Drug-Induced Nutritional Depletion and Food-Drug and Herb-Drug Contraindications
By Namwook Cho
Acupuncturists deal with patients who have been taking certain prescribed medications. But not many acupuncturists give nutrition-related information to their patient regarding drug-induced nutrition depletion.
It is not the only case for acupuncturists. Even medical doctors or pharmacists seem not to provide enough information such as precautions and food to avoid while on the medication.
The most frequently prescribed medications for patients who visit an acupuncture clinic are taking medications such as hypertension, acid-suppressing drugs, antidepressant, cholesterol-lowering medications, NSAIDs, oral contraceptives, and oral hypoglycemics.
Certain food could interfere with medications. There are also things to remember that certain herbs in a formula could make a medications’ effect way too much or critically lower the absorption ratio. Your patient should know this information during a consultation.
Patients On Certain Prescribed Medications Could Suffer Chronic Malnutrition
Herbs Should Be Carefully Prescribed To Prevent Advert Reaction For Patients On Prescribed Medications
ACE inhibitors and Diuretics
There are two kinds of medications for hypertension at large: ACE inhibitors and diuretics. Lisinopril, Benazepril, Enalapril, Ramipril, and Quinapril belong to ACE inhibitors. Diuretics are Bumetanide, Furosemide, and Hydrochlorothiazide. ACE inhibitors lower zinc in the system. And ACE inhibitor takers need to be recommended not to drink pomegranate juice with the medicine. Pomegranate juice may have additive ACE-inhibitor effects. Blood pressure and potassium levels should be monitored.
Diuretics reduce nutrients such as vitamin B1, calcium, folate, magnesium, potassium, zinc, and sodium. In human research and clinical review, diuretics interfered with the kidney’s ability to regulate magnesium concentrations. Celery may have diuretic properties, and it should be recommended not to eat with the diuretics. Some herbs should not be used for the patient on these medications. Mistletoe has been shown to cause severe dehydration, and concurrent use may increase the risk of adverse effects. Chinese motherwort (Leonurus heterophyllus) and other coumarin-rich plants have demonstrated diuretic activity. The most frequently used herb, licorice and diuretics may lead to addictive electrolyte effects and toxicity.
Acid-suppressing drugs
Proton pump inhibitors and H2 antagonists are the acid-suppressing medications. The proton pump inhibitors are for peptic ulcers and acid reflux. Esomeprazole, Lansoprazole, Omeprazole, and Pantoprazole are proton pump inhibitors and lower vitamin B12, calcium, iron, magnesium, vitamin c, and zinc. Ginger may increase stomach acid production and interferes with either proton pump inhibitors and H2 antagonists. Cranberry juice could be recommended for any proton pump inhibitors to increase the absorption of vitamin B12.
H2 antagonists such as Cimetidine, Ranitidine, and Famotidine are often prescribed for heartburn and acid reflux. H2 antagonists are known to reduce the amount of vitamin B12, iron, and vitamin D.
Antidepressants
Calcium and vitamin D should be added for those on SSRIs. Kava may cause excessive drowsiness when taken with SSRIs. White horehound may antagonize the effects of serotonin. Chocolate may stimulate the hypothalamus, inducing pleasurable sensations and affecting serotonin levels. While serotonin has a pleasurable effect, in high concentrations, it may be converted to melatonin, which, in large amounts, reduces sexual drives. Preliminary research suggests that synephrine might have antidepressant effects. Bitter orange contains tyramine, octopamine, and synephrine, MAO substrates.
Cholesterol-lowering medications (statins)
Patients on the medication will need more Coenzyme Q10. According to clinical review, meta-analysis, and animal research, caffeine may increase cholesterol and triglyceride levels. In laboratory research, the vasodilatory effects and activity of rosuvastatin on ecto-5′-nucleotidase activity were attenuated by caffeine. Researchers suggest abstaining from caffeine while using 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) to obtain the full clinical benefit. According to clinical research, soy as part of a diet high in fiber, vegetables, and nuts may reduce C-reactive protein and LDL cholesterol.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs (Aspirin) are used for pain relief, fever, and inflammation and affect vitamin C and iron levels, especially in elders on a low-dose regimen. In an animal study, the combination of indomethacin with creatine, as measured by the carrageenan-induced paw edema test, showed that the drug combination was more effective at reducing inflammation than either drug alone. According to secondary sources, the combination of creatine with nephrotoxic drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, indomethacin, naproxen, and piroxicam (Feldene®), may adversely affect renal function and be harmful to the kidneys. Renal function should be monitored.
Oral hypoglycemics (metformin)
Females on the birth control pills need more vitamin B6, vitamin B12, calcium, folate, and magnesium. In animal research, the constituent baicalein inhibited alpha-glucosidase activity as herbal medicine that contains huang qin and ge gen might lower too much glucose levels as a patient takes metformin along with an herbal formula that contains either huang qin or ge gen. Other animal research found that baicalin reduced elevated insulin concentrations following a high-fat diet. Scutellaria baicalensis was also found to enhance the antidiabetic activity of metformin in rats, as evidenced by elevated hepatic activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx); increases in plasma and pancreatic insulin levels; and decreases in plasma and hepatic triglycerides (TG) and cholesterol levels. According to animal research, kudzu and its constituents may have hypoglycemic effects and lower blood glucose levels. In human research, puerarin decreased fasting plasma insulin and increased insulin sensitivity index, and puerarin plus control treatment (metformin and captopril) and Avandia® decreased blood glucose. (Referred Drug-Induced Nutrition Depletion and Repletion Recommendations from Metagenics, and Korean Medicine Convergence Research Information Center.)
