Mechanisms and consequencesCoagulation (blood clotting) is a process that prevents excessive bleeding when a blood vessel is injured. Usually, a blood clot dissolves once the injury has healed however sometimes a clot will form inside a blood vessel without any obvious injury and/or may not dissolve naturally.Vitamin K is commonly associated with the coagulation process …

Mechanisms and consequencesDOACs (direct oral anticoagulants) are becoming the preferred option for coagulation management because they do not require the management strategies that warfarin administration necessitate such as regular and frequent INR monitoring, significant dietary restrictions, OH&S concerns relating to internal bleeds, etc especially for farmers, and elderly fallers.Evidence indicates the individual macronutrients, being proteins, …

Mechanisms and consequencesMedications, medicines, drugs are used interchangeably to describe chemical substances that are administered to confer therapeutic benefit; they interact with 3 key groups –Other medicines – aka drug-drug interactions,Nutrients – aka drug-nutrient interactions,Foods – aka drug-food interactions.Drug-drug interactionsDrug-drug interactions are well researched, and many facets of these interactions are included in the drug …

Mechanisms and consequencesAcid-base imbalance is now being associated with a range of Western health disorders including insulin resistance, diabetes, thyroid function resistance, osteoporosis, altered osteoclast and osteoblast activity, heart disease, hypertension, albuminuria, impaired renal function, chronic kidney disease, recurrent nephrolithiasis, impaired growth in children, and increased body fat in children, etc.Similar to steady state concentration, …

Mechanisms and consequencesSteady state concentration is the period during which the therapeutic levels remain constant. It is achieved when a defined amount of drug excreted is equal to the amount of drug absorbed within a defined timeframe.The elimination half-life of the pharmaceutical determines the time to achieve steady state concentration, as outlined in the table …

Mechanisms and consequencesI now understand why duration of therapeutic effect of the non-insulin diabetes drugs is not an integral part of most clinicians’ toolkits – the information is extraordinarily difficult to access. When I compiled my chart in 2015, I was very lucky as I had identified a good quality resource and was able to …

Mechanisms and consequencesInsulin resistance is defined as a lack of cellular response to insulin – likely due to closed, damaged or insufficient insulin receptor sites, or some form of within-cell impairment.  The lack of cellular response to insulin causes elevated blood glucose levels (hyperglycaemia). As a consequence of hyperglycaemia the pancreas increases the rate of …

Mechanisms and consequencesInsulin is a highly effective anabolic hormone that is primarily produced in the pancreas, and small amounts are also produced in some neurons.Increased plasma glucose levels trigger insulin’s release into the portal blood circulation and so it is transported to the liver which retains 50% of the insulin, the remaining 50% is released …

Mechanisms and consequencesSupported by policies, practices and programs, harm minimisation is essentially a philosophy, in a range of sectors, to minimise harm rather than to prevent harm.Harm minimisation applicationsHarm minimisation due to harmful substances or behaviours, can be achieved by the introduction of programs and practices that focus on -Demand – reducing ease of accessibility, …

Mechanisms and consequencesDenosumab 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 …

Mechanisms and consequencesBone 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 functionsBone …

Guest case studyA reader sent in this list of prescribed medications and did not provide any other information.Drug-food interactionsAllopurinolHigh 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/FrusemideDrug may lower threshold for …

Mechanisms and consequencesNeuroinflammation 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.Neuroinflammation markers and nutritionIs there evidence of an association between 3 common neuroinflammation …

Mechanisms and consequencesCosts 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 …

Mechanisms and consequencesPantothenate 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 which is an important metabolic intermediary.Acetyl-CoA is the substrate, intermediary, or product of various energy systems as well as being -the actual …

Mechanisms and consequencesAstrocytes 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 …

Mechanisms and consequencesElevated 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 …

Mechanisms and consequencesPyridoxine (Vitamin B6) is important in many body functions and is seemingly now becoming “sexy” to some in the research world …FunctionsB6 has many roles within the cell -as a cofactor in several one-carbon metabolic processes,as a coenzyme it is important in 150+ biochemical reactions,as an antioxidant and is similarly as effective as …

Time-saving templatesTemplates 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.Template examplesThese templates focus on statins.Statins interfere early in the …

Mechanisms and consequencesPantothenate is a nutrient that is very out-of-sight and out-of-mind – is there, or should there be, a pharmaconutrition concern?FunctionsPantothenate 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, …

Mechanisms and consequencesThe 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 …

Mechanisms and consequencesPhysiological 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 …

Mechanisms and consequencesA 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 …

Time-saving templatesPersonalising 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 …

Guest case studyThis email is based on a question from a reader.I have a curious case study – 89 year old lady with peripheral neuropathy in feet that started a few months ago.No change in medications or supplements – taking Magmin bd, Amlo, temazepan, Panadol osteo, Lyrica, Chlorsig.Lean at 43 kg 153 cm – BMI.Renal …

Mechanisms and consequencesA 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 …

Mechanisms and consequencesNutrition 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 …

Time-saving templatesTemplates 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.Key templates …

Mechanisms and consequencesEnter 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 …

Mechanisms and consequencesBiotin 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.Biotin rolesBiotin roles include –cofactor for a small group of enzymes catalyzing carboxylation, decarboxylation, and transcarboxylation reactions in fatty acid, glucose and amino …

Time-saving templatesTemplates 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!Template …

Providing care when limited evidenceMELAS (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 …

Guest case studyThis 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 …

Mechanisms and consequencesDeafness 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 …

Time saving templatesFrom 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 …

Pros and cons of nutrient budgetsMoney 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.Financial budgetsMoney 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 …

Mechanisms and consequencesCommonly 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 …

Potential research topicsSome 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 …

Mining and nutritionCall 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 …

Mechanisms and consequences“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, …