Common Drugs that Deplete Essential Nutrients

By David Hogsed, D.O.M.

Disclaimer: The following information is not a substitute for medical care or medical counseling and is not intended for the diagnosis, treatment or prevention of disease or symptoms. The following statements made regarding nutritional supplements have not been evaluated by the FDA.

Goals for Using Supplements with OTC and Prescription Medications

Safety No known interactions
(Contraindications and Cautions for MediHerb)

Supplements that replace drug induced nutrient depletions and minimize side effects (vitamin C, CoQ10, folic acid, zinc, B vitamins.) Supplements that may minimize dependence on OTC/non prescription medications (antacids, NSAIDs, etc.)

Essential Drug Reference Tools for Practice

The Nutritional Cost of Drugs
by James Laville R.Ph. and Ross Pelton R.Ph.

Epocrates.com
Easy reference for serious and common side effects as well as multiple drug interactions Download free basic app for smart phones or free basic program for computer.

Free Statins With Fast Food Could Neutralize Heart Risk, Scientists Say Science Daily (August 12, 2010) Fast food outlets could provide statin drugs free of charge so that customers can neutralize the heart disease dangers of fatty food, researchers at Imperial College London suggest in a new study.

Lipitor
Serious Reactions
Myopathy Tendon Rupture Rhabdomyalisis Renal Failure Hepatotoxicity Pancreatitis Anaphylaxis Angiodema Lupus Polymalgia Rheumatica Dermatomyositis Vasculitis Thrombocytopenia Leukopenia Hemolytic Anemia Photosensitivity Stevens Johnson Syndrome

Lipitor
Common Reactions
Headache Infection Rhinitis Sinusitis Myalgia Diarrhea Arthritis Rash Abdominal pain Back Pain Flu syndrome Allergic reaction Dyspepsia Flatulence Pharyngitis Constipation Elevated CK Elevated liver enzymes Decreased CoQ10

Solutions for the Statin Problem

1. Inform the patient that statins are likely to interfere with outcomes of pain management therapy (chiropractic, acupuncture, etc.) 2. Inform the patient that you cannot legally interfere with their prescription drugs. 3. To minimize side effects, the patient will need CoQ10 supplementation, and is likely to need additional liver and musculoskeletal support.

Compensation Support for Statins

1. CoQ10 Source (Cardio Plus, Ligaplex 2, Cellular Vitality) 2. Silymarin (3 per day) or Livaplex (6 per day)

3. Tuna Omega-3 Oil (4 per day)

Coenzyme Q10 improves endothelial dysfunction in statin-treated type 2 diabetic patients

Diabetes Care 2009 May;32(5):810-2 OBJECTIVE: The vascular benefits of statins might be attenuated by inhibition of coenzyme Q(10) (CoQ(10)) synthesis. We investigated whether oral CoQ(10) supplementation improves endothelial dysfunction in statintreated type 2 diabetic patients.

For more complete discussion on cholesterol, watch November 2011 webinar on lab testing

Antacid Medications
In 2009, Nexium was the second best selling prescription drug with a 4.6 sales increase from 2008 - drugs.com Prevacid was the tenth best selling prescription drug drugs.com How many over the counter antacid medications are sold each year?

Antacids and Nutritional Therapies

hydrochloric acid is necessary for: 1. Absorption of calcium 2. Absorption of iron 3. Absorption of B12 4. Absorption of zinc 5. Protein digestion 6. Allergy prevention 7. Gastrointestinal infection prevention And much, much more

Nexium Side Effects

Serious Reactions blood dyscrasias hepatic impairment anaphylaxis pancreatitis interstitial nephritis headache diarrhea abdominal pain nausea Common Side Effects headache diarrhea abdominal pain nausea

Hypochlorhydric stomach: a risk condition for calcium malabsorption and osteoporosis? Scandinavian Journal of Gastroenterology. 2010;45(2):133-8. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterolgy 2010 Jul;139(1):93-101.

HCL and the Immune System

Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease JAMA 2005 Dec 21;294(23):2989-95. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004 Oct 27;292(16):1955-60.
.

The Vicious Cycle of Low HCL

Low HCL = incomplete digestion = irritating acids = heartburn or acid reflux = increased need for antacids = low HCL = incomplete digestion = irritating acids = increased need for antacids..

Solutions for Patients Using Antacid Medications

1. Inform the patient that many foods and nutritional supplements will not be properly utilized while taking antacids 2. Inform the patient that you cannot interfere with prescribed antacids 3. Use Zypan (2-4 with meals) to compensate for side effects

I cant take HCL products. They burn my stomach

If chronic HCL insufficiency has been present, the irritating acids from incomplete digestion and the likelihood of helicobactor pylori overgrowth can eventually result in gastritis or ulcers. At this point, any acids (both good and bad) can create burning sensations. Discontinue Zypan and heal the stomach first!

Gastric Healing Support

To be used 4-6 weeks before reintroducing Zypan Chlorophyll Complex and/or Gastrex (3 capsules before meals.) Enzcore (1 with meals) and Multizyme (2 with meals) HiPep (1 with meals)
*5 extra Gastrex may be taken at any time for relief of acid reflux or heartburn

Warfarin
Serious Reactions hemorrhage skin/tissue necrosis gangrene cholesterol embolism purple toes syndrome hypersensitivity rxn anaphylactic rxns cholestatic jaundice hepatitis vasculitis tracheobronchial calcification anemia

Warfarin
Common Reactions
bleeding bruising easily abdominal cramps/pain nausea/vomiting diarrhea flatulence/bloating fatigue/malaise lethargy asthenia headache dizziness pruritus edema dermatitis rash/urticaria fever cold intolerance paresthesias alopecia

Plavix
Serious Reactions
bleeding, severe, fatal hemorrhage TTP neutropenia anaphylactoid rxns serum sickness angioedema hypersensitivity rxn Stevens-Johnson syndrome toxic epidermal necrolysis hepatitis hepatic failure, acute pancreatitis

Plavix
Common Reactions nausea dyspepsia diarrhea abdominal pain hemorrhage purpura rash pruritus influenza-like sx cough bronchitis dizziness headache fatigue arthralgia chest pain palpitations epistaxis UTI

Low Dose Aspirin Serious Reactions

Anaphylactic reaction angioedema bronchospasm bleeding GIulceration and perforation pancytopenia thrombocytopenia agranulocytosis aplastic anemia hypoprothrombinemia nephrotoxicity hepatotoxicity salicylism Reye's syndrome

Low Dose Aspirin Common Reactions

dyspepsia nausea vomiting abdominal pain rash tinnitus dizziness hyperuricemia bleeding ecchymosis constipation diarrhea

Nutrients depleted with Aspirin

Vitamin C Calcium Folic Acid Iron Potassium Sodium Vitamin B5

Aspirin and Vitamin C Together At Last

By Leo Galland M.D., April 13, 2010 Huffington Post

Aspirin side effects kill about a thousand people a year in the US. If aspirin were a new drug, it would have a tough time getting approved by the FDA and would only be available by prescription. Taking any dose of aspirin on a regular basis can triple your risk of dangerous gastrointestinal bleeding, according to some studies

Continued: Additional research indicates that if you're consuming just one serving of alcohol every day while taking aspirin on a regular basis, the risk of bleeding increases by another 250 percent. In other words, if you are one of the millions of Americans who have a glass of wine each day in the hope of improving your health, but are also taking aspirin, your risk of internal bleeding becomes seven times greater than if you didn't drink or take aspirin

Continued:
Aspirin also interferes with absorption of vitamin C, and regular use of aspirin can deplete your gastrointestinal lining of vitamin C. Taking equal doses of vitamin C and aspirin decreases the amount of stomach damage that occurs when compared to taking aspirin alone, according to research done at a German university. The protective effect of vitamin C on aspirin side effects has been demonstrated in healthy people and people with inflammation of the stomach caused by infection with Helicobacter pylori, a bacterium that causes ulcers.

Compensation support for Coumadin, Plavix, or Aspirin

Cyruta Plus (6) Silymarin (3) Immuplex (6) *For coumadin users, food sources of vitamin K2 like egg yolks, grass fed butter, and cheese are essential to prevent calcification problems.

Novel use of silymarin as delayed therapy for acetaminophen-induced acute hepatic injury.
Forsch Komplementmed 2010;17(4):209-13 Abstract AIM: Recently, we have demonstrated that silymarin has a comparable pharmaceutical activity as Phyllanthus urinaria extract when used to rescue mice from acetaminophen-induced acute liver injury. In the present study, we further compared the therapeutic action of silymarin with N-acetyl cysteine (commonly used in clinical practice for emergency treatments) as a rescuer in mice after administering a lethal dose of acetaminophen for 24 h.

 METHODS: Acute liver injury was induced in the treatment groups by intraperitoneally administered acetaminophen at a dose of 550 mg/kg body weight on day 1. The control group received an equal volume of physiological saline intraperitoneally. From day 2 to 4, the treatment groups received various doses of silymarin or N-acetyl cysteine orally once daily, while the control group and the acetaminophen group received an equal volume of water orally. The mortality rate was recorded in all groups. RESULTS: Silymarin greatly improved the counteracting effects on mortality rate as compared to N-acetyl cysteine. CONCLUSION: Silymarin should be further considered as an antidote for patients with acetaminophen induced acute hepatic injury and delayed treatment.

Milk Thistle Key Indications

Cirrhosis Hepatitis A, B, C Fatty Liver Gall Stones Digestive liver insufficiency Dyspepsia Nausea Constipation Type 2 Diabetes Hemachromatosis Heavy metal toxicity Food allergies Chemotherapy support

NSAIDs (Ibuprofen, Advil, etc.)

Serious Side Effects (GI bleed, ulceration, MI,
stroke, thromboembolism, CHF, nephrotoxicity, hepatotoxicity, thrombocytopenia, neutropenia)

Common Side Effects

(dyspepsia, nausea, abdominal pain, constipation, headache, elevated liver enzymes)

Induced Nutritional Deficiency (Folic Acid)

Chlorophyll Complex (6 per day) Ideal support for NSAID compensation

Supports liver and kidney function Supports gastrointestinal healing Source of folic acid Supports inflammation reduction, especially when combined with Tuna Omega-3 Oil

 Statins (Cardio Plus, Livaplex, Tuna Oil) Antacids (Zypan) Anti platelets, anti coagulants (Cyruta Plus) Acetaminophen/Tylenol (Silymarin) NSAIDs (Cholorophyll Complex, Tuna Omega 3 Oil)

When in Doubt
Catalyn (6 per day)
Whole food sources of all known vitamins

Silymarin (3 per day)

Liver and kidney support