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Often overlooked in patients’ nutritional regimen are the medications they take. Over $400 billion a year is spent on pharmaceuticals and over-the-counter preparations, with 85% of the population taking more than half a million drugs and prescriptions. U.S. sales rank highest in the world, with musculoskeletal and cardiovascular the fastest growing and highest volume.
Enter advances in genome mapping, and instead of the 500 biochemical receptors targeted today, drug companies are expecting a 20-fold leap to 10,000. With that much alteration of human physiology, it’s no wonder the body’s life-sustaining micronutrients can suffer serious decline.
The Nutraceutical Niche
Nutritional deficiencies caused by prescription or over-the-counter medications can create problems with digestion, metabolism, detoxification and the immune system. The paradox is that medication taken for curing one disease may ultimately cause another health problem. Chiropractors can play an important role in recognizing and treating these nutritional deficits.
Distinguishing drug-induced nutrient deficits can also explain the complicated overlapping of symptoms and provide a reliable standard of evaluation to improve outcome. For practices with nutritional support on-premise, the result is increased short- and long-term sales. Patients are more likely to choose your recommendations and therapeutic potencies, especially if your product line is exclusively available through licensed professionals. All of these factors add up to better patient compliance, increased product demand and greater confidence in your skill as a doctor.
Managing the Case
Supplements are not only needed while taking medications, but also afterwards to help with residual imbalances. Proper documentation of patients’ case histories should include what supplements they are currently taking, which provides a baseline for an appropriate course of treatment.
Depending on the jurisdiction your practice is in, it is generally within the accepted scope of chiropractic statutes to acquire and use this information as long as you are advising, not prescribing. On a case-by-case basis, you may consider referring a patient back to his or her medical practitioner for re-evaluation of the prescription.
Dealing with Drugs
For as many drugs that have been studied regarding a nutritional impact on the body, many more have not been analyzed, probably due to the sheer magnitude of the task and the constantly expanding list of new medications.
The problem may be more widespread than suspected. Of the top 200 pharmaceuticals dispensed in the U.S., 11 of the top 20 show potential nutrient deficits. Studies documenting the depletion of nutrients have been appearing in peer-reviewed journals for decades, but only now are receiving public attention. As data are made available to health-care practitioners, it becomes the doctor’s responsibility to respond and counsel patients accordingly.
Safety in Numbers
A 1994 study in the Journal of the American Medical Association reported that over 2 million hospitalized patients experienced serious drug reactions and over 100,000 deaths were drug-related. Deaths due to over-medication and pharmaceuticals rank as one of the leading causes of mortality.
An eight-year comparative study by the American Association of Poison Control Centers showed more than 4,000 deaths from drugs (prescription and non-prescription) as compared to five from ingesting nutrients (one of which was later determined to be in error). Natural nutraceuticals are therefore a safe option, statistically speaking.
Pharmaceuticals and Their Effects
There are several common medications that your patients may be taking that could affect their nutritional health.
Some of the most common may include:
- Antacids. Remedies for heartburn and acid indigestion are common. Aluminum salts bind with phosphate in the intestinal tract, preventing absorption and lowering phosphate levels (phosphorus is the second-most abundant mineral next to calcium, and aids in strengthening bones). The body compensates by releasing phosphate and calcium from the bones, setting the stage for bone loss. Reduction of acidity in the GI tract inhibits folic acid absorption, which can lead to anemia, birth defects, and increased risk of breast and colorectal cancer. Sodium bicarbonate in some antacids depletes folic acid and potassium, one of the body’s two major electrolytes, which can cause irregular heartbeat, dizziness and nervous disorders.
- Aspirin. Salicylates for pain, inflammation and blood thinning are thought to be the largest cause of vitamin C depletion through excretion in the urine. Calcium is also reduced, increasing susceptibility to fractures, high blood pressure and tooth decay, especially long-term. Other deficits may include B5 (vital for enzyme action), sodium, potassium, iron and folic acid.
- NSAIDs. Many non-steroidal anti-inflammatory drugs (anti-arthritics, like ibuprofen and acetaminophen) have been de-regulated are readily available over-the-counter. Although corticosteroid symptoms may not show up short-term, extended intake can decrease calcium and vitamin D, leading to hypokalemia (potassium loss) with tetany, dizzy spells and fluctuating blood pressure. Reduced zinc levels slow wound healing and cause insulin resistance. Also possible are deficiencies in magnesium (heart arrhythmias), vitamin C and iron, and low folic acid.
- Cardiovascular Drugs. ACE inhibitors can deplete zinc, while beta-blockers may deplete antioxidant CoQ10 and melatonin (a brain hormone that triggers sleep). Calcium channel blockers can create potassium deficiencies, which may produce muscle spasms and weakness, fainting spells and mental confusion. Drugs for hypertension that deplete CoQ10 are now thought to be one of the primary factors in congestive heart failure (deficiency first affects the heart). Vasodilators reduce CoQ10 and B6, resulting in greater risk of depression, insomnia and higher production of homocysteine, which destroys the arterial lining. Depletions caused by diuretics include calcium, magnesium, potassium, B1, B6, vitamin C, sodium, zinc, folic acid and CoQ10, exposing patients to potential osteoporosis and (ironically enough) cardiovascular disease.
- Oral Contraceptives. Not only is vitamin C depleted, but virtually all of the B complex vitamins, folic acid, magnesium, selenium and zinc may be, too. Some health-care professionals believe that high levels of folic acid depletion are related to the increasingly high incidence of cervical dysplasia (a pre-cancerous condition of the uterus usually detected in a woman’s annual Pap exam), for which some 800,000 hysterectomies are performed every year in the United States. One of the most common side effects of oral contraceptives is thrombus or blood clots. Many women take calcium to prevent osteoporosis. Without magnesium to thin the blood and relax muscles, excess calcium increases clotting and muscle contractions.
- Estrogen Replacement. Nearly 50 million prescriptions a year are written for Premarin. Nutrient deficiencies are similar to oral contraceptives, including B6 and thus insomnia and cardiovascular disease. The resulting magnesium deficiency not only causes heart arrhythmias, high blood pressure, PMS and increased severity of asthma attacks, but the likelihood of clot formation due to calcium/ magnesium imbalances. This mechanism also explains painful muscle cramping.
- Antivirals. Most prevalent are deficiencies of B12, copper, zinc and L-carnitine. Copper deficits may appear as anemia and fatigue (tiredness, weakness and fatigue also being typical of B12 deficiency, especially in elderly people), elevated serum cholesterol and problems with connective tissue repair. The amino acid carnitine facilitates fat transport across the cell membrane for production of energy; in short supply, the symptomatic picture includes muscle weakness, fatigue and cramps. Certain AIDS drugs are associated with loss of calcium, magnesium and potassium.
- Cholesterol-Lowering Drugs. Reductase inhibitors (statins) reduce CoQ10, robbing the body of its primary free radical fighter for combating oxidation, and can result in increased risk of cardiovascular disease. Currently less used but important due to its after-effects, are bile acid sequestrants, which deplete fat-soluble vitamins, B12, folic acid, beta-carotine, iron, magnesium, phosphorus and zinc. Gemfibrozil can deplete vitamin E, B12, copper and zinc. Although the drug has a successful track record for reducing blood cholesterol, it reportedly causes not only loss of CoQ10 and alpha tocopherol, but a 50% decline in gamma tocopherol (the form of vitamin E with cancer fighting properties).
- Laxatives. Many over-the-counter laxatives are mineral oil-based, which absorbs fat-soluble nutrients, thus rendering them inactive. Mineral oil hastens the movement of bowel content and can interfere with complete digestion and absorption of nutrients, establishing a mechanical barrier to absorption in the lower intestines. Food particles are coated and severe weight loss can occur. Depletions include vitamins A, D, E and K, and beta-carotene, calcium and phosphorus. Bisacodyl is another common laxative that can result in potassium deficiency with postural hypotension (fainting when changing from lying to sitting), irregular heartbeat, mental confusion and poor reflexes.
- Ulcer Medications. Two classes include H-2 receptor antagonists (over-the-counter) and proton pump inhibitors that decrease acidity in the stomach and intestinal tract. A less acidic environment is more soothing to the inflamed area when an ulcer is present, but many nutrients need an acidic pH for absorption. Considered the most common gastric infection in the world, experts now believe that 90% of gastritis cases are caused by Helicobacter pylori, which buries through the mucosal lining and thrives on an alkaline pH. Not only do anti-ulcer drugs not eradicate the infectious agent, they can encourage growth and reproduction of the bacteria. Other current treatment regimens include antibiotics along with the proton pump inhibitor, and/or vitamin C. One study showed 30% of patients taking 5,000 mg of vitamin C daily cured the ulcers and eradicated H. pylori. Ulcers and H. pylori are associated with a higher risk of stomach cancer. H2 blockers deplete B12, vitamin D, calcium, iron, zinc and folic acid. Proton pump inhibitors interfere with the process of metabolizing B12 by disrupting the balance of stomach acid, pepsin and intrinsic factor required for absorption.
Offering patients a well-chosen “extra” is what marketing experts call the unique selling proposition. The unique selling proposition has revolutionized many businesses — with pizza, it was the “fast and hot in 30 minutes, guaranteed” concept that immortalized Domino’s, and made a multi-millionaire out of entrepreneur Tom Monaghan, who now owns the Detroit Tigers.
Success moguls say of the 10 most effective things that increase your business, adding new services ranks third, just below adding new products. Despite a patient’s best efforts to stay healthy without the help of synthetic chemicals, drugs may be necessary from time to time. Mitigating the effects of these powerful chemicals through nutritional support can become a lucrative extension of an alternative practice, for which demand is rapidly expanding (statistics show that by 2010 over 90% of the population will choose alternative healthcare first before mainstream).
As Dr. Albert Szent-Gyorgy, scientist and discoverer of vitamin C put it in 1939, supplements are the “least expensive, most effective health insurance you can buy.” What improves your patients, improves your practice.