"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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Medical Drug Use

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Medical drugs have been central to the improvements in health that have been seen since the middle of the 20th century and new, better drugs continue to be developed.  However in the UK during 2007 1,031 people died as a result of prescribed medication according to the Department of Health.  This is a rise of 130% compared with the 441 deaths due to the same cause in 1997.

A more immediate effect of drugs is the adverse effect that some have on nutritional state by affecting the appetite, reducing absorption, increased losses or alteration in the metabolism of the nutrient:

  • Steroids if taken for a Persistent period of time increase the risk of potassium deficiency and osteoporosis for which calcium and vitamin D supplements are often given.
  • Diuretics such as furosemide and bendroflumethiazide increase the losses of potassium and magnesium in the urine.  Furosemide may also increase the risk of vitamin B1 – thiamine deficiency
  • Aspirin and non-steroidal anti-inflammatory drugs can slightly lower the level of vitamin C in the blood
  • Persistent use of antibiotics can destroy the bacteria in the bowel that produce vitamin K, lack of which may result in bleeding or bruising.
  • Some anticonvulsants may cause deficiency of folate or vitamin D.

The risk of drug-induced nutritional deficiency increases with:

  • the dose of the drug
  • the duration of treatment
  • the presence of other risk factors especially poor diet, low BMI and increasing age

In practice those who are well nourished and are not frail are unlikely to develop serios deficiency as a result of drug treatment alone.

www.ccc.nih.gov/cc/patient_education/drug_nutrient/

Pharmacology, Nutrition, and the Elderly: Interactions and Implications.  Couris RR, Gura KM, Blumberg J. in Geriatric Nutrition: The Health Professional’s Handbook. 3rd Edition. Ed Chernoff R. Jones and Bartlett Publishers, Inc. 2006.

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Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576