Ch 9 Nutrition and Nutraceuticals
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| Nutrient-Drug Interactions | Food may affect
•Drug Absorption
•Drug Metabolism
•Drug Excretion
•Drugs may affect nutrient status.
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| Influence of Diet on Drug Absorption | Drug absorption can be decreased, delayed, accelerated, or increased by food/Food in the gastrointestinal tract at the time of drug administration affects absorption and bioavailability/Food changes gastric pH/Food may bind with medication, decreasing absorption (e.g., tetracycline and milk)/Some drugs are better absorbed with food (e.g., griseofulvin)
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| Influence of Diet on Drug Metabolism | The rate of drug metabolism is affected by nutrient intake/A low-carbohydrate, high-protein diet may increase drug-metabolizing enzymes/Antioxidant cruciferous vegetables may increase the activity of drug-metabolizing enzymes/Grapefruit juice and CYP 3A4
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| Influence of Diet on Drug Metabolism | Increased levels of calcium channel blockers, cyclosporine, tacrolimus, and the statins/Foods and CYP 1A2/Vegetables (cruciferous), methylxanthine-containing beverages (caffeine), and charcoal broiling may lead to therapeutic failure
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| Influence of Diet on Drug Excretion | Some foods can change urinary pH, affecting drug excretion.
•Foods that alkalinize the urine
•Milk, vegetables, and citrus fruits
•Foods that acidify the urine
•Meat, fish, cheese, and eggs
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| Drug–Food Incompatibilities | Warfarin
•Vitamin K-containing foods
•Monoamine oxidase inhibitors
•Tyramine-containing foods (fermented, pickled, etc.)
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| Drug–Food Incompatibilities | Metronidazole
•Alcohol
•Caffeine
•Alcohol
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| Influence of Drugs on Nutrients | Drug-induced nutrient depletion
•Antacid therapy or potassium therapy can reduce absorption of folic acid, iron, and vitamin B12.
•Phenytoin reduces the level of folic acid.
•Loop diuretics affect sodium, calcium, and potassium levels.
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| Recognizing Drug-Food Interactions | Consult with a registered dietitian/The American Dietetic Association recommends populations who
need supplements\Infants and children, including adolescents, need 400 IU of vitamin D daily/Women of childbearing age who may become pregnant need 400 mcg/day of folic acid
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| Recognizing Drug-Food Interactions | Pregnant women need 600 mcg/day of folic acid, a multivitamin/mineral supplement, 27 mg/day of iron (60 mg/day if patient is anemic), and vitamin B12 if the patient is vegan or lacto-ovo-vegetarian/Older adults over age 50 need 2.4 mcg/day of vitamin B12 and need to ensure adequate intake of vitamin D and calcium./Patients at risk for suboptimal vitamin D levels should consume vitamin D-fortified foods and/or supplements.
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| Neutraceuticals | Foods that claim to have a medicinal effect on health: Fiber/Vitamins and minerals/Fatty acids/Plant sterols/Pre-, pro-, and symbiotics
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| Fiber | Decreased constipation
•Reduced risk for coronary heart disease
•25 gm/day for cardiovascular health
•Better glucose control in diabetics
•Improved lipid levels
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| Vitamins | Vitamin A/Critical role in vision, bone growth, reproduction, /Immune function, cell division and differentiation/Vitamin B1 (thiamine) /Deficiency can lead to beriberi or Wernicke’s encephalopathy/Alcoholics at high risk
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| Vitamins | Vitamin B2 (riboflavin)/Deficiency may be seen in alcoholics, anorexic patients, and lactose intolerance /May decrease headaches and migraines
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| Vitamins | Vitamin B3 (niacin)
•Used to treat hyperlipidemia
•Vitamin B6 (pyridoxine)
•Deficiency may be drug-induced
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| Vitamins | Pyridoxine given prophylactically to patients on isoniazid, cycloserine, or hydrazine to prevent peripheral neuropathy
•Vitamin B12
•Deficiency will lead to megaloblastic anemia
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| Vitamins | Vitamin C (ascorbic acid)
•Humans do not have the ability to synthesize vitamin C.
•Inadequate vitamin C intake may cause scurvy.
•Smokers have decreased vitamin C levels (+35 mg/day).
•Vitamin C does not decrease incidence of URIs.
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| Vitamins | Mixed results in decreasing cardiovascular disease and cancer
•Vitamin D
•Critical to bone health
•All infants, children, and adults need 400 IU per day.
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| Vitamins | Vitamin K
•A critical component of blood clotting
•Found in many foods
•Synthesized by intestinal bacteria
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| Vitamins | Newborns need 0.5 mg to 1.0 mg, ideally within the first hour of life, to prevent vitamin K-deficiency bleeding.
•Vitamin K is used as an antidote to critically high international normalized ratio in patients taking warfarin.
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| Vitamins | Folate: Critical to the production and maintenance of new cells/Found in foods such as green leafy vegetables, citrus fruits, and dried legumes/Folic acid is the synthetic form of folate./Folate deficiency occurs during pregnancy and with increased losses.
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| Vitamins | Folic acid supplementation is recommended for
•Childbearing age teens and women: 400 mcg/day
•Pregnant women: 600 mcg/day
•Lactating women: 500 mcg/day
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| Minerals | Calcium
•Required for muscle contraction, blood vessel health, bone health, and normal nerve conduction
•Adolescent females have inadequate intake.
•Recommended amounts vary by age to prevent osteoporosis.
•Iron
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| Minerals | Needed for oxygen transport/Patients with iron deficiency will develop microcytic- hypochromic anemia./Adequate intake is determined by age./All infants should be assessed for adequate iron in diet.
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| Fatty Acids | Essential fatty acids: Must be consumed, body cannot make /Alpha-linolenic acid (ALA) is an omega-3 fatty acid./Linoleic acid (LA) is an omega-6 fatty acid./Dietary sources of ALA are nuts, vegetable oils, and leafy green vegetables.
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| Fatty Acids | LA is found in vegetable oils and meat. /Eicosapentanoic acid and docosohexanoic acid are found in fish and organ meats./Omega-3 fatty acids are recommended for cardiovascular health. /Fish oil might have antiarrhythmic effects. /Children with autism or attention deficit hyperactivity disorder may respond to omega-3 supplements. /Patients can consume the supplement or eat fatty fish
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| Plant Sterols | Found in all plant-based foods/Similar in structure to cholesterol/Plant sterols compete with cholesterol in the intestine, reducing the amount of cholesterol that is absorbed. /Intake of 2 g/day of plant sterols has an associated 6% to 10% reduction in low-density lipoprotein cholesterol.
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| Plant Sterols | Plant sterols are present in: Edible oils (corn oil and canola oil have the highest amount)/Seeds and nuts/Commercial food products available with added plant sterols
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| Pre-, Pro-, and Symbiotics | Probiotics are nonpathogenic bacteria normally found in the intestinal microflora./Most common: Lactobacillus acidophilus and the Bifidobacterium species/Cochrane Review of probiotic use in rotavirus-associated acute diarrhea in children found it reduced diarrhea severity and duration by 1 to 3 days.
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| Pre-, Pro-, and Symbiotics | Reduced antibiotic-associated diarrhea
•May improve inflammatory bowel disease and necrotizing enterocolitis
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| Recognizing Drug-Food Interactions | Use up-to-date resources to evaluate the potential for
drug–food interactions.
Seek out educational materials that can provide accurate and appropriate drug information to patients.
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| Recognizing Drug-Food Interactions | Consult with practitioners, pharmacists, and registered dietitians to id drug–nutrient interactions.
Get complete patient profile: drug, herb, and nutrient intake, OTC, herbs, vitamins, alcohol, nutrient supplements
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