Chain reaction: Addressing patients’ nutrition deficiencies

Americans by and large have lousy diets, pharmacist and supplement expert James LaValle, CEO of Integrative Health Resources, told DSN Collaborative Care recently. Over a lifetime, those nutrient-poor diets contribute to the development of such chronic disease states as obesity, hypertension and diabetes. The medicines prescribed to treat those conditions then further deplete essential vitamins and minerals.

“Because of the poor nutrition status of people … there’s a lot more irritable bowel disease, colitis and hyperthyroidism. There’s a lot of conditions that relate to your ability to absorb nutrients from your food,” he said. “And when you combine that with food that isn’t as nutrient-dense, and then you combine that with medications that are depleting nutrients, it creates somewhat of a chain reaction, or momentum, that accelerates people toward [poor health] issues.”

For example, magnesium plays a role in maintaining healthy blood-sugar levels and is the most-identified nutrient depletion with the development of Type 2 diabetes and metabolic syndrome. “Culturally, we don’t get a lot of magnesium in our diet,” LaValle said. “And then if I put you on a medication that depletes magnesium, it exasperates the situation.”

It’s a vicious cycle. But it’s a cycle to which more practitioners are becoming sensitive. “With the advent of people studying nutrigenomics, what we’re seeing is that interface between a drug that depletes a nutrient and someone who’s genetically predisposed toward the depletion of that nutrient,” LaValle said. “That can accelerate the potential side effects that can occur from the drug.”

Some of the more significant medications causing nutrient depletion are oral contraceptives, which cause vitamin B-6 deficiency that triggers bouts of depression. The study of nutrigenomics has revealed that vitamin B-6 deficiency inhibits the methylation of serotonin and results in feelings of depression.

That’s just one example of how a nutrient depletion can contribute to the side effects associated with a particular medicine, which in turn could impact adherence to a medicine regimen if the side effect is too jarring to the patient. Paying attention to which medicines deplete which nutrients, and thereby avoiding some of these side effects, could improve medication adherence,  LaValle suggested.

Having a firm grasp of the importance of nutrient depletion is key for another reason: Many of those Americans who have poor lifestyle choices are enabled by medicines. So knowing what nutrients are important for specific disease states and medicine regimens can help turn the tide in getting those patients off those medicines because they no longer need them.

For example, men on statins are twice as likely to have low testosterone. Low testosterone has been linked to a higher risk of cardiovascular disease. To make testosterone, men need magnesium and zinc. However, to help control high blood pressure, physicians may prescribe a thiazide, which depletes magnesium and zinc. So a physician prescribing a statin and thiazide can in fact lead to increased cardiovascular risk for the patient if underlying nutrient depletions are not addressed in conjunction with the drug therapy.

There’s a curriculum trend in support of teaching the consequences of nutrient depletion and poor lifestyle choices at medical schools, LaValle noted. LaValle is the course director of George Washington University’s new Integrative and Metabolic Medicine program, a 270-hour course for physicians learning about exercise, lifestyle, stress response and nutrition. “All those aspects are not taught in school [currently],” LaValle said. “And there are other programs like that that are beginning to percolate everywhere in academia that are more oriented toward teaching physicians lifestyle, behavior, nutrition and prevention. Truly emphasizing to [medical students] the value of the type of diets that they put their patients on, the value in trying to get the patient to manage their health better so that the medications can be limited.”

Beyond lifestyle choices and prescription regimens, certain demographics may influence nutrient depletion. Members of high-income households (i.e., more than $75,000) are less likely to have nutrient shortfalls than households with less income. Obesity also raises the risk of nutrient depletion. Patients with a normal BMI typically have inadequate intake of calcium and vitamins A and C, but those who are overweight and obese also struggle with magnesium, and vitamins D and E.

A large percentage of older Americans have inadequate intakes of vitamins A, C, D and E; calcium; and magnesium, according to the National Health and Nutrition Examination Survey.

Of particular note, practically all older Americans are not meeting the recommended intake for vitamins D and E. These nutrients have important roles in bone and heart health, and in providing antioxidant support. And older Americans tend to consume fewer calories due to a decreased appetite, posing a challenge to correcting nutrient shortfalls through a food-only approach.

That makes it important to know which medicines deplete which nutrients, LaValle said, no matter what age you are.

 

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