One in three adults in the US are taking both prescription medications and dietary supplements, creating a risk for dangerous interactions, according to a new study.
April 30, 2014 (Reuters)
Multivitamins with added ingredients like herbs and fish oil were the most common form of supplement mixed with medications, researchers found. “Multivitamins are commonly assumed to be safe, but our analysis suggests multivitamins, which may include multivitamin ‘plus’ combination products, can also contain botanical and herbal ingredients that have the potential to interact with prescription medications.” Harris Lieberman told Reuters Health. Lieberman, the study’s senior author, a researcher with the Military Nutrition Division of the US Army Research Institute of Environmental Medicine (USARIEM) in Natick, Massachusetts.
For their study, Lieberman and his colleagues, used information taken from the 2005-2008 National Health and Nutrition Examination Survey (NHANES), which represents the entire national population. The researchers focused on 10,480 adults (4,934 women who were not pregnant and 5,016 men) who answered survey questions about their dietary supplement and prescription medication use, as well as whether they had any of the following conditions: asthma, arthritis, congestive heart failure, coronary heart disease, angina, heart attack, stoke, high blood pressure, high cholesterol, emphysema, chronic bronchitis, cancer, weak bones or problems with the liver, thyroid or kidneys.
The researchers found that 47% of participants diagnosed with any of those medical conditions used both supplements and prescription medications. That compared to about 17% of adults who didn’t have those conditions, but were taking prescription medications for other reason, such as birth control pills or antidepressants. Overall, 34% of the participants – representing some 72 million people in the US – were taking some kind of dietary supplement along with a prescription medication. Cardiovascular medications were most likely to be used along with dietary supplements, followed by central nervous system agents, hormones, metabolism-related drugs, psychotherapeutic agents and antibiotics or antivirals.
Multivitamins containing other ingredients were more common that standard multivitamins. The ingredients most often added to the enhanced multivitamins included fish oil, botanicals, herbs, probiotics, fiber, enzymes, antacids and glucosamine and chondrotin.
Supplement use was most common among people with diagnosed osteoporosis, followed by those with thyroid, cancer, arthritis, cardiovascular, kidney, diabetes, respiratory and liver conditions.
The authors call the finding “concerning” because some herbal supplements are known to alter the way the liver metabolizes drugs, and can increase or weaken the potency of a medication. “Patients, especially those taking medications or given new prescriptions, should always inform their doctors about what dietary supplements they are taking, and doctors can help patients by asking about their supplements,” Lieberman said.
MY TAKE:
Drug – herb interactions are common, so common that I have a 700 page textbook on herbal safety. I am constantly looking for potential interactions in my patient population. The herbs are really quite safe, when taken properly; it’s the way in which they react to many drugs that is at issue.
Honestly, drug – drug interaction is a much bigger issue. For example, lovastatin, commonly prescribed to lower cholesterol (currently taken by 49% of the population over the age of 60) has 214 known drug interactions, representing 632 band and generic drugs on the market.
The average American takes four prescription medications with little or no knowledge about how these drugs interact. It is estimated that a third of all cases of senile dementia in our country are from overprescribed medications.
The multivitamin is not really an issue. Recent studies have found they have little if any value in human health. The “plus” combinations in many multiple supplements contain so little content that they are neither helpful nor harmful. As noted in an earlier blog, herbal quality in the US in non-existent. Contamination is a bigger issue in the “proprietary blend” of herbs noted on the label.
Silymarin (milk thistle), St. John’s Wort and Black Cohosh will either increase or decrease drug clearing time through the cytochrome P450 liver pathway. This is a common metabolic pathway for many prescription drugs. However there are alternatives when medications prevent safe use of these herbs.
Ginkgo is a potent blood thinner and should not be used with other blood thinners, like Coumadin. The blood thinning effects of fish oil are generally overstated.
THE BOTTOM LINE:
You should review all the "drug to drug" and "drug to herb" interactions of any prescription medications you take. Throw that multiple vitamin away, it’s worthless anyway. Please do not take herbs without consulting a qualified nutritionist. They are potent and can be harmful it not taken properly.
I believe people who take supplements with medications are just looking for help. The drugs don’t restore their quality of life and they just hope that supplements will be of some benefit.
Showing posts with label cytochrome P450. Show all posts
Showing posts with label cytochrome P450. Show all posts
Monday, May 12, 2014
Friday, May 2, 2014
Can Coffee Treat Liver Disease?
Findings show there may be benefits to drinking coffee.
April 14, 2014 (Medscape)
More that 2.25 billion cups of coffee are consumed each day throughout the world. Although coffee consumption varies from country to country, most Americans drink coffee daily. Despite early concerns about the damaging effects of coffee on health, contemporary studies suggest that coffee is beneficial for many medical disorders, including Parkinson disease, diabetes, symptomatic gallbladder disease, stroke, and chronic liver disease.
Coffee contains caffeine that is also found in tea and other plants. The quantity of caffeine present in each cup varies, but in general, approximately 85mg of caffeine is absorbed in the stomach and small bowel. It is metabolized through the liver by cytochrome P450. The half-life of caffeine is 4-6 hours.
Current studies suggest that caffeine binds to adenosine receptors and reduces the development of hepatic fibrosis from liver injury by limiting stellate cell activation and the secretion of connective-tissue growth factors and collagen.
Coffee appears to have a significant effect on all-cause mortality. The National Institutes of Health- American Association of Retired Persons Diet and Health Study involving 229, 119 men and 173,141 women demonstrated an inverse relationship between coffee consumption and mortality. In other words, coffee drinkers had a reduction in mortality compared with non-coffee drinkers.
Alcohol consumption and cigarette smoking can increase gamma-glutamyl transferase (GGT) levels. Coffee appears to reduce circulating levels of GGT. Green tea had no effect of GGT levels.
Alcoholic liver disease develops with excessive alcohol intake; women are at greater risk for alcoholic hepatitis at lesser quantities of alcohol-containing beverages than are men. Fatty liver is common in patients with excessive alcohol intake and cirrhosis develops in 10%-20% of those with chronic alcoholism.
Alcoholics who also drank coffee had a significant reduction in the risk for alcoholic cirrhosis. For alcoholics who also had hepatitis B or hepatitis C, the risk of developing advanced liver disease was also reduced if they also consumed coffee on a daily basis.
For patients with chronic HCV (viral hepatitis), coffee drinkers and those consuming caffeine-containing beverages are more likely to maintain normal aminotransferase (SGPT) levels or to reduce SGPT levels than are those with lower caffeine intake. No chronic HCV-infected patient drinking decaffeinated coffee had improvement of SGPT levels.
Primary liver cancer is the third leading cause of death in the world; more than 600,000 new cases develop annually, with a survival rate of 3%-5%. Hepatocellular carcinoma (HCC) risk factors include cirrhosis, HBV and HCV, alcohol, and cigarette smoking. Coffee consumption appears to reduce the risk for HCC in those at elevated risk.
Daily consumption of coffee appears to have a preventative effect on developing fibrosis in some liver diseases, especially alcoholic liver disease and NASH (non-alcoholic sterato-hepatitis). However, coffee consumption had no apparent effect of the development of NASH. In addition, some reduction in fibrosis was noted in all liver disease with daily consumption of coffee.
Although many treatments are available for chronic liver disease, alcoholics and patients with NASH who are unable to control their associated causal factors might benefit from drinking 2 or more cups or regular coffee daily.
MY TAKE:
This article contained a lot of research data that I eliminated. There were also forty references for sited material. If you would like to read the full article, please visit Medscape.com.
Regardless of its potential health benefits or issues, coffee is here to stay. As a coffee drinker, it is nice to find support for one of “my vices”. I have long advocated the use of organic coffee rather than decaf. I limit myself to one cup in the morning. To be honest, I don’t feel any “lift” from drinking it or any fatigue if I skip it. I do really enjoy the ritual of brewing a cup for my wife and myself, then sipping it as we share a couple of minutes each morning before going off to work.
The nerve synapes in your brain produce norepinepherine, a neurotransmitter, which normally stimulates other nerves and then is chemically dismantled. This whole chemical process takes place repeatedly in less than a second. Caffeine actually prevents the norepinepherine from being dismantled so the neurotransmitter continues to stimulate. I tell my patients that caffeine is not like pressing the gas pedal on a car, it more like not letting you use the brakes.
Much like other herbs (yes, I consider coffee an herb) the best use is based on scientific research. When there is little research (approximately 80 of the 1500 herbs used medicinally have had significant research), I depend on traditional use. If something has been used for thousands of years, it probably has merit. Coffee certainly fits in this category.
Liver dysfunction is almost universal in my practice. If I have a patient complete a symptom survey, liver shows up as the most common cause of symptoms virtually 100% of the time. I believe it is the hundreds of thousands of man-made chemicals in our environment that damages our livers.
The SGPT and GGT are enzymes that elevate in the blood stream when the liver is inflamed and liver cell death escalates. These enzymes are measured on the complete metabolic profile (CMP) that I routinely run in the office. Frequently these enzymes are elevated. NASH, hepatitis C, alcohol and drug abuse are common issues.
Often prescription drugs are the culprit. Statin drugs commonly elevate liver enzymes so these blood tests are run every six weeks on patients taking statins to reduce cholesterol. For patients who can not or will not discontinue these medications, coffee may reverse some of the negative effects of medication.
I believe the influence of caffeine on the cytochrome P450 pathway in phase 1 liver detoxification is responsible for much of the benefit associated with drinking coffee. Many drugs are processed through this important pathway. Coffee, like silymarin (milk thistle) and St. John’s Wort, support this pathway and have hepatorestorative (liver healing) effects.
THE BOTTOM LINE:
If you are a coffee drinker, then rejoice, the benefits seem to outweigh any negative issues. I highly recommend you drink organic coffee to avoid all those chemical additives. The additives in decaffeinated coffee are even worse, so just avoid it. If you have a liver issue, talk to your physician about drinking coffee. It may be of significant benefit for you. If you take any prescription medications, please review any possible conflict between coffee and the metabolism of your meds. You can visit www.drugs.com and review your medications. Check to see if the drug is metabolized through the cytochrome P450 pathway. If so, you might have an issue.
April 14, 2014 (Medscape)
More that 2.25 billion cups of coffee are consumed each day throughout the world. Although coffee consumption varies from country to country, most Americans drink coffee daily. Despite early concerns about the damaging effects of coffee on health, contemporary studies suggest that coffee is beneficial for many medical disorders, including Parkinson disease, diabetes, symptomatic gallbladder disease, stroke, and chronic liver disease.
Coffee contains caffeine that is also found in tea and other plants. The quantity of caffeine present in each cup varies, but in general, approximately 85mg of caffeine is absorbed in the stomach and small bowel. It is metabolized through the liver by cytochrome P450. The half-life of caffeine is 4-6 hours.
Current studies suggest that caffeine binds to adenosine receptors and reduces the development of hepatic fibrosis from liver injury by limiting stellate cell activation and the secretion of connective-tissue growth factors and collagen.
Coffee appears to have a significant effect on all-cause mortality. The National Institutes of Health- American Association of Retired Persons Diet and Health Study involving 229, 119 men and 173,141 women demonstrated an inverse relationship between coffee consumption and mortality. In other words, coffee drinkers had a reduction in mortality compared with non-coffee drinkers.
Alcohol consumption and cigarette smoking can increase gamma-glutamyl transferase (GGT) levels. Coffee appears to reduce circulating levels of GGT. Green tea had no effect of GGT levels.
Alcoholic liver disease develops with excessive alcohol intake; women are at greater risk for alcoholic hepatitis at lesser quantities of alcohol-containing beverages than are men. Fatty liver is common in patients with excessive alcohol intake and cirrhosis develops in 10%-20% of those with chronic alcoholism.
Alcoholics who also drank coffee had a significant reduction in the risk for alcoholic cirrhosis. For alcoholics who also had hepatitis B or hepatitis C, the risk of developing advanced liver disease was also reduced if they also consumed coffee on a daily basis.
For patients with chronic HCV (viral hepatitis), coffee drinkers and those consuming caffeine-containing beverages are more likely to maintain normal aminotransferase (SGPT) levels or to reduce SGPT levels than are those with lower caffeine intake. No chronic HCV-infected patient drinking decaffeinated coffee had improvement of SGPT levels.
Primary liver cancer is the third leading cause of death in the world; more than 600,000 new cases develop annually, with a survival rate of 3%-5%. Hepatocellular carcinoma (HCC) risk factors include cirrhosis, HBV and HCV, alcohol, and cigarette smoking. Coffee consumption appears to reduce the risk for HCC in those at elevated risk.
Daily consumption of coffee appears to have a preventative effect on developing fibrosis in some liver diseases, especially alcoholic liver disease and NASH (non-alcoholic sterato-hepatitis). However, coffee consumption had no apparent effect of the development of NASH. In addition, some reduction in fibrosis was noted in all liver disease with daily consumption of coffee.
Although many treatments are available for chronic liver disease, alcoholics and patients with NASH who are unable to control their associated causal factors might benefit from drinking 2 or more cups or regular coffee daily.
MY TAKE:
This article contained a lot of research data that I eliminated. There were also forty references for sited material. If you would like to read the full article, please visit Medscape.com.
Regardless of its potential health benefits or issues, coffee is here to stay. As a coffee drinker, it is nice to find support for one of “my vices”. I have long advocated the use of organic coffee rather than decaf. I limit myself to one cup in the morning. To be honest, I don’t feel any “lift” from drinking it or any fatigue if I skip it. I do really enjoy the ritual of brewing a cup for my wife and myself, then sipping it as we share a couple of minutes each morning before going off to work.
The nerve synapes in your brain produce norepinepherine, a neurotransmitter, which normally stimulates other nerves and then is chemically dismantled. This whole chemical process takes place repeatedly in less than a second. Caffeine actually prevents the norepinepherine from being dismantled so the neurotransmitter continues to stimulate. I tell my patients that caffeine is not like pressing the gas pedal on a car, it more like not letting you use the brakes.
Much like other herbs (yes, I consider coffee an herb) the best use is based on scientific research. When there is little research (approximately 80 of the 1500 herbs used medicinally have had significant research), I depend on traditional use. If something has been used for thousands of years, it probably has merit. Coffee certainly fits in this category.
Liver dysfunction is almost universal in my practice. If I have a patient complete a symptom survey, liver shows up as the most common cause of symptoms virtually 100% of the time. I believe it is the hundreds of thousands of man-made chemicals in our environment that damages our livers.
The SGPT and GGT are enzymes that elevate in the blood stream when the liver is inflamed and liver cell death escalates. These enzymes are measured on the complete metabolic profile (CMP) that I routinely run in the office. Frequently these enzymes are elevated. NASH, hepatitis C, alcohol and drug abuse are common issues.
Often prescription drugs are the culprit. Statin drugs commonly elevate liver enzymes so these blood tests are run every six weeks on patients taking statins to reduce cholesterol. For patients who can not or will not discontinue these medications, coffee may reverse some of the negative effects of medication.
I believe the influence of caffeine on the cytochrome P450 pathway in phase 1 liver detoxification is responsible for much of the benefit associated with drinking coffee. Many drugs are processed through this important pathway. Coffee, like silymarin (milk thistle) and St. John’s Wort, support this pathway and have hepatorestorative (liver healing) effects.
THE BOTTOM LINE:
If you are a coffee drinker, then rejoice, the benefits seem to outweigh any negative issues. I highly recommend you drink organic coffee to avoid all those chemical additives. The additives in decaffeinated coffee are even worse, so just avoid it. If you have a liver issue, talk to your physician about drinking coffee. It may be of significant benefit for you. If you take any prescription medications, please review any possible conflict between coffee and the metabolism of your meds. You can visit www.drugs.com and review your medications. Check to see if the drug is metabolized through the cytochrome P450 pathway. If so, you might have an issue.
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