NUTRITION Recognizing Drug Induced Nutrient Depletion in Chiropractic Practice PART 2 OF A 2 PART SERIES (CONT. FROM PART 1 IN NOV, 2009) by James B. LaValle, R.Ph., M.S., N.D., C.C.N. Abstract: Detrimenlal effects of drugs on nutrition status are a common occurrence but. because they usually occur over time (vs. what is considered an adverse event or allergic reaction, which occurs quickly), they are seldom recognized or corrected. Chiropractic treatment, however, takes place over a much longer time frame. Because of this, doctors of chiropractic are in a unique position to recognize the interactions of medication and nutrition- al status and. if knowledgeable in the area of drug induced nutrient depletion, they have an opportunity to help their patients recover nutritional adequacy and restore metabolic homeostasis. Thiazide Diuretics: Hydrochlorothi- azide (HCTZ) depletes magnesium, zinc, CoQIO potassium and sodium. Side ef- fects ofthe drug include the development of back pain, anxiety and leg weakness. And long tenn. it can even contribute to development of Type 2 diabetes. The depletion of magnesium atone can lead to all ofthe above-mentioned side effects. CoQlO depletion significantly impacts energy production in cells because it is needed to shuttle carnitine into cells. Since heart cells are very dependent on that constant source of energy, CoQlO depletion can really affect the heart, in addition to other large muscles. People experiencing CoQ 10 depletion will often have noticeable muscle weakness. For example, I have had patients report much more difficulty getting up off theflooror even out of their chair. I make it a regular practice to put any patients on HCTZ for high blood pres- sure on magnesium and CoQIO at the very least; however, it is best if a multi vitamin includes some zinc and that they eat a high potassium diet. The CoQIO is especially important to prevent the development of congestive heart failure, the very problem you are trying to prevent from the high blood pressure for which this drua is used. Metabolic Induction of Nutrient Depletion by Common Drug Groups Mechanism Competitive Binding Hyperexcretion Through Kidneys Increased Turnover Inhibition of Coenzyme Biosynthesis Malabsorpfion pH Changes in Gastrointestinal Tract Nutrient Folate Thiamin Magnesium Phosphates Potassium Amino Acids Ascorbic Acid Magnesium Potassium Zinc Folate D K B-12 Ubiquinone (Coen- zyme Q10) A B-12 Folate B-12 C D Calcium Zinc All of the above + Iron Medication Aspirin Aluminum-based antacids Glucocorticoids (dexamethasone, prednisone, etc.) Indomethadn Folate Antagonists (for example, Methotrexate) Anticonvulsants (phenobarbitol, phenytoin, primidone) Methotrexate Statins (atorvastatin,fluvastatin,iovastatin, rosuvastatin calcium, pravastatain, simvastatin and combinations containing these agents) Bile add séquestrants (Clofibrate®, Colestipol®) Biguanides (metformin) Antiinflammatories (Azufidine*, Sulfasalazine) Proton Pump Inhibitors (esomeprazole/Nexium, lansoprazole/Prevacid, omeprazole/Prilosec. and others) H2-Receptor Antagonists (dmetidine, famotidine, nizatidine, ranitidine) 26 I The American Chiropractor I JANUARY 2010 www.annchiropractor.com
Transcript
NUTRITION
Recognizing Drug InducedNutrient Depletionin Chiropractic PracticePART 2 OF A 2 PART SERIES (CONT. FROM PART 1 IN NOV, 2009)
by James B. LaValle, R.Ph., M.S., N.D., C.C.N.
Abstract: Detrimenlal effects of drugs on nutrition statusare a common occurrence but. because they usually occurover time (vs. what is considered an adverse event or allergicreaction, which occurs quickly), theyare seldom recognized or corrected.Chiropractic treatment, however, takesplace over a much longer time frame.Because of this, doctors of chiropracticare in a unique position to recognize theinteractions of medication and nutrition-al status and. if knowledgeable in thearea of drug induced nutrient depletion,they have an opportunity to help theirpatients recover nutritional adequacyand restore metabolic homeostasis.
Thiazide Diuretics: Hydrochlorothi-azide (HCTZ) depletes magnesium, zinc,CoQIO potassium and sodium. Side ef-fects ofthe drug include the developmentof back pain, anxiety and leg weakness.And long tenn. it can even contributeto development of Type 2 diabetes. Thedepletion of magnesium atone can lead toall ofthe above-mentioned side effects.CoQlO depletion significantly impactsenergy production in cells because itis needed to shuttle carnitine into cells.Since heart cells are very dependent onthat constant source of energy, CoQlOdepletion can really affect the heart, inaddition to other large muscles. Peopleexperiencing CoQ 10 depletion will oftenhave noticeable muscle weakness. Forexample, I have had patients report muchmore difficulty getting up off the floor oreven out of their chair.
I make it a regular practice to put anypatients on HCTZ for high blood pres-sure on magnesium and CoQIO at thevery least; however, it is best if a multivitamin includes some zinc and that theyeat a high potassium diet. The CoQIOis especially important to prevent the
development of congestive heart failure, the very problem youare trying to prevent from the high blood pressure for whichthis drua is used.
Metabolic Induction of Nutrient Depletionby Common Drug Groups
26 I The American Chiropractor I JANUARY 2010 www.annchiropractor.com
AntacidsProton Pump Inhibitors (PPl's) such as
Prilosec (omeprazole).. Prevacid (lanso-prazole), Aciphex (rabeprazole). andProtonix (pantoprazole) have long beenknown to deplete vitamin B12 and folieacid. The H2bioeking drugs likeTagamet{cimetidinc) and Zantac (ranilidine) alsodeplete B12 and folale in addition lovitamin D and, because this category ofdrugs reduces stomach acid, it affectsthe absorption ofthe minerals, calcium,iron, and zinc.
These are the second leading categoryof drugs sold in the United States. Whilethese drugs were intended only for short-term use. many people remain on thesedrugs for years without monitoring vita-min D status or other symptoms. Studieshave now clearly shown a link betweenuse of these drugs and increased risk ofosteoporosis. In fact. PPl's now actuallycarry a warning that they can cause osteo-porosis. Typically, women are consideredto be a greater risk of osteoporosis; butthe studies found that these drugs alsodramatically increased the risk in men.as well. So. it is important to be on thelookout for both men and women whoare at risk of developing osteoporosisthrough long-term use of this categoryof drugs.
Oral ContraceptivesOral contraceptives, likewise., cause
significant chronic nutritional imbal-ances. In the past, we warned women thatoral contraceptives depleted B vitamins,including folate. vitamin C. magnesium,selenium, zinc, and the amino acid ty-rosine. Newer studies have found thatoral contraceptives also deplete CoQIO.While it is well known that young womenneed to replace folate after being on birthcontrol before trying to get pregnant, toprevent neural tub defects., it has beenmy observation that many young womenundergo mood changes after going onoral contraceptives, in addition to no-ticing that they are very tired. Severalstudies have reported that the B6 deple-tion results in depression because ofthereduced synthesis of serotonin in a subsetof women. However, these depletionscan lead to a host of problems includ-ing anemia, cervical dysplasia, bleedinggums, lowered immunity, and elevatedhomocysteine.
It has been discussed that these nutrientdepletions were observed in older studies
in which higher dosages of hormoneswere used. While I have noticed the ef-fects of lower dosage birth control are notas pronounced as they used to be in thehigher hormone dosage pills, dependingon the woman's nutritional habits priorto starting the pill, they can still havesignificant side effects.
The contraceptive Yaz (ethinylestradiol+ drospirenone) gets tremendous interestfrom women and huge ad dollars. Thismedication has been approved in Europelong enough that the Belgian governmentfinanced post-release impact studies. Yazcauses a relative deficiency of zinc bycausing accumulation of copper.' Othercontraceptives are also noted to cause aless severe accumulation of copper, butare better known for the depletions Imentioned above, as well as the disrup-tion ofthe metabolism ofthe carotenesand tocopherols. Specifically, oral contra-ceptives frequently result in depiction ofbeta-carotene and gamma- (although notalpha-) tocopherol.'' Depletion of theseimportant anti oxidants could increase aperson's risk of any ofthe diseases relatedto increased internal inflammation suchas heart disease and cancer.
These are just a few examples of howimportant it is to consider drug actions onmetabolism. Doctors of chiropractic arein an enviable position, because they canstop the downward spiral in their patients'health by counseling on drug-induced nu-tritional depletions and. in so doing, canbuild patient trust and satisfaction. Whilethis endeavor will require professionalsupervision of a carefully consideredprogram of nutritional supplementation,appropriate care for nutritional balancewill greatly enhance the ability to deliverthe results patients expect and deserve.
Dr. James B. LaVatle is aclinical pharmacist and boardcertified clinical nutritionistHe is co-founder of the LaValtvMetabolic Institute and an ad-junct professor of pharmacypractice at the University ofCincinnati Collegeof Pharmacy and University of South FloridaCollege of Medicine. He is the author of 16hooks and has 25 years of clinical experiencein pharmaco-nutrition and therapeutics. Call1-513-366-2127 for more information.
See references on page 59
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REFERENCES
Principles of a Sports Medidne Practice-by Jack Dalbin, D.C. (pg. 18-19)
1. LeadheilerMD. Ciinics in Spans Med \'i95; !4(2):353-4IO2. Kiblcr, MD. Clinics in Sporls Meii 1995; 14(2): 447-457
Seaman, DC, MS Top Clin Chiro 1997;4( 1 ) March vi-viiiNelson. IX'. Top Clin Chiro 1994;l:20-291 lerring. MD. Sied & Science in Sports and Exercise 1990; 22(4)453-456Weisel. MD. Backk'te 1997: 12 (5): 57Kibler, MD. Sports Induced Inflammatioii 1990; 15^-169
Advances in Sports Chiropractic from the Oiympic Athiete to the WeekendWarriof-Ciass iV Deep Tissue Laser Therapyby Phillip Santiago. D.C. and Julie L Scarano, D.C. (pg. 22)1. Steiii lechner C, Dyson M . Laser ihcrapy 1993; 5 (2): 65-742. Fricdm;in.H..etiil. JPhofochem riiotohiolB Bio/ ]'•)'•)] : !1 S7-9^.
Recognizing Drug Induced Nutrient Depletion in Chiropractic Practice
by James B. LaValle, R.Ph., M.S., N.D., C.C.N. (pg. 26-27)
6. G;iu n. i-lch V. Acharya U, Yang YX. Kao TC. Uses of protonpump inhibitors and serum potassium levels. Pharmacoep'idemiolDrug Saj: 2009 Sep; 18(9):íí65-71.
7. De Groóte D. d'Hauterive SP, Pintiaiix A, Balte;ui B. Gerday C,Claesen J, Foidart JM. Effects of oral eontraeeption with ethi-nylestradio! and drospirenone on oxidative stress in women 18-35years old. 1 : Conlraceplion. 2009 Aug;80(2);I87-93. Kpiib 2009Apr 22.
S. Pineemail .1, Vanbelle S, Gaspard U, Collette G. Haieng .1, Cher-amy-Bien JP. Cbarlier C, Chapelle JP. Giet D. Albert A. Limet R,Deiraigne JO. Etïect of dilTerent contraceptive methods on theoxidative stress status in women aged 40 48 years from the ELANstudy in the province of Liege, Belgium. Hum Reprod. 2007Aug;22(8):2335-43, Epub 2007 .lun 2O.|
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