The nutritional ramifications of pharmaceuticals in human bodies

Working in a post-Acute, Rehabilitation and transition Aged Care facility in the 1990’s, we frequently saw elderly people prescribed 12+ different medicines – never mind the number of tabs they consumed on a daily basis, and for some of these people it may have been 30+ tabs per day. The elderly people were often frail, dealing with many losses, were often losing weight, had poor appetites, and were not always responding well to rehabilitation interventions. What is the impact of all those different medicines on their nutritional health and how much is it impacting their responses? were questions I often asked.

Access to information on the impact of prescribed medicines on nutrition factors was extremely difficult in the 1990’s due to factors such as -

• no internet,
• long delays between request for research articles and their receipt,
• limited research,
• finding the articles as the published research was scattered through a broad range of publications,
• and more.

Out of curiosity and frustration I started to pull together the research, summarized it, and organized it into a table for quick access. I then told my staff that we would now include this information in all our clinical assessments and they asked “how” - more work was required, and twenty plus years later the “how” has mostly been sorted out.

The impact of prescribed medicines on nutrition factors is overlooked by doctors and pharmacists – mostly because nutrition is not included in their training. This is surprising given 80+% of western ill-health has an underlying negative nutrition component.

However, some of this oversight is likely to change primarily because there is a lot of research into the use of physiological transporters to deliver drugs to currently inaccessible bits of the body; the primary role of these transporters is to deliver nutrients to required areas. The early research shows that many of the currently researched drugs either inhibit the transporters or can be transported by them – both these scenarios mean nutrient displacement. Until this recent research there was no awareness of this degree of interference with nutritional factors.

Nutrients are typically absorbed during the meal as food is digested and nutrients released, whilst drugs are commonly administered before meals to improve their absorption, therefore drugs access the transporters before the nutrients and it is unlikely this nutrient deficit will be compensated.

Chronic, sustained medication intake can be for years and decades therefore a sustained interference with nutrient availability will result in mal-nutrition and cascading consequences including poor responses to treatment (which we probably already see and don’t recognize as such).

As most of the research is conducted by pharmaceutical companies, and published in pharmaceutical journals, it is likely pharmacists will become aware of the implications of this research and have the potential to become significant drivers of change, primarily through advising the prescribing doctors of negative interactions. However, given their lack of nutrition knowledge it is also likely this negative impact on nutritional factors will be overlooked. Therefore the most likely drivers of change will be the nutrition clinicians ie those with a degree and/or a post-graduate degree in nutrition.

Currently farsighted, visionary clinicians are already integrating this evidence into their clinical practice.

There are 2 components to medications and nutrition interactions - 

• accessing the information, and
• presenting the findings in a clinically meaningful format.

Accessing the information. The online platform Medications & Nutrition provides a comprehensive range of clinically-useful research evidence, that is updated on a regular basis, and is summarized to dot points, to improve the accessibility to the latest research in this important area of care for busy clinicians.

Presenting the findings in a clinically meaningful format. So how does one present the information in a clinically meaningful format? Through trial and error we have found that:

• a table is great for presenting summary information such the various different side effects (nausea, vomiting, etc) and nutrients affected (B12, Mg, Ca, Fe, etc),
• actually identifying individual impacts. For example, wound healing requires an increased nutrient intake to support the increased nutrient demands for healing purposes. If a number of drugs are prescribed that negatively impact the status of one or more nutrients then healing can be delayed.

Ultimately this website is about addressing both of the above identified components by providing resources to both easily accessible information and how to apply it in a clinically-meaningful format.

The final question to be asked is – what is the credibility behind the person promoting awareness of this oversight in healthcare? And the answer is –

• Bachelor of Applied Science (food science & nutrition),
• Graduate Diploma in Dietetics,
• Graduate Diploma in Health Education & Promotion,
• Thirty plus years clinical experience in both the Public Health system (Australia and overseas) and the residential Aged Care sector – one sees and learns a lot.

Our philosophy is to provide as much of the credible research that is accessible to us, in one place to increase ease of use for busy clinicians, and consequently enhance improvement in the outcomes of those in their care. With that proviso in mind the information is presented in dot points and then referenced so the source can also be easily accessed.

It is perhaps time to share some of our expertise!

If you have read this far then you must be a curious and probably a visionary clinician – I hope you find our resources are useful to your practice.

Yvonne Coleman