The document discusses the interactions between food and medication, highlighting how drugs can affect food intake, appetite, and nutritional status, particularly for vulnerable populations such as the elderly and malnourished. It also outlines specific drug classes that lead to nutrient depletion and provides dietary recommendations to mitigate these effects. Key interactions include the impact of acid suppressants on vitamin B12 absorption, and the role of various drugs in influencing appetite and gastrointestinal function.

1. Mixing Food and
Medicine
Presenter: Rasheed Perry
MPhil Student

2. Introduction
 Drugs can affect and be affected by food
 Patients must be assessed individually for the effect of:
 Food on drug action
 Drug on nutritional status
 Drug nutrient interactions are of greatest potential significance to
those in poor nutritional state
 Proper planning of meal & drug schedules is necessary

3. Introduction
• Drug - Any chemical substance, natural or
manmade (usually excluding nutrients, water, or
oxygen), that - by its chemical nature - alters
biological structure or functioning when
administered and absorbed

4. Introduction
• Food - Edible or potable substance consisting of
nutritive components such as carbohydrates, fats,
proteins, essential mineral and vitamins, which
when ingested and digestion sustains life,
generates energy, and provides growth,
maintenance, and health of the body.

6. Therapeutic Importance
Therapeutically important interactions are
those that:
—Alter the intended response to the medication
—Cause drug toxicity
—Alter normal nutritional status

7. Therapeutic Importance
• Patient with chronic disease
• Elderly
• Fetus
• Infant
• Pregnant woman
• Malnourished patient

8. The People Perspective:
Food vs Drug

9. The People Perspective:
Food vs Drug
• Both Food and Drug are often classified
as separate entities but the truth is they
are alike in many ways.
• Health
• Survival
• Treatment
• Prevention

10. Drug-Food
Interactions

11. Food Intake
• May affect food intake by:
• Decrease or increase appetite
• Interfering with taste (altered/diminished taste
sensation)
• Leaving an unpleasant aftertaste - allopurinal
• Causing sore mouth – many cancer drugs
• Dry mouth
• Nausea &/vomiting

12. Examples of Drug Categories That May
Cause Loss of Appetite
• Antiinfectives- Metronidazole (Flagyl)
• Antineoplastics - Valstar
• Bronchodilators - Theophylline
• Cardiovascular drugs - Nifedipine

13. Examples of Drug Categories That May
Cause Loss of Appetite
Taste Buds
Taste aversions develop because
of Dysguesia.
Zinc depletion is one of the
causes.
Zinc is used in the repair and
replacement of taste buds.
Drugs bind to zinc
in saliva reducing
availability

14. Considerations: Foods that
improve appetite and nausea
Beef
is high
in zinc
Citrus fruits
remove
unwanted
tastes
Fibre absorbs stomach
acids and gastric irritants

15. Examples of Drug Classes That
Cause Nutrient Excretion
Drug Food/Nutrient Recommendation
Furosemide (Lasix) Potassium depleting Ripe Bananas, Baked
potatoes with skin,
callaloo
Thiazide Potassium depleting Ripe Bananas, Baked
potatoes with skin,
callaloo
Hydralizine Pyridoxine antagonist Cabbage, bok choy,
tuna, potatoes, bell
peppers
Methyldopa Constipation, Dry mouth Fibre and adequate
hydration

16. Acid Suppressing Drugs and
Antacids
Anciphex, Nexium, Prevacid, Pilosec, Protonix, Tagament, Zantac,
Pepcid and others
Classified as:
H2 antagonists: antagonizes histamine (H2) receptors on gastric
mucosal cells and reducing production and secretion of acid.
Proton pump inhibitors block the acid-transporter pump on the
luminal surface preventing acid from entering the gastric lumen.

17. Acid Suppressing Drugs and
Antacids
 Antacids directly neutralize existing acid in the stomach.
 Nutrient interaction:
 H2 antagonists deplete calcium, iron, zinc, folate, vitamin D and B12
 Proton pump inhibitors deplete vitamin B12

18. Acid Suppressing Drugs and
Antacids
• Calcium – Milk, Callaloo, cheese
• Iron – Callaloo, liver, chicken
• Folate – Beans, Lentils, lettuce
• Zinc – seafood, beef, nuts, callaloo
• Vitamin D – Milk fortified, Tuna, Sardines
• B12 – Chicken, Pork, Peef

19. Analgesics
Cause nausea, vomiting and GI upsets
When oral intake is permitted, giving the medication along with food
can minimize these side effects
Salicylates (Aspirin) – increases urinary loss of ascorbic acid,
potassium and amino acids.
Diet should emphasize potassium and ascorbic acid.

20. Anti-Hypertensives
Categories:
Ace Inhibitors, Angiotension Receptor blockers
(enalopril), Calcium Channel blockers (Nifedipine), Beta
Blockers (Propanolol), thizade diuretics
Works by reducing total peripheral resistance or by
reducing cardiac output or both

21. Anti-Hypertensives
• ACE Inhibitors deplete zinc
• Calcium channel blockers and thiazade diuretics deplete
potassium
• Beta blockers deplete coenzyme Q10
• Diet should be supplied with
• Adequate potassium: Bananas, potatoes, callaloo
• Q10: beef, poultry, herring

22. Anti-Hypertensives
 Diuretics: Lasix, Microzide (HCTZ), Zaroxolyn, Aldactone, Diamox
and others
 Nutrient Interactions:
 Depletion of Zinc, magnesium and potassium
 Potassium sparing diuretics deplete folic acid.

23. Cholesterol Lowering Drugs:
Statins
Lipitor, Crestor, Pravaschol, Zocor, Lescol, Mevacor and
others
Statins inhibit HMG reductase
Nutrient Interaction:
Q10 deficiency
Supplement with sources of:

24. Oral Hypoglycemics
• Biguanides: Metformin ( glucose
production in liver and Insulin sensitivity)
• Sulphonylureas: Diamicron MR ( Insulin
Production)
• Thiazolidinediones: Actos ( Insulin
sensitivity)
• DPP-4 Inhibitors : Januvia ( inhibits
DPP- 4

25. Oral Hypoglycemics
• Nutrient Interaction:
• Vitamin B12 and Folate deficiency
• Supplement with sources of:
B12 Folate
Shell fish Beans
Beef ( highest in liver) Callaloo
Fish (highest in mackerel) Lentils
Fortified cereal Avocado

26. Antianxiety Agents
• Benzodiazepines enhance the effect of the
neurotransmitter gamma-aminobutyric acid (GABA) at
the GABAA receptor, resulting in sedative, hypnotic
(sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant,
and muscle relaxant properties.

27. Antianxiety Agents
• Can cause drowsiness which interferes with food
intake
• Alprazolam and choldiazepoxide can stimulate
the appetite and lead to weight gain.
• Diazepam, lorazepam and oxazepan can cause
constipation, diarrhea or dry mouth.

28. Antianxiety Agents
• Nutrient interaction:
• Endogenous melatonin depletion
• Increase in metabolism of Vitamin D, reduction in Ca+ uptake
• Supplement Diet with sources of
Vitamin D:

29. Sedatives
• Sedation may lead to reduced food intake.
• Cause nausea
• Propofol
• a lipid based sedative that contains 1.1 kcal per milliliter
and can provide a significant amount of energy from fat.
• When propofol is provided to acutely stressed clients,
enteral and parenteral formulas must be adjusted to
avoid overfeeding.
DeChicco et al, 1995

30. Marijuana
• Recently decriminalized
• THC and CBD most studied cannabinoids.
Drugs available
• Dronabinol – used to treat appetite loss in patients living
with HIV/AIDS
• Nabilone – used to treat nausea and vomiting in patients
undergoing chemotherapy.
Haney et al, 2007

31. Marijuana
• Nutrition
Carbohydrates - fructose, galactose, arabinose, glucose, mannose, rhamnose,
sucrose, maltose and raffinose, cellulose, hemicellulose, pectin, xylan.
Fats - Linoleic acid (53–60% of total fatty acids), linolenic acid (15–25%), and
oleic acid.
Proteins – Edestin
(Brenneisen R, 2012)

32. References
• Brenneisen R (2012). Chemistry and Analysis of Phytocannabinoids and Other
Cannabis Constituents. Retrieved from:http://www.medicinalgenomics.com/wp-
content/uploads/2011/12/Chemical-constituents-of-cannabis.pdf
• Caribbean Food and Nutrition Institute (1994). Clinical Nutrition: Food – Drug
Interactions. Caribbean Food and Nutrition Institute.
• DeChicco R, Matarese L, Hummel A.C, Speerhas R. , Seidner D, Steiger E.
(1995). Contribution of Calories from Propofol to Total Energy Intake. Retrieved
from
website:http://www.sciencedirect.com/science/article/pii/S0002822395004386

33. References
• Haney M, Gunderson E.W, Rabkin J, Hart C.L, Vosburg S. K,Comer
S.D and Foltin R.W. (2007). Dronabinol and Marijuana in HIV-
Positive Marijuana Smokers Caloric Intake, Mood, and Sleep.
Retrieved from
website:http://www.safeaccess.ca/research/pdf/HaneyTHCCannabis
HIVAIDS2007.pdf
• Merk Manual (2016). Drug information. Retrieved from website:
http://www.merckmanuals.com/professional/appendixes/brand-names-of-s