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8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 173
Drug-HerbDrug-Nutrient
Interactions amp Depletions
Mario Roxas NDACHS 2010
Portland OR
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 373
144million
Source Health United States 2009 table 95httpwwwcdcgovnchsdatahushus09pdf095
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 473
$287billion
Source Consumer Reports
httpwwwconsumerreportsorghealthprescription-
drugsbest-drugs-for-lessoverviewbest-drugs-for-lesshtm
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 573
$94billion
Source Nutritional Supplements in the US 4th Edition
httpwwwpackagedfactscomNutritional-Supplements-Edition-2642045
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 373
144million
Source Health United States 2009 table 95httpwwwcdcgovnchsdatahushus09pdf095
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 473
$287billion
Source Consumer Reports
httpwwwconsumerreportsorghealthprescription-
drugsbest-drugs-for-lessoverviewbest-drugs-for-lesshtm
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 573
$94billion
Source Nutritional Supplements in the US 4th Edition
httpwwwpackagedfactscomNutritional-Supplements-Edition-2642045
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 373
144million
Source Health United States 2009 table 95httpwwwcdcgovnchsdatahushus09pdf095
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 473
$287billion
Source Consumer Reports
httpwwwconsumerreportsorghealthprescription-
drugsbest-drugs-for-lessoverviewbest-drugs-for-lesshtm
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 573
$94billion
Source Nutritional Supplements in the US 4th Edition
httpwwwpackagedfactscomNutritional-Supplements-Edition-2642045
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 473
$287billion
Source Consumer Reports
httpwwwconsumerreportsorghealthprescription-
drugsbest-drugs-for-lessoverviewbest-drugs-for-lesshtm
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 573
$94billion
Source Nutritional Supplements in the US 4th Edition
httpwwwpackagedfactscomNutritional-Supplements-Edition-2642045
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 573
$94billion
Source Nutritional Supplements in the US 4th Edition
httpwwwpackagedfactscomNutritional-Supplements-Edition-2642045
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 673
Top 20 Prescription Drugs in 2009in units sold
1 Lipitor
2 Nexium
3 Plavix
4 Singulair5 Lexapro
6 Pro-Air HFA
7 Synthroid
8 Crestor9 Advair Diskus
10Diovan
11 Cymbalta
12 Effexor XR
13 Klor-Con
14 Prevacid15 Diovan HCT
16 Actos
17 Flomax
18 Seroquel19 Levaquin
20 Tricor
(httpwwwdrugscomtop200_unitshtml)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 773
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Clinical Indication
bull Cholesterol-lowering medication
Actionbull Inhibits HMG CoA Reductase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 873
Tricor(fenofibrate)
Clinical Indication
bull Cholesterol-lowering medication
Action
bull Fibrate ndash Peroxisome proliferator-activated receptoralpha (PPAR-α) agonist
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 973
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1073
HMG-CoA Reductase
Pathway
Source enImageHMG-CoA_reductase_pathwaypng
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1173
PPAR-alpha Pathway
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1273
CoQ10
Nutrient Depletion
bull Coenzyme Q10
ndash Decreases CoQ10 serumlevels
ndash Consider supplementation
w CoQ10
ndash 100 mgday prevented
Q10 drop
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1373
Statins can reduce serum levels of
coenzyme Q 10 by up to 40
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1473
Lipitor (atorvastatin)
Crestor (rosuvastatin)
Nutrient Interaction
bull Niacin ndash Concomitant use may increase potential for myopathies
bullL-Arginine ndash Coadministration may enhance triglyceride-lowering effect
bull Vitamin A ndash Higher blood vitamin A levels found in individuals taking
HMG CoA reductase inhibitors for 2 years
ndash Unknown mechanism (hepatic storage)
bull Vitamin D ndash Deficiency may increase risk of myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1573
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1673
Statins and Niacin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1773
Statins and L-Arginine
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1873
Low Vitamin D a Cause of Statin-induced Myositis-Myalgia
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 1973
Tricor(fenofibrate)
Nutrient Interaction
bull CoQ10
- May deplete natural stores
- Concurrent supplementation may be
beneficial
bull Vitamin E
- May deplete natural stores in liver
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2073
Tricor (fenofibrate) and CoQ10
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2173
Tricor (fenofibrate) and vitamin E
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2273
Red Yeast Rice(Monascus purpureus)
Monacolin K (aka mevinolin)
The HMG-CoA reductase activity of red yeast ricecomes from a family of naturally occurringsubstances called monacolins
Monacolin K is the ingredient in red yeast rice thatMerck amp Co pharmaceutical manufacturer ofMevacorsbquo (lovastatin) asserts is a patentedpharmaceutical
However red yeast rice contains a family of ninedifferent monacolins all of which have the ability to
inhibit HMG-CoA reductase
Other active ingredients in red yeast rice includesterols (betasitosterol campesterol stigmasterolsapogenin) isoflavones and monounsaturated fattyacids
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2473
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2573
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2673
Nexium (esomeprazole)
Prevacid (lansoprazole)
Clinical Indication
bull Hyperchlorhydria GERD
Action
bull Proton Pump Inhibitors
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2773
Nexium (esomeprazole)
Prevacid (lansoprazole)
Nutrient Depletion
bull Beta Carotene
bullVitamin B12
bull Folates
bull Calcium
bull Chromium
bull
Copperbull Iron
bull Selenium
bull Zinc
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2873
Plavix(clopidrogrel)
Clinical Indication
bull StrokeMI Prevention
Action
bull Anti-platelet agent -
Specifically inhibits P2Y12 ADP
receptors involved in platelet
aggregation
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 2973
Plavix
(clopidrogrel)Nutrient Interaction
Depletion
bull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3073
Warfarin-induced Atherosclerosis
In rats arterial calcification was induced by warfarin and reversed by vitamin K
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3173
Warfarin-induced Atherosclerosis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3273
Is Vitamin K Really Contraindicated with Warfarin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3373
Is Conventional Wisdom Really Wise
bull double-blind 6-month RCT
bull n=70 patients on warfarin
with unstable anticoagulation
bull 150 mcgday vit K or placebo
bullK supplementation resulted in
significant decrease in
variation of INR
bullK supplementation alsoresulted in sig increase in of
time within target INR range
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3473
Is Conventional Wisdom Really Wise
Conclusion Small series of 8 patients poorly controlled on warfarin 100 mcg K
daily ldquosignificantly increased the number of INRs in range as well as the time in
range and decreased INR fluctuation in this small series of selected patientsrdquo
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3573
Bottom line on Vitamin K and Anticoagulants
Wise to avoid high doses of vitamin K in patients on
anticoagulant therapy
Low-dose ndash 100-150 mcg ndash may actually benefit
patients on warfarin
Need to do in conjunction with prescribing doctoras would need to adjust warfarin dose accordingly
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3673
Seroquel
(quetiapine)
Clinical Indication
bull Schizophrenia Bipolar
Disorder Depression
Action
bull
Atypical antipsychotic
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3773
Seroquel(quetiapine)
Nutrient InteractionDepletion
bull No established cases
bull But one food to avoid isgrapefruit
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3873
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Indication
bull Depression
bull Anxietybull Peripheral
neuropathy
(Cymbalta)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 3973
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
Action
bull Selective Serotonin
Reuptake Inhibitor(SSRI) Selective
Serotonin and
Norepinephrine
Reuptake Inhibitor(SSNRI)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4073
Lexapro (escitalopram)Cymbalta
(duloxetine)Effexor XR (venlafaxine)
HerbNutrient Interactions
bull St Johns wort
bull 5-HTPL-tryptophan
bull Chromium
bull Zincbull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4173
ldquoI want a new drugrdquo- Huey Lewis
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4273
5-MTHF(5-methyltetrahydrofolate)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4373
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4473
5-MTHF
(5-methyltetrahydrofolate)
bull J Clin Psychopharmacol 2003 Jun23(3)309-13
bull Prediction of treatment response in geriatric depression frombaseline folate level interaction with an SSRI or a tricyclicantidepressant
bull Alpert M Silva RR Pouget ER
bull
Department of Psychiatry New York University Medical Center 550First Avenue New York NY 10016 USA
bull Abstract
bull Depressed geriatric patients have lower levels of folate (FOL) thancontrols Also FOL supplement can reduce depressive morbidityOne hypothesis consistent with this is that FOL deficiency causes alowering of CNS serotonin that contributes to depression Thepresent report is from one site of a multicenter study that comparedan SSRI (sertraline) with a nonspecific tricyclic antidepressant(nortriptyline) in geriatric depressed patients We added measures ofFOL at baseline and outcome for 22 depressed patients older than 60years Both treatments were effective At baseline FOL levels werewithin the normal range Higher FOL levels at baseline predictedgreater improvement Further study of FOL interaction with SSRI iswarranted For the group treated with the SSRI baseline FOL levelwas a more efficient predictor of improvement especially for resultson a self-rating depression scale (POMS)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4573
5-MTHF
(5-methyltetrahydrofolate)
Ann Clin Psychiatry 2002 Mar14(1)33-8
Folinic acid (Leucovorin) as an adjunctive treatment for
SSRI-refractory depressionAlpert JE Mischoulon D Rubenstein GE Bottonari K Nierenberg AA Fava MDepression Clinical and Research Program Department of Psychiatry Massachusetts
General Hospital Boston 02114 USA jalpertpartnersorg
Abstract
Low folate is associated with poorer response to selective serotonin reuptake
inhibitors (SSRIs) in major depressive disorder (MDD) Folate supplementation
in MDD has been studied in other settings with promising results The
objective of this study was to assess the efficacy of methylfolate as an
adjunctive treatment among adults with MDD and inadequate response to an
SSRI Twenty-two adults (59 female mean age 452 +- 110 years) withDSM-IV MDD partial or nonresponse to an SSRI after at least 4 weeks of
treatment and a 17-item Hamilton Depression Rating Scale (HAM-D-17) score
gt or = 12 were enrolled in this 8-week prospective open trial Exclusion criteria
included current use of anticonvulsants or psychotropics other than an SSRI or
B12 deficiency Leucovorin (folinic acid) which is metabolized to methylfolate
was added to SSRIs at 15-30 mgday Folate levels rose from 28 +- 19 ngmL
to 301 +- 203 ngmL (p lt 0001) HAM-D-17 scores among the 16 completers
decreased from 191 +- 39 to 128 +- 70 (p lt 001) However only 31 of
- -
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4673
Singulair
(montelukast)
Indication
bull Asthma
bull Seasonal Allergies
Action
bull Leukotriene inhibitor
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4773
Singulair(montelukast)
Nutrient Interaction
Depletion
bull
No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4873
ProAir HFA(albuterol inhalation)
Indication
bull AsthmaCOPD
Action
bull Beta-II-adrenoceptor agonistbronchodilator
Nutrient InteractionDepletion
bull
Calciumbull Magnesium
bull Potassium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 4973
Advair Diskus(fluticasone and salmenterol)
Indication
bull AsthmaCOPD
Actionbull Corticosteroidbeta-agonist
combination inhaler forbronchodilation and anti-
inflammatory supportNutrient Depletion
bull Calcium
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5073
Advair Diskus(fluticasone and salmenterol)
Nutrient Depletion (cont)
bull Magnseium
bull
Potassiumbull Selenium
bull Zinc
bull
Folatebull Vitamin C
bull Vitamin D
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5173
Synthroid(levothyroxine)
Indication
bull Hypothryoidism
Action
bull Synthetic thyroid hormone
Nutrient InteractionDepletion
bull Iron
bull Soybull Bugleweed (Lycopus spp)
bull Lemon Balm (Melissa officinalis)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5273
DiovanDiovan HCT(valsartan and hydrochlorothiazide)
Indication
bull Hypertension CHF post-MI
Action
bull
Angiotensin II receptor agonistthiazide diuretic combination
Nutrient Depletion
bull Magnesium
bull
Phosphorousbull Potassium
bull Sodium
bull Zinc
Di Di HCT
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5373
DiovanDiovan HCT
(valsartan and hydrochlorothiazide)
Pezza V Bernardini F Pezza E et al Am J Hypertens 1998111267-1270
Nutrient Interaction
bull L-Arginine
ndash Co-administration may
improve blood pressure in
essential hypertension
l
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5473
Indication
bull Hypokalemia
Action
bull Prevention of hypo-kalemia
Nutrient InteractionDepletion
bull No established cases
Klor-Con(potassium hydrochloride)
A
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5573
Indication
bull Anti-diabetic agent
Action
bull Thiazolidinedione
Nutrient InteractionDepletion
bull No established cases
Actos(pioglitazone)
Fl
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5673
Flomax(tamsulosin)
Indication
bull BPH
Action
bull Alpha-adrenergic blocker
Nutrient InteractionDepletionbull No established cases
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5773
L i
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5873
Action
bull
Antibiotic
Nutrient Depletion
bull Vitamin K
bull Magnesium
bull Quercetin
Levaquin(levofloxacin)
Nutrient DepletionInteractions
bull Bifidobacterium bifidum
bull Lactobacillus acidophilus
bull Biotin
bull B Vitamins
bull Calcium
bull Iron
Levaquin
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 5973
Levaquin
(levofloxacin)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6073
Lactobacillus sporogenesbull Spore-forming highly stable
Bacillus organism
bull Also known as Bacillus
coagulans
Saccharomyces boulardii
bull a subspecies of
Saccharomyces cervesiaebull Beneficial yeast for the GI
tract
Celebrex
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6173
Celebrex(celecoxib)
Indication
bull OsteoarthritisRheumatoidarthritis
Action
bull Sulfa non-steroidal anti-inflammatory drug (NSAID)
COX-2 InhibitorNutrient Depletion
bull Folate
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6273
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6373
THE CURCUMIN COMPLEX
Three main polyphenols
Curcumin I
Demethoxy-curcumin (Curcumin II)
Bis-demethoxy-curcumin (Curcumin III)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6473
THE CURCUMIN COMPLEX
Over 3000 scientific articles
Antioxidant
Anti-inflammatory Joint Protective
GI Protective
Modulates cholesterol
Improves blood vessel function
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6573
Extensive research within the past two decades has shown that curcuminmediates its anti-inflammatory effects through the down regulation of
inflammatory transcription factors (such as nuclear factor Kappa B) enzymes
(such as cyclooxygenase 2 and 5 lipoxygenase) and cytokines (such as tumor
necrosis factor interleukin 1 and interleukin 6)
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6673
CURCUMIN
Anti-Inflammatory Mechanisms of Action
Inhibition of NF-kB Downregulation of COX-2
Inhibition of lipoxygenase
Inhibition of inducible nitric oxide synthase
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6773
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6873
Aim A proprietary complex of curcumin with soy phosphatidylcholine (Merivareg Indena SpA) was evaluated
in a registry study to define its efficacy in 50 patients with osteoarthritis (OA) at dosages corresponding to
200 mg curcumin per diem
MethodsOA signssymptoms were evaluated by the WOMAC scores Mobility was studied by walking
performance (treadmill) and inflammatory status was assessed by measurementsof C-reactive protein (CRP)
Results After three months of treatment the global WOMAC score decreased by 58 (Plt005) walking
distance in the treadmill test was prolonged from 76 m to 332 m (Plt005) and CRP levels decreased from
168 plusmn 18 to 113 plusmn 41 mgL in the subpopulation with high CRP In comparison the control group
experienced only a modest improvement in these parameters (2 in the WOMAC score from 82 m to 129 m
in the treadmill
test and from 175 plusmn 123 to 112 plusmn 222 mgL in the CRP plasma concentration) while the treatment costs(use of anti-inflammatory drugs treatment and hospitalization) were reduced significantly in the treatment
group
Conclusion These results show that Merivareg is clinically effective in the management and treatment of
osteoarthritis and suggests that the increased stability and better absorption of curcumin induced by
complexation with phospholipids has clinical relevance and sets the stage for larger and more prolonged
studies
PANMINERVA MED 201052
50 patients
250 mg bid of curcuminphospholipid combo (200 mg
curcuminday)
Significant improvement in CRP
Significant improvement in walking distance
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 6973
CURCUMIN amp CANCER
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7073
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7173
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7273
Conclusions
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you
8132019 Drug Induced Nutrient Depletion
httpslidepdfcomreaderfulldrug-induced-nutrient-depletion 7373
Thank you