Denosumab is prescribed for the treatment of bone loss in adults at high risk of bone fractures. It is a human monoclonal antibody that binds to RANKL which inhibits the RANK/RANKL pathway resulting in inhibition of osteoclast formation, function and survival. The consequent outcome is a reduction in bone resorption and therefore increase in bone

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Bone health is so important and so overlooked and is usually only considered once there is a problem.Bone is constantly being remodelled and is fully replaced approximately every 10 years; remodelling enables growth in childhood and repair in adults. Loss of co-ordination between bone formation and bone degradation results in skeletal impairment.Bone has several primary

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A reader sent in this list of prescribed medicines and did not provide any other information.Drug-food interactionsAllopurinol High intake of salicylates is likely to decrease therapeutic benefit. Interacts with caffeine to enhance drug effect. May interact with theophylline to increase duration and extent of theophylline effect; food sources of theophylline include tea.Furosmide/Frusemide Drug may lower threshold for salicylate toxicity

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Neuroinflammation occurs when the brain’s innate immune system is challenged by factors such as injury, infection, toxin exposure, or neurodegeneration, and the responses can be both physiological and biochemical; neuroinflammation can both cause, and be caused by excitotoxicity and oxidative stress.Is there evidence of an association between 3 common neuroinflammation markers and some nutrition factors?Interleukin-1ß

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Costs of inaction is a term typically associated with business decisions – what are the costs if you choose not to purchase this product or that service – would there be loss of revenue, loss of opportunity, loss of expansion, increased risk of harm in some form.If we apply costs of inaction to the health

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Pantothenate is important in many basic physiological functions, and especially as a precursor for Coenzyme A also known as CoA and CoA-SH; CoA is the precursor for the formation of acetylCoA; acetylCoA is an important metabolic intermediary.Acetyl-CoA is the substrate, intermediary, or product of various energy systems as well as being -the actual molecule through

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Caffeine is a commonly consumed foodstuff, typically found in beverages such as coffee, tea, cola, energy drinks, and foods such as guarana, cocoa and chocolate.Caffeine can alter the absorption, distribution, excretion, and induction or inhibition of metabolizing enzymes for a range of prescribed medications by -1. Altering absorptionchanging the dissolution profile – increasing or decreasing

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Astrocytes are overlooked essential intermediaries in neurological physiology. Astrocytes operate on a network system whereby they service hundreds, if not thousands of neurons. Therefore, if anything damages one astrocyte then the harm is expressed extensively.Astrocytes have 2 primary functions -provision of all the substances essential for neurons to survive and thrive,removal of neuronal garbage.If anything

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Elevated blood levels of nutrients are currently neither looked for nor considered to contribute clinically to disease processes and so remain unrecognised and untreated.With the advent of significant “drug” transporter research, our understanding of the extent and potential extent of prescribed medications and other substances on nutrient availability for body function is steadily growing and

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Templates are useful for ensuring essential information is passed on without any aspect being overlooked as they can be copied, pasted and modified as required – the days we are tired or rushed or distracted are the days we are likely to overlook something important.These templates focus on statins.Statins interfere early in the cholesterol metabolic

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A nutrient that is very out-of-sight and out-of-mind is pantothenate – is there, or should there be, a pharmaconutrition concern?Pantothenate is a B vitamin that is important -as the precursor for production of Coenzyme A (CoA or CoA-SH),in the synthesis of acyl carrier proteins essential in fatty acid biosynthesis,in the synthesis of pantethine, a naturally

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The combination of identification of physiological transporters and their potential for accessing currently inaccessible-for-pharmaceuticals parts of the body in conjunction with FDA (Food and Drug Administration) requirements to identify potential drug-drug interactions associated with the inhibition and/or inducement actions on the functions of transporters has resulted in a lot of pharmaceutical money being spent globally

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Physiological transporters (aka “drug transporters”) are seemingly a one-way gate for substances to pass from one carrier to another. Using an airport as an analogy, a range of carriers – cars, buses, trains, ferries, trams, other – carry a person from somewhere to the departure lounge of the airport, the person passes through one or

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A recent seminal study (DOI 10.1074/jbc.RA120.013610) found that ThTr1/2 (Thiamine Transporters 1/2) can transport both thiamine and pyridoxine from the brush border membranes of the small intestines into the epithelial cells. This study established 3 key findings, being -the first to identify an intestine-to-epithelium transporter for pyridoxine,that ThTr 1/2 are actually multi-specific transporters that can

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Personalising templates is a more effective use of time than writing each essentially-similar entry from scratch – the days we are tired or rushed or distracted are the days we leave out something important. Another benefit that templates confer is the consistency of the information being passed on which means the readers are more likely to

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Whilst researching a related topic for a soon-to-be-published MedNut Mail email, I came across this diagram and asked the question “what are the likely mechanisms of action for metformin to alter pyridoxine’s (vitamin B6) metabolic pathway?”There is now early evidence that metformin use is associated with a higher risk of B6 deficiency, with one study

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A fall is defined as an event in which a person inadvertently comes to rest on the ground or other lower level. A fall can result in physical harm such as broken skin and bones, emotional and mental harm such as loss of confidence, and damaged ego as falling is quite inelegant. Falls are the

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Nutrition support products are typically administered if a person has lost weight or has very poor appetite, and their purpose is to improve nutritional health, with success typically being identified as weight gain. They are formulaic drinks based on either water or milk and typically contain a range of added nutrients.The article titled Distribution of

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Templates are useful to ensure inclusion of relevant points and to streamline work efficiency. Further, they can be amended as new research adds to our body of knowledge. These templates have focussed on some of the negative pharmaconutritional impacts of diabetes – a diagnosis that seems to be the forerunner of further poor health.Diabetes drugsXXXXX

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Enter your text here..Constipation is a common side effect of many prescribed medications and contributes to further issues such as increased brittleness in pain management, increased risk of falling, increased confusion, increased frequency and duration of parkinson’s freezing, increased frequency and duration of difficult, resistive, aggressive behaviours, inexplicable vomiting, etc. These consequences typically result in

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Biotin is a B vitamin that helps the body break down fats, carbohydrates, and proteins and is important in cell growth, the metabolism of fats and amino acids, and energy production; roles include –cofactor for a small group of enzymes catalyzing carboxylation, decarboxylation, and transcarboxylation reactions in fatty acid, glucose and amino acid metabolism and

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Templates are useful for ensuring essential information is passed on without any aspect being overlooked as they can be copied, pasted and modified as required. These templates have focussed on some of the negative nutritional impacts of proton pump inhibitors (PPI) primarily because they seem to be about as popular to consume as lollies!Currently prescribed

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MELAS (Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-like) is caused by mutations in mitochondrial DNA and is considered to be an Inborn Error of Metabolism. Clinical manifestation is typically before the age of 40 therefore presentation in older adults is very unusual.I found this man (details in Case Study) several years ago and there was very

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… hSVCT1 (Sodium Vitamin C Transporter 1) expression and function were significantly decreased in intestinal epithelial cells by the histone deacetylase inhibitors (in Australia – Vorinostat – Zolinza), valproic acid, and sodium butyrate (NaB) is part of a comment from a recent abstract (https://doi.org/10.1016/j.jnutbio.2021.108838). Effectively this means sodium valproate decreases vitamin C absorption. As we are

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This email is based on a question from a reader.I have a client who is tube fed, currently on XXX enteral feed as she can’t tolerate regular/standard formula. She is on a few medications that affect carnitine levels/absorption- including Frisium, Epillim and Lamictal.She has been experiencing a lot of the symptoms also associated with carnitine deficiency,

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Deafness is a multifactorial, global health issue that is commonly inadequately managed in healthcare services; for example a person who responds inappropriately to a question is automatically labelled “? dementia” and no-one even considers the alternative ie “? deafness”.When a deaf person does not respond appropriately, even when spoken to with a raised voice, then

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From a practical, work efficiency perspective, many of the people we see are prescribed similar combinations of medications and so we find we’re frequently repeating ourselves. For my clinical practice I created a file called Regular Notes, in which I templated much of the repeatable content with identifiers for the bits requiring change (people names,

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Calcium carbonate is a commonly prescribed therapeutic intervention and is listed on the Pharmaceutical Benefits Scheme (PBS). However, there is increasing concern regarding the therapeutic effectiveness of calcium carbonate when there is concurrent administration of a proton pump inhibitor (PPI).Calcium is primarily absorbed throughout the intestines and predominantly from the duodenum and jejunum.Calcium carbonate.Calcium carbonate

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Money and nutrients have some surprising commonalities –similar income/intake on a relatively regular basis,other income/intake on a regular basis,regular costs,pleasure costs.Money management typically starts with a budget – with a defined portion of money being allocated to various accounts such as regular bills, mortgage/loan repayments, Xmas/holidays, savings, and what’s left, and possibly a bit more,

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Commonly the pre-breakfast BSLs may be the only routine monitoring strategy for those with long term diabetes and deemed relatively stable. Further, commonly, if the pre-breakfast BSL is within acceptable range then further daily monitoring is rarely considered. Therefore, those people with diabetes and who are also prescribed prednisolone may be experiencing regular afternoon hyperglycaemia

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Some people can be prescribed medications from a very young age eg diabetes, epilepsy, and will consume a range of medications for most of their lives ie for decades. As the limited research indicates there are potentially many significant negative impacts that some of these longterm drugs may have on nutrient status and consequently health

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Call for emergency action to limit global temperature increases, restore biodiversity, and protect health: Wealthy nations must do much more, much faster is the headline in a recent AJCN (The American Journal of Clinical Nutrition, Volume 114, Issue 4, October 2021, Pages 1267–1269, https://doi.org/10.1093/ajcn/nqab281).It sounds great, but …This editorial is a reflection about a recent

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“Can you see Mr EYOM (Eighty Year Old Man) – he’s been losing weight?”The weight graph showed a stable weight until a defined moment when the loss was dramatic – steep enough to abseil down.The standard causes were excluded – no amputation, no gastro, no unwellness, no hospitalization, no falls, no nasty wound, no bad

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Iron supplements are generally prescribed if serum iron levels are low. Poorly absorbed iron, typically from sources such as iron supplements, results in increased iron availability to the gut microbiota with consequentincrease in the virulence of faecal enteropathogens,increase in the ratio of faecal enteropathogens to protective microbiota such as bifidobacteria and lactobacillus,favouring of the colonisation

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Nutrition research, including pharmaconutrition, is an interesting and challenging field, with an added dimension that is not essential to any other area of research – the reversibility/irreversibility component of physiological response that is integral to all findings. Do you want to be someone who contributes to good quality research in the area of pharmaconutrition and

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Because chlorpromazine (a phenothiazine), imipramine (a tricyclic acid) and amitriptyline (a tricyclic acid) have a very similar structures to riboflavin there was concern that these drugs may adversely affect riboflavin status. In fact, animal research in 1981 found that they do have a negative impact on riboflavin status. However, there has been no follow-up research

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In the early 1990s a Canadian research team was investigating whether alcohol interacted with nifedipine/felodipine and unexpectedly found that the effects of these drugs were altered by concurrent intake with grapefruit juice – this was a seminal finding. Three questions arise from this findingwhat ingredient or ingredients caused the response in the grapefruit-drug interaction?which other

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Drug-food interaction advice is quite inconsistent and falls into three main groups – advice not provided, food contra-indicated, and advice yet-to-be-determined.  Examples of advice not provided include:typically, advice is only given to abstain from alcohol intake whilst consuming antibiotics and yet there is an extensive range of drugs whereby alcohol intake is contra-indicated;a low-salt diet no

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Confusion, falls or has poor balance, insomnia, and lethargy – would you immediately be trying to decide if this person is deficient in biotin or pantothenic acid? When I raised this at a Medication Advisory Committee meeting, all the committee members (GP, Clinical Care Co-ordinator, supplying pharmacist, Accredited Pharmacist) looked at me in amazement that

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Abnormally high B12 levels are typically due to a medical disorder, however this article is specifically about elevated B12 levels due to ongoing therapeutic B12 interventions.Vitamin B12 interventions are commenced upon diagnosis of low B12 status, typically comprise high dose injections until levels are within acceptable range, and then the intervention is changed to a

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Twenty years ago, this was a very short list! Of necessity this list has grown as there has been minimal research to address these and other questions. This is the first of a monthly 3-part series.Nutrition research, including pharmaconutrition, is an interesting and challenging field, with an added dimension that is not integral to any

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Maximising drug dose or minimising side effects were the only interactions that pharmaceutical companies considered in relation to food until the early 1990s. Then the grapefruit response was discovered – and increased awareness that foods may interact with drugs.Whilst many questions arise out of the drug-food interaction topic there seem to be two key questions:which

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Commonly the pre-breakfast BSLs may be the only routine monitoring strategy for those with long term diabetes and deemed relatively stable and further daily monitoring is rarely considered. Therefore, people with diabetes and who are also prescribed prednisolone may be experiencing regular afternoon hyperglycaemia and no-one is aware. Prednisolone has a time to peak of 4-6

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The APAC Guidelines (Australian Pharmaceutical Advisory Committee) were established by the three key peak bodies (doctors, nurses and pharmacists) involved with drug management in residential care facilities. Is there a role for nutrition?Medication Advisory Committee’s (MAC’s) are an ideal forum for addressing a range of issues that have a medication:nutrition interface. MAC’s activities include:addressing immediate

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