Drugs and Vitamins 101 - a Lifesaver
With at least half of America on at least one prescription
medication and an estimated one third self medicating, there is
a serious gap in the knowledge of interactions between medicine
and nutraceuticals.
So much news is made of the occurrence and prevalence of
diseases such as cancer and AIDS; and of viruses such as Bird
Flu and SARS that one could be easily be mistaken in thinking
that humans are a species at risk. Although some of these
possible pandemics are a sobering thought, you may take solace
in the fact that we have a smaller chance of getting, and a
better chance of beating, a damning diagnosis than ever before.
In part, this has been achieved through the dual advance of the
pharmaceutical and nutritional sciences: we have an arsenal of
both nutraceuticals and drugs for prevention, treatment and cure.
At the last big count, 7.5% of Americans aged 18 to 44 take 3 or
more prescribed drugs, this rises to a huge 47.6% in those aged
65 or over. At the same time over a third of the US population
uses dietary supplements daily and over 20% have used some form
of natural product in the past 12 months. When these statistics
are put together it would be safe to assume that many people are
on at least one drug and at least one nutraceuticals at the same
time. A recent study also estimated that 70% of patients fail to
tell their doctor they are undergoing alternative treatment for
their problems. Problems like depression, asthma, diabetes,
arthritis, allergies, flu and high blood pressure are now so
well characterized and supported by drugs that physicians may
feel less inclined to investigate the condition, or the person,
further.
Side effects of drugs are well known with huge legal cases such
as Vioxx bringing the industry and the regulation process into
the spotlight. Drug-drug interactions are also well documented
and millions of dollars are spent on research and testing to
find out exactly what can, and can't, be used concomitantly.
However, when it comes to nutraceuticals, few people have much,
if any, knowledge about what happens in the body when you take
these with prescription medicine. And with scant formal training
for herbal products or nutraceuticals in medical school, your
doctor may be more in the dark than you are.
Drug Supplements Interactions - Two Rights Can Make a
Wrong
Many drugs are cleared from the body by certain enzymes in the
liver, especially those from a certain family called cytochrome
P450s. These enzymes may also be responsible for breaking down
other substances, such as alcohol, nutrients and herbal
products. These particular enzymes can be held up by breaking
down a nutraceutical you have ingested, while the drug will be
circulating in your bloodstream a lot longer than the physician
had planned. If you are taking multiple doses of the drug then
it can build up to dangerous levels, and if the drug has a
narrow window between good effects and harm then overdose is a
distinct possibility.
A good example is Digoxin, a cardiovascular drug. If Digoxin is
taken with licorice, the levels of the drug in the bloodstream
can be increased four fold, the effects and side effects will be
increased dramatically to a possibly lethal endpoint.
Drugs and vitamins, herbs or nutraceuticals can also have a
synergic effect when taken together. They may produce the same
reaction in your body or interact in some way to produce
unexpected and undesirable results. This can happen with the
anti-anxiety drug, Alprazolam or Xanax. When Xanax is taken with
the popular herb Kava, also used for anxiety, they can have a
drastic effect upon the central nervous system. The reasons are
not fully understood but at least one person has been
hospitalized with severe mental problems by taking this
combination.
Nutraceuticals may also have the opposite effect on these P450
enzymes and they can have what is called an "inductive effect"
whereby the nutraceutical boosts the activity of the enzyme to
higher than normal levels. The enzyme then breaks down and
clears the drug from the body much faster than was expected by
your physician. Because the dose of a drug is a very exact
calculation, a prescribed amount is designed to stay in the body
for a time long enough to be effective. If the drug is cleared
early it may have a reduced effect or no effect at all.
Further Information on Drug Dietary Supplement
Interactions
You should first and foremost tell your doctor and pharmacist
what you are taking. Unfortunately, there is not a high level of
understanding in the medical or pharmaceutical world into herbs
and nutraceuticals although some research has been conducted
into the popular herbs such as St. John's Wort, Ginseng, Gingko,
Cayenne, Saw Palmetto and Valerian. A dietician may have better
knowledge than your doctor but there are also a number of
sources of information concerning prescription drug-dietary
supplement interactions on the internet below.
The Merck
Manual is a comprehensive resource of up to date medical
information and has some good primers on interactions as well as
in depth analysis.
The National Institute of
Health's Office of Dietary Supplements has a number of good
fact sheets on different supplements
Mitamins.com is an online retailer of custom vitamins and offers a free
drug interaction checker. The website allows the design of a
custom multivitamin according to the prescription drugs you are
taking. An online library also allows two-way reviewing of drugs
or supplements, listing the type of interactions.