The growing fusion of natural medicines with nutrition and allopathic medicine has spawned a new area of specialization called drug/nutrient depletion.

Current estimates are that 62 to 68 percent of North Americans take "alternative" medicines and therapies (including herbs, botanicals, vitamins, minerals and homeopathy). The growth in this industry has increased unabated for over a decade. Although the media is full of reports on nutritional supplements, many consumers (and unfortunately many physicians and other health professionals) don't understand that some medications can. reduce absorption (and even cause depletion) of vitamins, minerals and electrolytes crucial for good health.

Pharmacists can play an important role in educating customers about this potentially serious problem.

Many pharmacists, widely regarded as the "drug experts" in American medicine, feel compelled to "catch-up" and learn as much as possible about integrative pharmacy practice.

The concerns that a patient may have interactions with nutrients versus drugs, nutrient versus nutrient or drug versus food, adds volume and credibility to the role of the pharmacist in role as a counselor. A health professional (particularly a pharmacist) who can have a foot in both worlds (of allopathic and complementary medicine) is in a unique position to counsel patients in this emerging area of expertise.

There are numerous problematic interactions that can take place between drugs and nutrients. Some involve similar structures and metabolic pathways that may affect vitamin depletion. A common example is aspirin's negative effect on the body's depletion of vitamin C and iron.

Other times, depletions may impair system metabolism. An example would be a diuretic drug's effect on potassium loss, or an oral contraceptive's depletion of folic acid and vitamin C. Sometimes depletions can cause another disorder to arise. An example of this may be how statin drugs deplete co-enzyme Q10 levels or how antibiotics eradicate intestinal flora, spurring Candida outbreaks. Lastly, certain nutrients may interfere with the accuracy of lab results, resulting in false (positive or negative) readings. A common example of this is concurrent use of ginkgo biloba and warfarin, and other anti-coagulate medicines. This misreading could prove extremely dangerous, or even fatal, to the patient.

The following list is a concise, but accurate measure of common drug/nutrient depletions.

Antibiotics

Intestinal Bacterial Flora: A healthy, physiological intestinal flora is ver> important for a healthy organism. Although antibiotics arc quite effective in eradicating the body of harmful "bad" bacteria, they unfortunately also rob the body of beneficial "good" bacteria, located in the gut. Research shows that the absence of good gut flora can cause problems with digestion. This also leads to a malab-sorplion of nutrients (especially from vour food) and symptoms such as bloating, gas. diarrhea, belching, constipation, pressure and sometimes rebound acidity. To ensure that your bowel flora is intact, supplement with:

  • Acidophilus: To replenish and replicate the friendly bacteria. It is suggested to take lacitobacillus acidophilus each time you take the antibiotic, and possibly take it for five to seven days after the course of antibiotics is finished to ensure normalization. (Yogurt is a good natural source of acidophilus, but it may be a problem for people sensitive to lactose intolerance).
  • Fruclo-oligosaccharides (FOS) and Other Prnbiotic Support: To help restore other gastrointestinal problems that the antibiotics may induce (especially the stronger, third-generation type) and help offset the imbalance or the Gl flora.

Antidepressant Drugs

  • Includes drugs used to stimulate the mood of a depressed patient. Some are used in eating disorders, treating obesity, and panic disorders. Drugs include tricyclic and SSRI medicines such as Amitriptyline, Elavil. Trazodone, Desipramine, Pamelor, Nortriptyline, Serzone, Paxil, Prozac, Zoloft and Imipramine.
  • B-Complex Vitamins: Additional B-\itamins are critical when taking antidepressants for short or extended periods. Vitamin B12 and folic acid are especially necessary. There may also be an additional need for riboflavin (B2).
  • Selenium: Stores of selenium are compromised with extended use of these drugs. A suggested supplementation dose would be 50 to 100 micrograms daily.
  • Zinc: Depletion of this antioxidant can slow wound healing reduce the sense of taste. Supplement with a dose of 10-35 mg per day.
  • L-Gluthathione: An important amino acid that decreases free radicals and helps to protect your liver.
  • Calcium/Magnesium: Take for nutritional support, along with additional minerals.
  • Vitamin C

Diabetic Medications

Includes sulfonylurea drugs such as Diabinese and Tolinase; second generation drugs Glynase and Diabeta; and miscellaneous diabetes drugs such as Metformin and Acarbose.

  • Chromium: This mineral is essential for the body's metabolism of glucose. Low levels may lead to insulin insensi-tivity and abnormal insulin usage.
  • Vitamin C: Vitamin C improves all aspects of diabetes, and is often depleted due to free-radical destruction and increased urinary excretion.
  • Magnesium: There is a direct relationship between magnesium deficiency and insulin resistance. Magnesium also improves all aspects of diabetes aiding in arterial strength, normalizing blood pressure, and aiding in glycolysis. Most diabetics have an 80 to 85 per cent deficiency.
  • Vitamins B6 and B2: B6 may aid in healthy eye support and proper vision. Bilberry, lutein and other bioflavonoids may be supplemented when vision problems, diabetic retinopathy or macular degeneration are present. (Note: these herbs would be contraindicated with warfarin use.)
  • Folic Acid: A deficiency is especially noted with Metformin use.

Estrogen and Progesterone

Includes oral contraceptives agents and estrogen compounds (Premarin, Estratest) and estrogen-progesterone combinations (Prem-pro).

  • B-Complex Vitamins: B vitamins are important to maintain healthy skin, nails, nerves, hair and cells. They are also critical in the production of energy. An increased requirement for vitamin B6 may be even more acute. Folic acid may be required, especially with oral contraceptives.
  • Calcium/Magnesium: Perhaps there are no two more important minerals for women (especially menopausal or post-menopausal). Calcium supplement with vitamin D are especially recommended.
  • Vitamin C, E and Beta Carotene: These three essential anti-oxidants are valuable in reducing a woman's risk of post-menopausal breast cancer. They help to reverse free-radical destruction and boost the immune system. Additional supplementation with vitamin E may ease hot flashes and other menopausal symptoms.
  • Essential Fatty Acids: The omega-3 and omega-6 essential oils aid in anti-inflammatory and immunoregulatory properties. They can be depleted in a typical North American diet of high saturated fatty foods.

Arthritis Medications

Includes non-steroidal anti-inflammatory (NSAID) drugs such as Aspirin. Ibuprofen and Advil.

  • Calcium/Magnesium: These two critical minerals are essential when taking arthritis medicines. Both are needed to build bone, muscles and nerves all through life, especially in your senior years. Long term depletion can lead to high blood pressure, heart irregularities, muscle cramps and asthma-like symptoms. Since bone loss can ensue with continued steroid use, vitamin D should be supplemented to prevent osteoporosis.
  • Vitamin C: NSAID medicines can cause increased urinary excretion of Vitamin C. This vitamin is essential for maintaining connective tissue, reducing the levels of free radicals that weaken the immune system and synthesizing collagen to strengthen bones.
  • Folic Acid: Lower levels of this important nutrient, aiding in the inhibition of uric acid.
    Glucosamine: Although not an anti-inflammatory, glucosamine and chondroitin play a role in stimulating cartilage cells, regenerating cartilage and binding with collagen so that cartilage can be strong. It relieves the pain of arthritis and may decrease the need for NSAIDs.
  • Essential Fatty Acids: The omega-3 and omega-6 essential oils aid in anti-inflammatory and immunoregulatory properties. They "lubricate" the joints.

Corticosteroids

Steroid drugs are used as anti-inflam-niiilorics and for a wide range of diseases, including dermatitis, autoimmune diseases, aslluna and allergic disorders. Drugs include costisonc. hydrocortisone. prednisone. triamci-nolonc. dexamalhasone and azulfidine

  • Vitamin C: Steroid overuse can deplete vitamin C stores, leading lo easy bruising, lower immunity, asthma and allergy-like s\mptoms. and poor wound healing.
  • B-Complcx Vitamins: Tolic acid depletion can lead to anemia and cardiovascular disease. Steroid use can also raise blood sugar: chromium might he needed as an additional supplement.
  • Potassium: Loss leads to edema, irregular heartbeat and muscle weakness. Supplementation amount are determined by blood levels.
  • Zinc
  • Selenium
  • Calcium/Magnesium

Diuretics

Includes all drugs used in the management of edema associated with congestive heart failure and renal or liver disease, including furosemide. I .asix. hydrochlorothiazide, Dyazide, humelanide, Bumex. spironolactone and chlorthalidone.

  • Potassium: All of the loop diuretics and the thinzides can contribute to severe potassium deficiency that can lead to defects in the kidnevs, skeletal muscle, central nervous system, gastrointestinal tract and heart muscle. Excessive loss loads to edema, irregular heartbeats and muscle weakness.
  • Calcium/Magnesium: Long term use of diuretics can eliminate those essential minerals vital for cardiac function, along with potassium.
  • B-Complex Vitamins: Diuretics can especially deplete thiamin (vitamin B.) and pyridoxine (\ilamin B,). This, depletion can elevate homocvsluinc levels, leading to harm to the heart.
  • Zinc
  • Vitamin C