For those who don't put much faith in the effects of vitamins, minerals, trace elements, herbs and oils, facts cited in the following article substantiate that they not only do affect us - but that they can change the way that prescription and over-the-counter medicines work in our bodies.

Copyright 2001
The Detroit News


Meals and meds sometimes don't mix

Everyday foods can react with drugs and change their effectiveness or lead to deadly results

By Tracy Boyd / Special to The Detroit News

One person's healthy eating can be another person's poison.

Take that lovely spinach salad you had for dinner. Though it's rich in iron and other nutrients, it would be dangerous for the millions of people who take anticoagulants (blood thinner medication). People on these kinds of medications need to avoid large servings of leafy green vegetables, because they can change the effect of the medication.

A warning also applies to people who take certain drugs for depression and eat cheese or sausage, and those who combine caffeine-rich coffee with the drug theophylline, an asthma medication.

Eating certain foods while taking medicine can change a drug's effectiveness, causing you to get more or less of the drug than prescribed. Some drugs can cause nutrient loss when taken over long periods of time. In some cases, these food-drug interactions can be harmful or even deadly.

"Most patients do receive the appropriate information about the drugs they're taking, and heed that advice about what foods to avoid," says Rozelle Dingle, a clinical pharmacist with the Nutrition Support Team with Henry Ford Hospital. "But some people are not aware that mixing certain foods with certain prescription drugs can cause serious interactions."

With prescription drug use continuing to rise, we all have cause for concern about our prescription medicines and how they may interact with food.

Last year, U.S. prescription drug sales grew 14.9 percent to $145 billion, according to the pharmaceutical tracking organization IMS America. Nearly two-thirds of that sales growth came from higher prescription volume as opposed to higher prices, according to the company.

"Approximately 85 million American adults take one or more prescription medicines," says Linda Golodner, president of the National Consumers League, an advocacy organization in Washington, D.C. "Yet, despite this widespread use, many consumers do not know about potential risks, side effects and possible drug interactions."

When you take a pill or swallow a liquid medication, a complex process begins.

Most medicines taken by mouth are not digested in the stomach. They travel into the small intestine, where they are broken down by enzymes. Then the drug is absorbed into the bloodstream through the walls of the small intestine and carried to your liver. There it is processed by enzymes and sent to the area of action, or where the drug's effect begins. Eventually, the remnants of the drug are eliminated through your urine or by breakdown in the liver.

But before this process can happen, the drug must be in your stomach with whatever else you're eating.

Sometimes the reaction between drugs and food is immediate. For example, taking the antibiotic tetracycline with food or milk quickly decreases the drug's effectiveness. That means you don't get as much drug as your doctor prescribed.

Other times, there is a buildup of the drug and chemicals found in food, and they react together and build to dangerous levels days or even weeks after you have started to combine them. Drugs called monoamine oxidase (MAO) inhibitors, often used to treat depression, can react with foods rich in the chemical tyramine. Tyramine is found in aged cheese, wine, beer and sauerkraut.

"If you eat those foods on a daily basis, tyramine can build up in your system," says Dingle. "You can have a high-blood pressure crisis that can lead to a stroke or a seizure."

Unfortunately, misinformation abounds. In the 1990s, doctors and pharmacists discovered grapefruit and grapefruit juice could influence how a drug works in the body. An erroneous press report said grapefruit juice reacted negatively with the popular prescription allergy antihistamines Claritin and Allegra and could cause serious heart problems. That report was repealed two days later.

However, grapefruit and grapefruit juice do interact with other medications. The scientists believe the contents of the juice or fruit inhibit enzymes in the small intestine that help to break down so many of the drugs we take. If those enzymes aren't available to break down the drug and render it inactive, that means more of the drug makes its way in to the bloodstream. Concentrations in the body are therefore higher.

"Doctors prescribe medications assuming this specific metabolic process is going to take place," says David Edwards, professor of pharmacy at Wayne State University's College of Pharmacy and Allied Health. "Taking grapefruit juice, for example, can circumvent this situation so that you get more drug absorbed than you usually would. So 10 mg of a medication could act more like 20 to 40 mg of the drug."

Many other foods fall into this class of causing interactions with medication. Eating onions or garlic while taking an anticoagulant, also called a blood thinner, can increase that drug's effect and lead to bleeding. And just as milk can decrease the effect of some antibiotics, eating highly acidic foods such as tomatoes or fruit juice causes a similar effect.

Some of the potential interactions are rather unremarkable. For example, the drug digitalis, prescribed to strengthen weak heart muscle contractions or correct irregular heartbeats, can be affected by high-fiber foods such as bran or prune juice. They cause the drug effect to be less than prescribed, meaning you don't get all of the medication your doctor wants you to have. Taking an antacid with your meal instead of one hour afterwards can decrease the effect of the medicine. Taking antibiotics such as tetracycline with dairy products can nullify the effect of the drug.


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But other interactions can be severe -- even deadly.

The best advice to avoid these potentially dangerous situations is to become informed. Heed the warnings and dietary restrictions you receive from your doctor, nurse, pharmacist and dietitian, says Stephea Scheurer, a registered dietitian. She is the clinical nutrition and patient services manager at St. John Detroit Riverview hospital.

"In my experience, the patients are very receptive," says Scheurer, who counsels patients daily about their medications and diet. "People want to do whatever possible to maximize their health, and they all appreciate tips from a nutritional standpoint in order to do that."

Dietitians and pharmacists are specially trained in the reaction of drugs and food. Be sure to ask if you have any questions about what to eat or not eat while taking a medication.

Combinations to Avoid

Where to learn more

Dealing with an overdose

Because some foods cause a medication to be absorbed quickly or in greater amounts than intended, a drug overdose can sometimes result.

If the victim is unconscious and not breathing, tell someone to call 911 and begin mouth-to-mouth breathing. Do not try to make the victim vomit. Take the medication or empty bottles to the emergency room with you when the ambulance arrives.

If the victim is unconscious but breathing, call 911. If you can't get help immediately, transport the victim yourself to the nearest emergency room. Watch the victim carefully on the way to the hospital; if heart or breathing stops, perform CPR. Again, take medication bottles or labels to the hospital with you.

Keep the number for the nearest poison control center handy, too. In the Detroit area, the number is (800) 764-7661.

Take precautions

Whether you're taking a prescription drug, an over-the-counter medication or a supplement, a few general rules apply:

This article comes from The Detroit News

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