing/modulating,
depurative, lymphatic, anti-inflammatory, vulnerary,
sialogogue.
Although roots are used most frequently, the
dramatic variability of echinacea products may be
ascribed to the varying plant parts used in different
preparations.
Echinacea History
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Information regarding the therapeutic use of
Echinacea first came from Native American tribes.
The eclectic physicians (a groups of doctors that
reached prominence around the late 19th to early
20th century in the US) then adopted this use.
The most common treatment prescribed by the
Eclectics was the root of E. angustifolia, by 1921.
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Source: Wagner H. Z Phytother 1996; 17: 79-95
Echinacea History
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Native Americans preffered E. angustifolia and used only the
root
The Eclectics used only lilophilic extracts (high alcohol
concentration) of dried roots of E. angustifolia.
Eclectics described good quality Echiancea root as “imparting
a persistent tingling sensation”.
Tingling caused by active ingredients in E. angustifolia known
as alkylamides; presence of tingling sensation indicates
presence of active constituents (quality marker).
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Sources:
Felter HW, Lloyd JU. King’s American Dispensatory. 18th Edn, 3rd revision. First published 1905, reprinted Eclectic
Medical Publications, Portland, 1983.
Bauer R, Wagner H. In Wagner H, Farnsworth NR eds. Economic and Medicinal Plant Research, Vol 5, Academic
Press, London, 1991.
Echinacea History
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In the 1930s, German herbalist Madaus had trouble
growing E. angustifolia ; used E. purpurea instead.
Used the stabilized juice of fresh E. purpurea tops
(aerial parts), likely due to his background in
homeopathy.
This hydrophilic extract of echinacea contains very
low levels of alkylamides (no tingling sensation).
Only echinacea roots are likely to contain sufficient
concentrations of active ingredients (alkyl-amides)
necessary for therapeutic benefit.
Echinacea: Quality Problems
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This contributed to today's multitude of
preparations available on the market,
often:
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Non-traditional species of echinacea
used
Wrong plant part used
Improper extraction method
Improper manufacturing process
Echinacea: Clinical Research
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NK cells decline in number and function with age
and this is thought to be one factor behind the
increase in various diseases with age.
Experiments in healthy, elderly mice found that 2
weeks of oral doses of Echinacea root returned NK
cell number and function to the levels normally
found in young adults
In addition, for mice fed Echinacea purpurea root
from 7 weeks of age to 13 months, lifespan was
significantly extended compared to controls.
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Sources:
Currier NL, Miller SC. Exp Gerontol 2000; 35: 627-639
Brousseau M, Miller SC. Biogerontology 2005; 6: 157-163
Echinacea: Clinical Research
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An Echinacea root formulation was compared against a herbal
adaptogenic formulation and a placebo in the prevention of
winter colds over a 90-day period.
The trial recruited 260 medical students who were under
stress from their studies.
The placebo group averaged an infection rate of 10%,
whereas this dropped to as low as 2% by day 70 (p=0.013) in
the Echinacea group.
Source: McIntosh A et al. AANP Convention, Coeur d’ Arlene, 1999.
Echinacea: Clinical Research
Randomized, double blind, placebo-controlled clinical trial:
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175 participants travelling return from Australia to North America,
Europe or Africa for 1 to 5 weeks.
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Active tablets each contained extract from 1.275 g Echinacea root
(4.4 mg alkylamides)
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Priming dose was 2/day, travel dose was 4/day, and dose when ill
was 6/day
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The Echinacea group exhibited significantly lower average
respiratory infection symptom score (about half) compared with the
placebo group (p<0.05) after return from travel.
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Tiralongo E et al. Evid Based Complement Alternat Med 2012; 2012: 417267
Echinacea: Clinical Research
Tiralongo E et al. Evid Based Complement Alternat Med 2012; 2012: 417267
Tribulus History
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As an herb which improves libido and male sexual
performance, Tribulus terrestris has grown in popularity.
Main Actions: tonic, aphrodisiac, oestrogenic in females
(indirectly), androgenic in males (indirectly), fertility agent
It is used by phytotherapists to:
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improve male and female fertility
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for menopausal symptoms
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to enhance physical performance and fitness.
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Source: Morgan M, Bone K.Tribulus terrestris.
Professional ReviewAug 2001; No. 76, pp 1-4.
Tribulus History
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A common weed found in many parts of the world,
Tribulus has been employed therapeutically in
traditional medical systems such as Ayurveda and
Chinese medicine.
Bulgarian research using a standardized Tribulus
leaf preparation which is rich in furostanol saponins
(especially the marker phytochemical protodioscin)
lead to the modern uses noted above.
Since furostanol saponins are important, active
constituents, the Bulgarian extract was
standardized to contain at least 45% of these
saponins as protodioscin.
Tribulus: Phytochemistry
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Meticulous analytical studies (using HPLC), have
determined the following:
There is a substantially higher content of
protodioscin in the leaves (1.337%), than in the
stem (0.276%) or fruit (0.245%) (plant samples
taken from Bulgaria).
Plant material from Eastern Europe is higher in
protodioscin than material from India, China or
Australia.
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Sources:
Lehmann RP et al. Rev de Fitoterapia 2002; 2(S1): 217 (Abstract B006)
Ganzera M et al. J Pharm Sci 2001; 90: 1752
Tribulus: Quality Problems
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Most Tribulus products on the market are very
different from the Bulgarian extract.
As demonstrated in one study, Tribulus leaf from
Australia and India did not contain protodioscin.
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Morgan M, Bone K.Tribulus terrestris. Professional ReviewAug 2001; No. 76, pp 1-4.
In an assessment of products selected from the US
market, deficiencies of protodioscin were
discovered in the majority.
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Sources:
Morgan M, Bone K.Tribulus terrestris. Professional ReviewAug 2001; No. 76, pp 1-4.
Ganzera M, Bedir E, Khan IA. Determination of steroidal saponins in Tribulus terrestris by
reversed-phase high-performance liquid chromatography and evaporative light scattering
detection.J Pharm Sci 2001; 90(11): 1752-1758.
Tribulus: Clinical Research
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In an unblinded, placebo-controlled study, treatment
with concentrated extract of Tribulus terrestris leaf
from Bulgaria had a beneficial effect on
menopausal symptoms:
improvement in hot flushes, sweating, insomnia and
depression in 98% of the 50 participating women
Improvement in libido in nearly 70% of women.
Intake of placebo was ineffective.
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Zarkova S. Tribestan: Experimental and Clinical Investigations. Chemical Pharmaceutical
Research Institute, Sofia, Bulgaria.
Tribulus: Clinical Research
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A number of uncontrolled clinical trials have been conducted by
Bulgarian research teams including over 300 men with fertility
problems and impotence.
Concentrated extract of Tribulus terrestris leaf, containing furostanol
saponins (predominantly protodioscin, at least 45%) was found to
have a stimulating effect on sexual function.
Treatment with Tribulus extract increased serum testosterone in
some patients with lowered levels, (levels were not increased in
those with normal values of testosterone)
Concentrated extract of Tribulus terrestris leaf was found to be well
tolerated, with gastrointestinal upset occurring in only a few patients.
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Sources:
Protich M et al. Akush Ginekol 1983; 22: 326
Kumanov F et al. Savr Med 1982; 4: 211
Viktorov IV et al. MBI: Medicobiologic Information 1982, cited in Zarkova S. Tribestan: Experimental and Clinical Investigations. Chemical
Pharmaceutical Research Institute, Sofia, Bulgaria.
Nikolova V, Stanislavov R. Dokl Bolg Akad Nauk 2000; 53: 113
Stanislavov R, Nikolova V. Dokl Bolg Akad Nauk 2000; 53: 107
Nutrition and Herbal Therapy
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When used correctly by a healthcare
professional knowledgeable in
phytotherapy / herbalism and nutrition,
herbal therapy, appropriate nutrition, and
nutritional supplements can be used to:
Reduce drug side effects / toxicities
Reduce drug-related organ impairment
Reduce drug-induced nutrient depletion
Improve drug therapeutic effects
Drug-Induced Nutrient
Depletion
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some commonly prescribed medications, when taken chronically, can
deplete the body’s reserves of essential vitamins, minerals, enzymes,
co-factors, and other nutrients.
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“To carry on the life process, each of the 80 to 100 trillion cells must
digest constructive food, excrete wastes, repair itself, and carry on
other essential functions. Every cell requires all the known and
unknown elements of nutrition.” -- Dr. Janet Lang
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Prolonged nutrient depletion can result in diseases of any organ
system depending on the specific nutrients being depleted.
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Likely contributes to leading causes of death in the US including
heart disease, cancer, dementia, etc.
Drug-Induced Nutrient
Depletion
Drug-Induced Nutrient
Depletion
What to do about nutrient
depletion?
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Is taking a synthetic
nutrient supplement
the solution?
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What is the difference
between chemically
synthesized nutritional
supplements and
those derived from a
whole-food source?
Not All Supplements are
Created Equal
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When you take a synthetic vitamin
supplement, your body is merely getting
isolated chemicals. Examples include:
Vitamin A (as beta carotene or as Vitamin A
palmitate or acetate)
Vitamin C (as ascorbic acid, or as calcium
ascorbate)
Vitamin E (as d-alpha-tocopherol,
tocotrienols, or as mixed tocopherols)
Not All Supplements are
Created Equal
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In food or herbs, nutrients are never isolated; they are always
in complexes with other nutrients, without which they cannot
function, and therefore, cannot enable the body to function.
“Nutrients in foods are highly synergistic interactive
complexes. Synergy means that the whole is greater than the
sum of its parts, that the relationship which the parts have to
each other is the most catalytic, most empowering, most
unifying, most functional or effective part. Synergy means that
1 + 1 may equal 8, 24, or even 1,600. Synergistic function
produces more and better results than any action of any part
separated from the whole…”
"Separating the group of compounds (in a vitamin complex)
converts it from a physiological, biochemical, active
micronutrient into a disabled, debilitated chemical of little or no
value to living cells. The synergy is gone."-- Dr. Judith DeCava
Not All Supplements are
Created Equal
Whole Food Complex
Synthetic Isolates
Not All Supplements are
Created Equal
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To give an analogy, a vitamin taken from food is part of a complex
machine like a clock. Many interlocking gears and other parts are
necessary for a clock to function correctly, which are all found in the
food.
Manufacturers who make synthetic vitamins are analogously
gathering large quantities of several types of these gears, throwing
them together in no particular order within a pill, and trying to
convince you that they will work like a clock within your body.
Furthermore they try to convince you that more of a particular vitamin
(a huge daily value) is better; this is like saying that having more of a
particular part needed to make a clock is more important than having
all of the necessary parts of that clock in their correct arrangement.
Thus, 50 mg of vitamin C (or A, E, etc.) from a food (or whole food
supplement) is more nourishing and contains far more functional
components than 1000 mg of ascorbic acid (the antioxidant wrapper
that protects the functional components) from a synthetic
supplement.
Not All Supplements are
Created Equal
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Vitamin C complex structure includes:
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Ascorbinogen and bioflavonoid
complexes
Tyrosinase (copper-bearing enzyme)
(Most Functional Part)
P, K, and J factors
Ascorbic acid - this antioxidant wrapper is
the only part of the vitamin C complex
found in synthetic supplements
Not All Supplements are
Created Equal
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Vitamin E complex structure includes:
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Xanthine
Selenium
Manganese
Lipositols
Polyunsaturated fatty acids
Alpha, Beta, Gamma, and Delta Tocopheral –
these antioxidant wrappers are the only part of
the vitamin E complex found in synthetic
supplements (only some of them eg. delta and
alpha tocophreal).
Synthetic “vitamins” increase
cancer risk in smokers
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Results: Unexpectedly, we observed a higher incidence of
lung cancer among the men who received beta carotene than among
those who did not (change in incidence, 18 percent). Fewer cases of
prostate cancer were diagnosed among those who received alphatocopherol than among those who did not. Beta carotene had little or
no effect on the incidence of cancer other than lung cancer. Alphatocopherol had no apparent effect on total mortality, although more
deaths from hemorrhagic stroke were observed among the men who
received this supplement than among those who did not. Total
mortality was 8 percent higher among the participants who received
beta carotene than among those who did not, primarily because there
were more deaths from lung cancer and ischemic heart disease.
Conclusion: We found no reduction in the incidence of lung cancer
among male smoker after 5-8 years of dietary supplementation with
alpha-tocopherol or beta carotene. In fact, this trial raises the
possibility that these supplements may actually have harmful as well
as beneficial effects.
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N Engl J Med. 1994 Apr 14;330(15):1029-35. The effect of vitamin E and beta carotene on the
incidence of lung cancer and other cancers in male smokers. The Alpha-Tocopherol, Beta Carotene
Cancer Prevention Study Group.
Not All Supplements are
Created Equal
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In effect, when large quantities of synthetic vitamins are
ingested, your body treats them more like drugs or xenobiotics
(foreign substances) than nutrients.
To prevent them from causing biochemical imbalances, the
body attempts to quickly excrete them (eg. high-dose synthetic
B vitamins are rapidly excreted after ingestion, turning the
urine a bright yellow color)
Moreover, the parts that are retained are still missing many of
the components required to make them functional.
The body is forced to scavenge these missing components
from its own tissue reserves
This is why synthetic supplements seem to work in the shortterm, but stop working once these tissue reserves are
depleted, sometimes resulting in a larger imbalance than
before starting on the supplements.
Not All Supplements are
Created Equal
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To prevent these imbalances, choose
supplements made from real food (whole
food concentrates) rather than chemicals.
Must research quality of supplement
production process from the growing and
harvesting of foods used to make the
supplements to the manufacturing and
quality control process.
Best to have guidance of health care
professional in choosing a supplement.
Adverse Drug Reactions
(ADRs) in the U.S.
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Over 2 MILLION serious ADRs yearly
100,000 DEATHS yearly
ADRs 4th leading cause of death ahead of
pulmonary disease, diabetes, AIDS, pneumonia,
accidents and automobile deaths
Ambulatory patients ADR rate—unknown
Nursing home patients ADR rate— 350,000 yearly
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Sources:
Institute of Medicine, National Academy Press, 2000
Lazarou J et al. JAMA 1998;279(15):1200–1205
Gurwitz JH et al. Am J Med 2000;109(2):87–94
COMMONLY USED DRUGS AND ASSOCIATED
TOXICITY MANAGEMENT: EXAMPLES
Reducing Drug-Related
Toxicity / Organ Impairment


Not only can nutrients (especially from
whole food sources) and high quality herbs
be used to support Pts. with various health
problems, they can also be used to minimize
the adverse effects of any drugs these Pts.
are taking.
Functional Approach:


Address underlying cause of why Pt. is taking
drug
Minimize ADRs and drug associated toxicity
Pts. Taking Statin Drugs


Statin drugs are known to deplete a molecule critical for
cellular respiration (energy production) called Coenzyme Q
Address underlying cause




Nutrition/exercise/lifestyle
Cardiovascular health
Inflammation
Protect against drug-induced organ impairment:




cardiovascular
Hepatic
Musculoskeletal
CNS
Pts. Taking ACE-I/ARB Drugs


ACE-I/ARB are a class of antihypertensive
drugs known to cause renal impairment
Address underlying cause




Nutrition/exercise/lifestyle
Cardiovascular health
Endocrine balance
Protect against drug-induced organ
impairment:


Renal system
Cardiovascular system
Pts. Taking Antibiotics


Broad spectrum antibiotics (especially) will
eliminate essential intestinal flora
Address underlying cause:



Nutrition/exercise/lifestyle
Immune System support
Reduce adverse drug effects:


GI system
restore/rebuild healthy gut flora to the extent
possible
Pts. Taking NSAIDS



Non-Steroidal Anti Inflammatory Drugs
Known to deplete folic acid (vitamin B9), which is involved in a
number of functions in the body a few of which include DNA
synthesis, repair, and methylation, and erythrocyte maturation.
Address underlying cause:



Assess cause of pain and undertake correcting measures
Manage pain meanwhile
Protect against drug-induced organ impairment:



Cardiovascular System
GI system
Renal System
Pts. Taking Acid-Suppressing
Drugs


Prolonged administration of acid-lowering drugs is
known to inhibit digestion and result in nutrient
deficiency (B-12, folate, vitamin D, calcium, iron,
zinc).
Address underlying cause:



Nutrition/exercise/lifestyle
Improve digestion
Protect against drug induced organ impairment:



Digestive
Immune
Musculoskeletal
Thank You
Questions?
References
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