Nutritional Pharma

Question 1

Drug Side Effects

Answer 1

• Nutrient deficiencies e.g., metformin and B12 deficiency.
• Metabolic effects e.g., omeprazole and hypomagnesaemia.
• Dependence e.g., diazepam, opiate analgesics (codeine).
• Osteoporosis e.g., corticosteroids.
• Gout e.g., thiazide diuretics.
• Cardiovascular disease e.g., diclofenac (NSAID).
• Peptic ulceration e.g., NSAID.

Question 2

PPI side effects

Answer 2

• Bone fractures.
• Hypomagnesaemia (low blood magnesium)
• Vitamin B12 deficiency.
• Bacterial enteric infections e.g., serious Clostridium difficile.
• Rebound acid hypersecretion (when PPI is stopped)
• Kidney disease.
• Dementia.

Question 3

Garlic

Answer 3

• Interactions have been reported with cholesterol and blood pressure drugs , such as atorvastatin, propranolol, hydrochlorothiazide or captopril.
• Garlic could theoretically interact with anticoagulant or antiplatelet drugs, but current evidence has shown that at 4g / day it has little effect on warfarin stabilised patients.
• Garlic interspersed throughout the diet is okay, but regular, high dietary intake and / or supplements could allow for interactions.

Question 4

Gingko

Answer 4

• Should be avoided with any antiplatelet and anti coagulant medication, as it has a small potential to increase bleeding risk. It should be stopped one week before surgery.
• Due to possible CYP induction, it is best to monitor with the following drugs: Benzodiazepines (sedatives), anti-epileptic medication, anti-psychotic drugs, diabetic drugs, HIV medications, omeprazole (for gastrointestinal reflux), nifedipine and talinolol (blood pressure drugs).

Question 5

Grapefruit/Pomegranate

Answer 5

Selectively inhibits CYP3A4 in the intestinal wall for up to 24 hours, but NOT in the liver. Caution is advised with the many drugs that are metabolised via this pathway ― e.g., digoxin, statins. CYP 3A4 is involved in the metabolism of over 50% of all drugs.

Question 6

Green vegetables

Answer 6

• Large amounts of green vegetables such as broccoli, spinach, cabbage, Brussels sprouts seem to reduce the effect of anticoagulants such as warfarin.
• They contain indoles which increase the metabolism of warfarin, and also contain vitamin K, which reduces the anti clotting effects of warfarin. Vitamin K is a coagulant, whilst warfarin is an anti coagulant.

Question 7

Soy

Answer 7

• Soy decreases absorption of levothyroxine: Separate ingestion by three hours.
• Soy may also interfere with oestrogen blocking drugs such as Tamoxifen, due to its isoflavone content (both positive and negative effects observed).
• Soy may reduce the effectiveness of warfarin.

Question 8

Dairy products

Answer 8

• Calcium can bind to antibiotics like the quinolones and tetracycline, and also bisphosphonates reducing their absorption; reduces levothyroxine absorption (take four hours apart).

Question 9

PPI depletion

Answer 9

Beta-carotene, calcium, chromium, iron, magnesium, folate, vit. B12, vit. C, zinc.

Question 10

Steroids depletion

Answer 10

Calcium, vit. D, chromium, folic acid, magnesium, potassium, strontium, zinc.

Question 11

Statins depletion

Answer 11

CoQ10

Question 12

Antibiotics depletion

Answer 12

Biotin, pantothenic acid (B5), pyridoxine (B6), riboflavin (B2), thiamine (B1), vit. B12, vit K

Question 13

Metformin depletion

Answer 13

Vit B12, Folate

Question 14

Diuretics depletion

Answer 14

Calcium, magnesium, potassium, folate, vits B1, B6, C

Question 15

Antacids depletion

Answer 15

Calcium, iron, chromium, folate

Question 16

Thyroxine depletion

Answer 16

Calcium

Question 17

Oral Contraceptive Pill

Answer 17

Vitamin A
Vitamin B1
Vitamin B2
Vitamin B6
Folate
Vitamin B12
Vitamin C
Magnesium
Zinc