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9 Need-to-Know Drug-Nutrient Interactions

In a previous blog post, I described the ways nutrients interacted with one another, sometimes increasing absorption and activity and other times inhibiting one another. A similar situation occurs with medications and nutrients.  

If you take medication, your doctor might have discussed with you certain foods or supplements to avoid. However, many people remain unaware of how their medication use might impact their nutrient status and how supplementation or even food consumption might contribute to medication side effects. As you will see, this is an important discussion to have with your doctor or pharmacist. 

Drug-Nutrient Interactions: Why It Matters  

Although this is an important area of knowledge, we do not have as much evidence for drug-nutrient interactions as we do for drug-drug interactions. A comprehensive review estimates there are more than 100 times the number of studies on drug-drug interactions compared to those of drug-nutrient interactions. With over half of the U.S. adult population taking supplements, based on the 2011 – 2012 NHANES data, and almost half of Americans taking at least one prescription drug, according to the Centers for Disease Control, there is the potential for some overlap between the two, ultimately impacting many people’s health and well-being.  

There are a few ways in which drugs and nutrients interact with one another, which can lead to an increased efficacy of medicine, a deficiency of a nutrient, a decreased efficacy of medication, increased risk of side effects, and more. Examples of mechanisms of interactions include:   

  • Nutrients influence digestion and absorption of medication 
  • Nutrients influence the metabolism, distribution, and detoxification of medication 
  • Nutrients influence excretion 
  • Nutrients can change the forms or function of medication and vice versa  
  • Medication contributes to depletion of a nutrient, requiring higher consumption of that nutrient 
  • An imbalance of nutrient levels (e.g., sodium/potassium ratio imbalance with steroids) 
  • Increased activation of the CYP 450 enzymes, which increases the metabolism of the drug (e.g., grapefruit) 

Common Medications and Nutrient Interactions  

There are some commonly-known interactions between food and/or nutrients and medications, such as the advice to avoid grapefruit with certain medications. However, there are many other examples, especially when including common herbal supplementsCertain cuisines might be more likely to interact with drugs. One study found that North American cuisine had the highest risk of drug interactions, with the foods most commonly associated with the reactions being milk, garlic, and coffee. 

Below is a table of some of the most commonly prescribed medications and their interactions with specific nutrients, based on the current evidence. This is just a snapshot of interactions, as there are thousands of food components and phytonutrients that might interact with medication in some way. So, be sure to always talk with your doctor and/or pharmacist about your medication and supplement use. 

Drug Type  Conditions   Nutrients  Additional Information 
PPIs (Proton pump inhibitors)  Acid reflux or GERD (gastroesophageal reflux disease)
Damage caused by acid reflux
Ulcers 
Vitamin B12
Iron
Vitamin C
Calcium
Magnesium
Zinc
Beta-carotene 
Reduction of acid prevents proper digestion and absorption of certain nutrients, leading to a potential deficiency and an increased risk of anemia and bone fractures 
NSAIDs (nonsteroidal anti-inflammatory drugs  Pain relief
Fever
Inflammation 
Vitamin C
Iron
Vitamin E 
 
ACE inhibitors and diuretics   High blood pressure
Kidney problems
Heart disease  
Calcium
Magnesium
Thiamine
Zinc
Potassium
Folate
Iron  
Diuretics inhibit reabsorption and/or increase the excretion of minerals  

 

Statins   High cholesterol 
Heart disease 
CoQ10
Vitamin D
Vitamin E
Beta-carotene
Niacin 
Supplementing with vitamin D3 might help to reduce statin-induced myotoxicity in those with low levels of plasma 25(OH)D3 
Metformin  Type-2 diabetes  Vitamin B12
Calcium
Vitamin D
Folate 
Metformin users experienced a decrease in B12 (especially with prolonged use) and folate, including red folate cells  
Steroids (oral and inhaled), also known as corticosteroids or glucocorticoids   Autoimmune disorders
Arthritis
Asthma
Eczema
Some cancers 
Calcium
Vitamin D
Sodium
Potassium
Chromium 
 
Antidepressants  Depression   Calcium
Vitamin D
Folate and B-vitamins
Tryptophan 
Taking B6, B9, and B12 for more than a year significantly enhanced the response to antidepressants in adults with major depressive disorders 
Hormonal Birth Control  Pregnancy prevention
Hormonal regulation
PCOS
Endometriosis
Amenorrhea
PMS 
Vitamin B6
Vitamin B12
Folate
Calcium
Magnesium
Selenium
Zinc
Vitamin C
Vitamin E 
Taking B6 reduced side effects of oral contraception, especially nausea, headaches, and depression in a Cambodian population 

What to Do  

Medications play a role in health, and for some people, they are life-saving and/or life-changing. However, it is important to recognize the potential side effects and interactions, including that of nutrient depletion or interactions. Just being aware of some of the common nutrients that can easily be depleted might help to lessen some of the side effects of medication use.  

In some cases, you will need to increase your intake of certain vitamins and minerals, depending on your medications. In other cases, you will need to watch your intake or take them at different times of the day to minimize the impact. However, you might need to do more than just take a B-vitamin complex if you are on birth control or take calcium and vitamin D alongside your metformin. General steps to take include: 

  • Consume a nutrient-dense diet  
  • Time your medication and nutrient consumption 
  • Separate your medication and your supplement use 
  • Know the foods that have potentially inhibiting or beneficial nutrients and consume the right amounts   
  • Know when to avoid certain nutrients  
  • Check the known drug interactions 

Most importantly, talk with your doctor and/or pharmacist about your medication usage and unique situation to find the right steps to take for you. 

 

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