Working with people on medications
I got asked the other day if I work with people on medications. The answers Yes! A resounding yes. I completed a Drug Nutrient Interaction course with Debbie Grayson, an amazing pharmacist and nutritional therapist, to ensure I built the knowledge for exactly this.
I know it’s something people worry about and as there’s some important considerations as we work through the process I thought I’d write a blog about it.
DISCLAIMER! Before I get into it, this blog is meant to give some orientation of my approach and some key considerations and is not in anyway advice for anyone on medications. If you think you need some support alongside your medications, get in touch with me or your healthcare professional to discuss.
How do I approach clients who take regular medications?
The process isn’t hugely different to someone without medication, there’s just some additional steps. The consultation allows me to understand the full picture of health. During which I gather information on medications and supplements, purpose, frequency and duration. This, together with knowledge on how the medication interacts with the body, is taken into consideration when reviewing the situation and building a protocol.
Photo Credit: Volodymyr Hryshchenko
Key considerations when creating a nutritional and lifestyle protocol:
Are any symptoms being experienced linked to medication side effects?
Some medications can generate nutrient depletion which creates side-effects. For example:
Statins prevent the production of CoQ10, an endogenous, fat-soluble antioxidant that plays an indispensable role in intracellular energy production. If you’re not able to produce this because the process is blocked there can be a myriad of symptoms which could be supported with some supplementation.(1)
Oral contraceptives deplete certain nutrients in the body, especially B Vitamins which when depleted can contribute to bad Pre-menstrual tension amongst other issues such a mental clarity and detoxification. (2)
Proton Pump Inhibitors (PPIs) such as Lansoprazole and Omeprazole are made to reduce stomach acid production, however stomach acid is needed for magnesium and B12 absorption, so depletions can occur and which can be supported through specific types of supplements.(3)
NSAIDs (non-steroidal anti-inflammatories such as Ibuprofen) have been shown to increase risk of erosion of the stomach lining creating digestive issues and overtime have been found to cause immune issues.(4)
So for all medications I consider what impact the medication could be having and how I can support you safely whilst on your medication.
Are there any interactions to consider with regards to utilising and detoxing the medication?
What we consume in the body is metabolised in the liver, including medications, and doing anything to speed or or slow down certain detoxification processes can impact the effect the medication (and supplements) have.
It’s therefore important to understanding the impact the liver processes have on the drug and what enzymatic pathway the medication is using so we can minimise anything that competes and/or changes toxicity of the medication.
For example grapefruit can increase the strength of some medications due to the impact on certain enzyme pathways in the intestine (5). The strength of cardiac medication Digoxin, means we need to avoid doing anything which could increase or slow its uptake in the body, such as decreasing potassium in the blood which slows a key steps and increase toxicity. Tamoxifen, a hormone therapy for breast cancer, has no impact until it’s been through the liver twice, so doing anything that blocks the enzymes which work on this will stop the medication being activated. (6)
Can supplements be used and if so when and what form?
Certain supplements with some people just can’t be used. Adaptogens like Ashwagandha could be too stimulatory on the immune system for anyone immunosuppressed. Lemon balm can interfere with the conversion of T4 thyroid medications to the active form T3 in the body (7). Anyone on Warfarin, is unlikely to be able to take any supplements due to the blood thinning affect it has, so this will be a food only approach, avoid many herbs (8).
If a supplement can be taken then the next consideration is when. Calcium can interfere with the absorption of Thyroid medications and so if required should be taken at least 4-hours from the medication (9).
Corticosteroids have an oppositional affect with melatonin, which we need for sleep. Too much cortisol in the body can therefore affect how we sleep so taking steroidal medication earlier in the day (if possible) could reduce its impact on sleep (10).
And finally, once we know if we can supplement and when, we need to think about what’s the best form. For someone with depleted B12 and on PPIs for digestive issues a B12 spray into the mouth would work more efficiently as it bypasses the digestive process that’s creating the deficiency.
You can see from just these examples how important it is to understand the condition, the medication and the symptoms someone is experiencing. However, medication, chronic conditions and long-term health issues shouldn’t stop you from accessing the benefits of nutritional support. It can make a big difference to quality of life, as long as interventions are practiced safely, taking into account all the important factors for what can and can’t be done.
In some instances, the work done in nutritional and lifestyle interventions can support the body to rebalance and enable medications to be reviewed and changed with the doctor, diabetes medication is an example of this (11).
Obviously, no medications will ever be changed or stopped by me. That’s the responsibility of your doctor and something you would discuss with them. And, I will always communicate to your doctor, with your consent, what I’ll be working with you on so they are fully aware.
Wondering if I can help you? Get in touch! We can have a chat about your situation (for free) and see what might be right for you.
References:
Deichmann, R., Lavie, C., & Andrews, S. (2010). Coenzyme q10 and statin-induced mitochondrial dysfunction. The Ochsner journal, 10(1), 16–21.
McArthur, J. O., Tang, H., Petocz, P., & Samman, S. (2013). Biological variability and impact of oral contraceptives on vitamins B(6), B(12) and folate status in women of reproductive age. Nutrients, 5(9), 3634–3645.
Qorraj-Bytyqi, H., Hoxha, R., Sadiku, S., Bajraktari, I. H., Sopjani, M., Thaçi, K., Thaçi, S., & Bahtiri, E. (2018). Proton Pump Inhibitors Intake and Iron and Vitamin B12 Status: A Prospective Comparative Study with a Follow up of 12 Months. Open access Macedonian journal of medical sciences, 6(3), 442–446.
Allison, M. C., Howatson, A.G., Torrance, C.J., Lee, F. D., Russell, R. I. (1992). Gastrointestinal Damage Associated with the Use of Nonsteroidal Antiinflammatory Drugs. N Engl J Med; 327:749-754
Harvard Health Publishing. (2020). https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-note
Jordan V. C. (2007). New insights into the metabolism of tamoxifen and its role in the treatment and prevention of breast cancer. Steroids, 72(13), 829–842.
Ulbricht C., Brendler T., Gruenwald J., Kligler B., Keifer D., Abrams T. R., et al. (2005). Lemon balm (Melissa officinalis L.): an evidence-based systematic review by the Natural Standard Research Collaboration. J. Herb. Pharmacother. 5 71–114.
Leite PM, et al. Mechanisms and interactions in concomitant use of herbs and warfarin therapy: An updated review. Biomedicine & Pharmacotherapy. 2021.
Zamfirescu, I., & Carlson, H. E. (2011). Absorption of levothyroxine when coadministered with various calcium formulations. Thyroid : official journal of the American Thyroid Association, 21(5), 483–486.
Dokoohaki, S., Ghareghani, M., Ghanbari, A., Farhadi, N., Zibara, K., & Sadeghi, H. (2017). Corticosteroid therapy exacerbates the reduction of melatonin in multiple sclerosis. Steroids, 128, 32–36.
Delahanty, L. M. (2017). Weight loss in the prevention and treatment of diabetes. Preventive medicine, 104, 120-123.