Nutritional Deficencies

Published on May 08, 2019

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PRESENTATION OUTLINE

Nutritional Deficencies

Drug Induced Depletions
Photo by Roberta Sorge

Acid Reducers

Aciphex, Nexium, Tagament, Zantac, Pepcid, Protonix, Prilosec, Prevacid

H2 Agonist: Histamine 2 (H2) blockers, block histamine receptors that are located on the mucosal gastric cells this decreases both the secretion & the production of stomach acid. Without good levels of stomach acid minerals & vitamins are not broken down to a bio-available level.

Photo by Mae Mu

H2 Agonists Include

  • Famotidine (Pepcid as a prescription, Pepcid-AC as an OTC medication)
  • Cimetidine (Tagamet and Tagamet-HB)
  • Nizatidine (Axid and Axid AR)
  • Ranitidine (Zantac and Zantac 75)
Photo by Collin Grady

H2 Agonists Deplete

  • Calcium
  • Iron
  • Zinc
  • Folic Acid
  • Vit D
  • Vit B12
Photo by AJC1

Proton Pump Inhibitor: PPIs block the acid transporter pump located on the luminal surface. This prevents stomach acid from traveling into the gastric lumen. Again, without good levels of stomach acid minerals & vitamins are not broken down to a bio-available level.

Photo by Mae Mu

Proton Pump Inhibitor can usually be identified by their ending "azole"

Photo by Fatima Akram

Proton Pump Inhibitors Include

  • Dexlansoprazole (Dexilant)
  • Esomeprazole (Nexium and Nexium 24HR)
  • Lansoprazole (Prevacid)
  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)
  • Omeprazole (many names: Including Zegerid & Prilosec
Photo by eliz.avery

Proton Pump Inhibitors Deplete

  • Vit B12
  • Magnesium
Photo by fdecomite

Supplement Dosage for Acid Reducers

  • Vitamin B12: 25–1000 mcg/day
  • Magnesium: 250–400 mg/day
  • Calcium: 500 mg daily
  • Vitamin D: 1000–2000 IU daily
  • Zinc: 11 mg daily

Tagament & green tea can have a strange interaction. Tagament can change the way green tea is metabolized by reducing how quickly it is cleared from the body.

Both Goldenseal & Ginger actually increases stomach acid which can interfere with acid reducer's functions.

Photo by Hans Vivek

Antibiotics

Amoxil, Bactrim, Ceclor, Cipro, Levaquin & more

Antibiotics Deplete

  • Calcium
  • Magnesium
  • Potassium
  • Vit K
  • B Vitamins: B1, B2, B3, B5, B6, B9, B12

Supplement Dosage for Antibiotics

  • Calcium: 500–1000 mg daily
  • Magnesium: 250–400 mg daily
Photo by 917press

Antibiotics can cause photosensitivity so caution when using in conjunction with other photosensitivity increasing meds such as St Johns Wort

Photo by Daoudi Aissa

Calcium, Iron, Magnesium, & Zinc can affect the absorption rate of antibiotics so should be taken at different times of day.

Antidepressants

Cymbalta, Lexapro, Paxil, Prozac, Zoloft
Photo by Anthony Tran

Types of SSRIs: (serotonin)
citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline.

Types of SNRIs: (serotonin & norepinephrine)
duloxetine
venlafaxine
desvenlafaxine

Photo by Nik Shuliahin

Atypical antidepressants:
bupropion
trazodone
mirtazapine.

Types of tricyclic antidepressants: (serotonin, norepinephrine, dopamine)
amitriptyline, clomipramine, desipramine
doxepin, imipramine, nortriptyline, protriptyline
trimipramine.

Photo by nilswer

Types of MAOIs (monoamine):
isocarboxazid, phenelzine, selegiline, tranylcypromine.

Photo by Ian Espinosa

The body's natural melatonin levels are depleted by antidepressants affecting the re-uptake of serotonin. Unfortunately, supplementing with melatonin can interfere with the same antidepressant and should be avoided.

Photo by Abbie Bernet

Folic acid is often depleted by antidepressants supplementing with 240 mcg daily

Photo by Nik Shuliahin

St John's wort, 5htp & other herbs that increase serotonin, can increase a patient's risk of serotonin syndrome, when taken in conjunction with antidepressants that also increase serotonin.

Serotonin syndrome is a potentially life-threatening syndrome due to too much serotonin or over activation of serotonin receptors. This consists of a combination of mental status changes, neuromuscular hyperactivity, & autonomic hyperactivity. Serotonin syndrome can occur via the use of serotonergic drugs alone, an intentional overdose of serotonergic drugs, or classically, as a result of a complex drug interaction between two serotonergic drugs that work by different mechanisms. A multitude of drug combinations can result in serotonin syndrome.


-Jacqueline Volpi-Abadie, MD, Adam M. Kaye, PharmD, FASCP, FCPhA, & Alan David Kaye, MD, PhD

Photo by 阿簡

ANTIEPILEPTICS/Anticonvulsants

Dilantin, Lyrica, Mysoline, Tegertol, Trileptal & others
Photo by aftab.

ANTIEPILEPTICS/
Anticonvulsants: Decreases the firingof overactive neurons in the brain or by slowing the spread of overactive neuron activity to nearby areas of the brain.

Photo by reloeh

While not depleted by by antidepressants. Most patients on antidepressants can be supported through the supplementation of 500 mg Calcium daily, 25–1000 mcg B12 daily,1000–2000 IU Vit D daily

Photo by RuggyBearLA

ANTIPSYCHOTICS

Abilify, Haldol, Seroquel, Risperdal, Zyprexa & more

Antipsychotics block the receptors for specific neurotransmitters such as dopamine & serotonin. This can reduce the severity of symptoms
for schizophrenia such as agitation
& aggression. This has a mood stabilizing affect in psychiatric conditions such as bipolar disease.

Photo by Ben White

Antipsychotics block the receptors for specific neurotransmitters such as dopamine & serotonin. This can reduce the severity of symptoms
for schizophrenia such as agitation
& aggression. This has a mood stabilizing affect in psychiatric conditions such as bipolar disease.

Antipsychotics deplete Vitamin B2 (Riboflavin patients should supplement with

Photo by Nik Shuliahin

While not depleted by by antipsychotics. Most patients on antipsychotics can be supported through the supplementation of 250–500 mg Vit C daily

ANXIETY MEDICATION/Benzodiazepines

Ativan, Prosom, Restoril, Valium, Xanax & more

Benzodiazepines treat conditions characterized by an excessive activity of neurons in the brain leading to symptoms such as anxiety & seizures. Benzodiazepines may work by increasing the effects of gamma-aminobutyric acid (GABA) in the brain. Increasing the effectiveness of GABA a neurotransmitter with a benzodiazepine, reduces brain activity.

Photo by Niklas Hamann

Treated with Benzodiazepam

  • Anxiety
  • Nervousness
  • Panic disorders
  • Muscle spasms
  • Insomnia
  • Siezures
  • Alcohol Withdrawl
  • Status epilepticus
  • Premenstrual syndrome
Photo by Carolina Heza

Types of Benzodiazepams

  • alprazolam (Xanax, Xanax XR)
  • triazolam (Halcion)
  • temazepam (Restoril)
  • lorazepam (Ativan)
  • diazepam (Valium, Diastat Acudial, Diastat)

Types of Benzodiazepams

  • chlordiazepoxide (Librium)
  • clonazepam (Klonopin)
  • clobazam (Onfi)
  • clorazepate (Tranxene)
Photo by Gabriel

Benzodiazepine drugs are habit forming & can lead to addiction. Long-term use also can lead to tolerance, which means that lower doses will become ineffective & patients will need higher doses. These drugs are abused due to their effects on the brain.

Photo by Xin

Benzodiazepines decrease calcium absorption by increasing the metabolism of
Vit D, which is needed for calcium absorption. 500–1000 mg Calcium daily in
divided doses is recommended

Photo by ASweeneyPhoto

BIRTH CONTROL/Oral Contraceptive

Photo by JD Hancock

Oral contraceptives are synthetic & semi-synthetic estrogens &/or progesterone that are used to prevent pregnancy by inhibiting ovulation, thickening of the cervical mucus &/or diminishing endometrial integrity.

Photo by Brooke Lark

Suggested Dosages

  • 240 mcg of folic acid
  • 250–400 mg Mg+
  • 5 mg B6
Photo by JD Hancock

While not depleted by by oral contraceptives. Most patients on oral contraceptives can be supported through the supplementation of 500 mg Calcium daily

BLOOD PRESSURE/Anti-hypertensives

ACE Inhibitors, AngiotensinReceptor Blockers (ARBs), BetaBlockers, Calcium ChannelBlockers.

Anti-hypertensive drugs classes included: ACE inhibitors, ARBs, beta blockers, & calcium channel blockers. Anti-hypertensive drugs help to decrease blood pressure by decreasing peripheral resistance, cardiac output or both.

ACE inhibitors will deplete zinc levels. A dose of 11 mg daily of zinc is recommended

Calcium channel blockers deplete levels of Potassium. A dose of
≤ 100 mg daily of potassium is recommended

While not depleted by by Anti-hypertensive. Most patients on Anti-hypertensive can be supported through the supplementation of
100–200 mg of CoQ10 daily
& Iron (dosage dependent per patient case)

BLOOD THINNING/Anticoagulants/Antiplatelets

Aspirin, Coumadin (Warfarin), Plavix, Ticlid & more

Anticoagulants reduce the
clotting through decreasing the Prothrombin Thrombin-Fibrinogen cascade.

Anti-platelets reduce the potential for clots by decreasing platelet aggregation

Use caution with the following supplements as they may increase the blood thinning qualities of the medication &
increase risk of bleeding.
Bilberry
Cod Liver Oil
Dong Qual
Evening Primrose Oil
Feverfew
Fish Oil
Flaxseed Oil
Garlic
Ginger Root
Ginkgo biloba
Ginseng
Glucosamine
Goldenseal
Grape Seed Extract
Green Tea
Horse Chestnut
Milk Thistle
Saw Palmetto
Vitamin C
Vitamin E

Use caution with the following supplements as they may increase the blood thinning qualities of the medication &
increase risk of bleeding.
Ginseng
Glucosamine
Goldenseal
Grape Seed Extract
Green Tea
Horse Chestnut
Milk Thistle
Saw Palmetto
Vitamin C
Vitamin E
Glucosamine
Goldenseal
Grape Seed Extract
Green Tea
Horse Chestnut
Milk Thistle
Saw Palmetto
Vitamin C
Vitamin E

Most patients taking Vit K who are on anticoagulant medications should maintain consistent amount of Vit K in their diet & supplements essentially avoiding fluctuations in Vit K intake.

CoQ10 is structured chemically close to vitamin K this may interfere with
anticoagulants.

CHOLESTEROL MEDICATION/

Crestor, Lescol, Lipitor, Mevacor, Zocor & more

Statins inhibit the enzyme HMG CoA reductase. An important component in the liver's synthesis of cholesterol. The reduction of cholesterol creation then increases the liver’s removal of serum LDL.

This enzyme (HMG CoA reductase) affected by cholesterol lowering meds is also an important enzyme for the synthesis of coenzyme Q10. This is why supplementing with 100–200 mg of CoQ10 daily.

Cholesterol meds can reduce a patient's fat soluble vitamins
(vit A, D, E, K)

It is receomended for a patient on cholesterol meds to take a dosage of 1000–2000 IU of Vit D daily.

Red yeast rice contains naturally occurring lovastatin which lowers blood cholesterol levels. Red Yeast rice should not be taken with cholesterol-lowering drugs unless under the supervision of the prescribing physician of the cholesterol meds.

Prolonged use of cholesterol lowering drugs may increase vitamin A levels in the blood. Vitamin A levels may need to be
monitored in some individuals

CORTICORSTEROIDs

Prednisone

Corticosteroids are synthetic compounds that mimic the effects of hormones naturally produced in the body by adrenal glands. They are known for relieving inflammation, pain and discomfort resulting
from various health conditions

Corticosteroids reduce the body's levels of minerals such as calcium & magnesium It is recommended for chronic user of corticosteroids supplement with 500 mg calcium daily and 250–400 mg Magnesium daily

DIABETES MEDICATION/Oral Hypoglycemics

Avandia, Diabeta, Glucophage (Metformin), Prandin, & more.

Oral hypoglycemics reduce the body's levels of Folic acid & Vit B12. It is recommended for patients using of corticosteroids to supplement with 120–240 mcg of folic acid daily & 25–1000 mcg of Vit B12 daily.

DIGIOXIN

Cardoxin, Digitek, Lanoxicaps, Lanoxin & more

Digoxin is derived from the leaves ofthe Digitalis lantata plant (a variety of
foxglove). It is used to treat heart failure & atrial fibrillation.

Digoxin depletes

  • Calcium: 500–1000 mg daily in divided doses
  • Magnesium: 250–400 mg daily
  • Phosphorus
  • Potassium: 100 mg daily
  • Vitamin B1 (Thiamin)

DIURETICS

DND: Loop & thiazide diuretics deplete

Loop & thiazide diuretics deplete

  • Magnesium: 250–400 mg daily
  • Potassium: 100 mg daily
  • Zinc: 11 mg daily

Potassium sparing diuretics deplete

  • Folic Acid 240 mcg daily

Thiazide diuretics reduce calcium excretion by the kidneys & may increase risk for hypercalcemia, metabolic alkalosis & possible renal failure.

HORMONE REPLACEMENT THERAPY

Estrace, Premarin, Prempro

Hormone replacement therapy is used to replace female hormones that are no longer produced after menopause.

Hormone Replacement Therapy Depletes

  • Folic acid: 240 mcg daily
  • Magnesium: 250–400 mg daily
  • Vitamin B6: 5 mg daily
  • Vitamin B12: 25–1000 mcg daily

The stimulating effects of caffeine may be increased due to inhibition of metabolism
or clearance of caffeine by hormone
replacement therapy.

Calcium and Vit D may increase absorption of hormone replacements. These supplements are recommended to improve bone mineral density during estrogen therapy.

These supplements may interfere with the activity or absorption of hormone replacement therapy.

St. John’s wort may alter hormone metabolism including estrogen and progesterone. This supplement is not recommended during hormone
replacement therapy.