Food-Drug-Herb-Nutrient Interactions & Depletions

Section I | Drug-Food-Herb-Nutrient Interactions

1. Biography & Objectives
Welcome! Meet your instructor RoseMarie Pierce as she shares a bit about her professional background and journey to becoming a holistic pharmacist.

2. Terminology, Stats, Interactions & Evidence
To begin, RoseMarie introduces important terminology, statistics, and trends and speaks to the prevalence and risk of drug-food-herb-nutrient interactions and the evidence and identification of both interactions and depletions.

3. Mechanisms of Interactions  
Understanding the physiological mechanisms of interactions is essential before moving deeper into specific interactions. RoseMarie shares the pharmacokinetic basics and pharmacokinetic A.D.M.E. (absorption, distribution, metabolism, excretion). She introduces the role of metabolism and metabolic enzymes, and distinguishes between inducers and inhibitors. 

4. Pharmacokinetics: Metabolism & CYP3A4
Focusing on pharmacokinetic metabolism, RoseMarie introduces the most important CYP enzyme involved in drug metabolism, CYP3A4. She explains how both CYP3A4 and common drugs are induced by St. John’s Wort.

5. Pharmacokinetics: Distribution & Excretion
RoseMarie introduces how P-Glycoprotein (P-Gp), a transmembrane efflux pump, contributes to the distribution of drugs and toxins within the body. She also explains how St. John’s Wort induces P-Gp with certain drugs and how other substances can inhibit its function.

6.  Food & Natural Health Product Inhibitors
RoseMarie looks at several herbs and natural health products that inhibit the CYP enzyme and increase drug levels. She also focuses specifically on grapefruit juice and the drug categories it impacts via CYP enzyme inhibition. Other fruits are also addressed as potential inhibitors.

7. Factors Affecting CYP enzyme system
RoseMarie discusses the various diet, environmental, and lifestyle factors that can contribute to the induction or inhibition of the CYP enzymes and how they impact drug levels.

8. Pharmacokinetic Excretion & Absorption
Expanding on pharmacokinetic excretion, RoseMarie demonstrates how the absorption of calcium, magnesium, potassium, and iron are impacted by specific drugs and even phytochemicals within certain foods.

9.  Pharmacodynamic Interactions
RoseMarie looks at how certain foods and herbs can interact with a drug when they have the same effect on the body as the drug. She explores some of the dangers associated with these types of interactions.

10. Serotonin Syndrome
RoseMarie explains how the use of specific natural health products can lead to a life-threatening condition when combined with certain prescription and over-the-counter medications, or even illicit drugs.

11. Black Pepper & Black Pepper Extract
RoseMarie looks at how a chemical compound found within black pepper enhances the absorption of certain drugs and natural health products.

12. Hypertension & NHPs
RoseMarie explains how specific natural health products can impact blood pressure and potential precautions for those with a blood pressure-related condition.

13. Antihistamines as Anticholinergics
RoseMarie focuses on antihistamine as anticholinergic. First, she explains what anticholinergic substances are, and then she lists common antihistamines that have anticholinergic effects. RoseMarie then discusses the statistically significant association between anticholinergic drugs and dementia. Finally, she lists both the drug categories and herbs that have anticholinergic effects.

14. Iodine Interactions with Certain Drugs
RoseMarie demonstrates how iodine deficiency may be exacerbated by concurrent vitamin and mineral deficiencies and interactions that iodine has with a number of drug categories.

15. Daylight Saving Time & Melatonin
RoseMarie details several factors that influence melatonin levels and the public health ramifications associated with lower levels. She explains how the body synthesizes melatonin and the vitamin and mineral deficiencies associated with lower melatonin levels. 

Section II | Drug-Induced Nutrient Depletions

16. Drug Categories Responsible for Depletion
RoseMarie begins Section II by introducing the drug categories responsible for most nutrient depletions.

17.  Antibiotics
This lesson explores the first major category of drug-induced nutrient depletion. RoseMarie leads with a discussion on the national and global antibiotic crisis. She also explains how antibiotic use impacts the microbiome, what precautions to follow when taking antibiotics, and how to reestablish your gut flora. Finally, she details specific antibiotic categories and their associated nutrient depletions.

18. Oral Contraceptives, Estrogen, & HRT
RoseMarie presents the evidence associated with oral contraceptives, estrogen, and hormone replacement therapy and how they impact nutrient depletion. She also looks further into the depletion of an important trio of nutrients, magnesium, vitamin b6, and zinc, and the associated physiological implications.

19. Antidepressant & Anti-Anxiety Medications
RoseMarie discusses the nutrient depletions associated with both common anti-anxiety drugs and antidepressants, including Selective Serotonin Reuptake Inhibitors (SSRIs) and Tricyclics.

20. The Effect of Drugs on Melatonin
RoseMarie shifts her focus to melatonin and how this hormone is impacted by several drug categories via different mechanisms.

21. Cholesterol & the Statins
In this major drug category, RoseMarie first details the functions of cholesterol in the body and the conventional theory associated with the prescription of cholesterol-lowering drugs. She then explains the mechanisms by which statins work and illustrates how they interfere with an important pathway involved in the production of several other important body compounds. RoseMarie then explains the various side effects and toxicity of statin drugs and finishes the lesson by covering three categories of cholesterol-lowering drugs and the associated nutrient depletions.

22. Coenzyme Q10 
RoseMarie builds the connection between Coenzyme Q10 and statin drugs. She also covers other drug categories implicated in Coenzyme Q10 depletion.

23. Cardiovascular Drugs  
RoseMarie discusses several cardiovascular drugs and the nutrients they deplete. She also provides an explanation of how ACE inhibitors and Angiotensin Receptor Blockers work on the same biochemical pathway to stop high blood pressure. Lastly, RoseMarie expands her discussion on magnesium: how it is impacted by several other drug categories and the important roles it has on our physiology.    

24. Anti-Diabetic Drugs
RoseMarie discusses the nutrient depletions associated with certain common glucose-lowering drugs. She also delves into the topic of insulin-resistance and alternative strategies for treating it. Lastly, she discusses melatonin’s role in insulin and how that impacts Type 2 Diabetes patients.

25. Thyroid Replacement Medications
RoseMarie looks at common thyroid replacement medications and which nutrients they deplete. She also looks at certain toxic agents in these drugs and how they impact iodine in the body. Lastly, RoseMarie discusses how cruciferous vegetables and even smoking can impact the body’s uptake of iodine.

26. Miscellaneous Medications
RoseMarie covers miscellaneous medications and their associated nutrient depletions.

27. Anti-Inflammatory Medications
RoseMarie introduces common over-the-counter and prescription anti-inflammatory medications and the extensive list of nutrients they are associated with. She also offers some precautions and guidelines associated with taking Acetaminophen (Paracetamol). Lastly, RoseMarie offers her recommendations for vitamin, mineral, and superfood supplementation.

28. Acid-Reducing Drugs & Depletions
RoseMarie covers acid-reducing drug categories and the associated nutrient depletions. She also details the importance of maintaining alkalinity within the body and acid production within the stomach. She then shares her expertise on various stomach pH tests.

29. Electrolytes & Alkaline Minerals
RoseMarie explains how medications impact pH within the body. She also details the importance of electrolytes within the body, and the physiological effects associated with electrolyte depletion. Recommendations for electrolyte intake are provided. RoseMarie also provides an extensive list of alkaline-forming foods and a separate list of drugs that reduce bone density and cause Osteoporosis.

30. References & Conclusion
RoseMarie concludes the course by sharing a number of useful resources and provides some advice and guidance for those wishing to apply this knowledge to their practice.