In order to ensure the healthy lifestyles we must understand about medication and how they relate with our food and nutrients intake. Here!!!! When to use food after drugs When to use drug after food Which drugs can be used after meal Which drugs should be used before meal Which drug can be used with meal When to drink water for well healthy meal Why we should use supplements When to use supplements Which food to use more for specific disease tratments.

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2. Our topic today!!!
DRUG, FOOD AND NUTRIENT
INTERACTION

3. Drugs can interact with other drugs, foods, and beverages.
Interactions can either
• lessen or magnify the desired therapeutic effect of a drug,
or
• may cause unwanted or unexpected side effects.
There are thousands of possible
• drug-to-drug and
• drug-to-food interactions,
and many medications and supplements are
contraindicated (i.e. not recommended) under certain
conditions or in patients with specific diseases and
disorders.

4. This is why it is imperative
(important) that patients always
keep their physician fully informed
about
•all drugs and
•dietary supplements (including
herbal remedies) they are taking.

5. Site of drug metabolism
The primary site of drug metabolism is the liver, the organ
that plays a major role in
• metabolism,
• digestion,
• detoxification, and
• elimination of substances from the body.
Enzymes in the liver are responsible for chemically
changing drug components into substances known as
metabolites.

6. Metabolites are then bound to other substances
for excretion through
the lungs, or
bodily fluids such as saliva, sweat, breast
milk, and urine, or
through re-absorption by the intestines.
The primary mode of excretion of metabolites is
through the kidneys.

7. Food can affect the way drugs are used by the body.
The absorption of a drug can be:
reduced,
delayed, or
increased
by food consumption.
This is why
• the timing of the drugs is important, and
• people should follow the advice of doctors or pharmacists on when to
take their medications.

8. Some drugs
•are better absorbed on an empty
stomach,
•Some are better absorbed with a
meal so they remain in the
stomach for longer time.

9. If some drugs remain too long in the
stomach, they may be broken down
before they reach the intestine to be
absorbed, this may delay the
therapeutic response.
Some drugs are usually absorbed more
quickly on an empty stomach than
when taken with food.

10. When taken with food, the drug mixes with the food and it is released from the
stomach into the intestine more slowly.
For example the presence of food in the stomach
can reduce and delay the absorption two antibiotics, penicillin and amoxicillin
It can also delay the absorption of the high blood pressure medication Captopril 35 to
48%.
The exposure of Captopril to stomach acid for a longer time may cause it to
dissolve and break down too soon

11. The presence of food in the
stomach may also
• impair the absorption of the
antibiotic erythromycin by delaying
gastric emptying.
This will expose the drug to
stomach acid for a longer time,
causing it to break down too soon

12. •Food may delay absorption of
some drugs without significantly
affecting the extent (amount) of
drug absorption.
•Food may also act as a barrier by
preventing a drug from reaching
the surface of the GI tract to be
absorbed.

13. •Dairy products (milk, cream, and other dairy products)
containing calcium can prevent the absorption
of antibiotics such as
 tetracycline,
 doxycycline, and
 ciprofloxacin
when they are taken with the drug.
• In addition, whole milk with vitamin D can
cause milk-alkali syndrome in patients taking
aluminum hydroxide antacids.

14. •Deficiency of such nutrients as calcium,
magnesium, or zinc may impair drug
metabolism
•Energy and protein deficiencies reduce tissue
levels of enzymes and may impair the
response to drugs by reducing absorption
•Drug response may also be affected by
impaired absorption due to changes in the GI
tract

15. Vitamin C deficiency is associated with
decreased activity of drug-metabolizing
enzymes.
The frequency of adverse drug reactions in the
elderly may be related to low vitamin C status.
Many drugs affect appetite, absorption, and
tissue metabolism

16. Certain drugs affect mineral metabolism.
Diuretics ( a class of drugs used to remove excess fluid from the body which
helps to lower blood pressure), especially thiazides, and
corticosteroids can cause potassium depletion,
which increases the risk of cardiac arrhythmias
(abnormal heart beats)

17. Corticosteroids are involved in a wide range of
physiological processes, including
 stress response,
Immune response,
regulation of inflammations,
carbohydrates metabolism,
protein catabolism,
 blood electrolyte levels, and
behavior

18. • Potassium depletion may also result
from the regular use of purgatives
(substances which cause intestinal
evacuations)
•Sodium and water retention also occurs
with
oestrogen- progesteron oral contraceptives
and
oThe use of phenylbutazone ( a drug for the
short-term treatment of pain and fever)

19. •Oral contraceptives can lower plasma zinc and
elevate copper; and
• Prolonged use of corticosteroids can lead to
osteoporosis.
Mechanisms:
Direct inhibition of osteoblast (bone forming
cells) function
Direct enhancement of bone resorption
Inhibition of gastrointestinal calcium absorption
Increased urine calcium loss

20. Vitamin metabolism is affected by certain
drugs.
Ethanol impairs thiamine absorption, and
isoniazid ( drug for treating tuberculosis) is
a niacin and pyridoxine antagonist.
Ethanol and oral contraceptives inhibit
folic acid absorption.

21. Vitamin B12 mal absorption has been reported
with
 amino salicylic acid (is an antibiotic used to
treat tuberculosis),
 colchicine ( drug to relieve pain from gout),
 trifluoperazine (tranquilizer) ,
 ethanol, and
 oral contraceptives.

22. Diuretics for high blood pressure wash
potassium, magnesium, sodium, and zinc and
vitamin B12 right out of your body along with
water
Cholesterol lowering medications deplete
numerous
vitamins: B2, C,D, niacin, folic acid biotin as well
as
minerals: calcium, iron, magnesium, potassium,
zinc and several trace minerals

23. Estrogen replacement drugs e.g. Premarin , can leave you
deficient in
all the B-complex vitamins as well, as
vitamin C as well as
very important minerals to the heart (magnesium and zinc)
Antacids steal from your tissues important vitamins :
• vitamin A, Vit. B1, folic acid and
• minerals Ca, Cu, iron and phosphorus
N.B.
• Hormone replacement refers to medications containing female
hormones to replace the ones the body no longer makes after
menopause e.g. estrogen

24. Antibiotics deplete numerous
•vitamins: B2, C, D, niacin, folic acid, biotin
and
•minerals Ca, Fe, Mg, K and Zn
They also
•kill the flora that keep intestines healthy
making it unable to absorb the nutrients we
do consume
•creating the atmosphere for yeast growth.

25. From this background,
Why then do elderly people require micronutrient
supplementation?
The aged constitute only 10% of the total population but they
consume about 25% of drugs prescribed because of
increased health problems in the old age
At any age there is a risk of harmful
• drug - drug
• drug-nutrient interactions,
but elderly persons seem to have more than their share.

26. Several things contribute to this increased risk among the elderly:
•They are likely to take more drugs for longer
periods to control chronic diseases
•The elderly are at increased risk owing to:
pathophysiological changes related to aging,
 endocrine dysfunction and
the common ingestion of restricted diets
•Illnesses, mental confusion or lack of drug
information may increase errors in self-care

27. Nutrients can affect drug action by
altering the:
odigestion,
oabsorption,
oDistribution and metabolism
and/or
oexcretion of the drug.

28. Drugs may exhibit their effects on nutritional status through
several avenues/ways:
• effects on food intake,
• alteration of nutrient absorption,
• alteration of nutrient metabolism and
• alteration in nutrient excretion
The rate of drug metabolism and detoxification in the liver is
much slower in older people.
So drugs remain in the body longer to exert their influence
on the metabolism of nutrients.

29. The elderly population often takes the highest amount of
medications, and with the use of multiple drugs, certain
problems may exist.
• A loss of appetite,
•a reduced sense of taste and smell, and
•swallowing problems
All these may result from medication use in elderly people
Remember,
ELDERLY PEOPLE THEREFORE NEED MICRONUTRIENT SUPPLEMENTATION

30. Recommendation
In order to maintain your healthy treatment from
your medication. Then track food and nutrients
setbacks
For any personal assistance
Email us on.
internationalnutritionist@gmail.com
References………….

31. References
1. Ismail (2009). Drug-Food Interactions and Role of Pharmacist. Asian Journal of
Pharmaceutical and Clinical Research, vol 2(4):1-10.
2. . Størmer FC, Reistad R, Alexander J. Glycyrrhizic acid in liquorice–evaluation of health
hazard. Food Chem Toxicol 1993. Apr;31(4):303-312 10.1016/0278-6915(93)90080
3. . Serra A, Uehlinger DE, Ferrari P, Dick B, Frey BM, Frey FJ, et al. Glycyrrhetinic acid
decreases plasma potassium concentration in patients with anuria. G. Am. Soc.
Nephrol. 2002;13:191-196
4. . Ploeger B, Mensinga T, Sips A, Seinen W, Meulenbelt J, DeJongh J. The
pharmacokinetics of glycyrrhizic acid evaluated by physiologically based
pharmacokinetic modeling. Drug Metab Rev 2001. May;33(2):125-147 10.1081/DMR-
100104400
5. . Størmer FC, Reistad R, Alexander J. Glycyrrhizic acid in liquorice–evaluation of health
hazard. Food Chem Toxicol 1993. Apr;31(4):303-312 10.1016/0278-6915(93)90080-I
6. . Van H.K., Grundmeijer, H.G. (2007). Hypertension due to liquorice and liquorice tea
consumption. Ned Tijdschr Geneeskd. ; 22;151(51):2825-8. [PubMed]
7. . Hodel M, Genné D. Rev Med Suisse. Antibiotics: drug and food interactions. 2009 Oct
7;5(220):1979-84. [PubMed]
8. 45. McCabe BJ, Frankel EH, Wolfe JJ, eds. Hand book of food-drug Interactions (2003),
CRC Press, Boca Raton, pp. 2.