Mechanisms and outcomesIron supplements are generally prescribed if serum iron levels are low. Poorly absorbed iron, typically from sources such as iron supplements, results in increased iron availability to the gut microbiota with consequentincrease in the virulence of faecal enteropathogens,increase in the ratio of faecal enteropathogens to protective microbiota such as bifidobacteria and lactobacillus,favouring of …

Potential research topicsNutrition research, including pharmaconutrition, is an interesting and challenging field, with an added dimension that is not essential to any other area of research – the reversibility/irreversibility component of physiological response that is integral to all findings. Do you want to be someone who contributes to good quality research in the area of …

Mechanisms and consequencesWhat do physiological transporters aka drug transporters and bus services have in common?Networks, hubs, defined load capacities and probably defined turnaround times.When we travel by bus, we have timetables, designated stops and hubs or stations where we can connect with the next bus to go to wherever we’re going.Seemingly the physiological transporters operate …

Potential research topicsIn the early 1990s a Canadian research team was investigating whether alcohol interacted with nifedipine/felodipine and unexpectedly found that the effects of these drugs were altered by concurrent intake with grapefruit juice – this was a seminal finding. Three questions arise from this findingwhat ingredient or ingredients caused the response in the grapefruit-drug …

Mechanisms and consequencesConfusion, falls or has poor balance, insomnia, and lethargy – would you immediately be trying to decide if this person is deficient in biotin or pantothenic acid? When I raised this at a Medication Advisory Committee meeting, all the committee members (GP, Clinical Care Co-ordinator, supplying pharmacist, Accredited Pharmacist) looked at me in …

Mechanisms and outcomesAbnormally high B12 levels are typically due to a medical disorder, however this article is specifically about elevated B12 levels due to ongoing therapeutic B12 interventions.Vitamin B12 interventions are commenced upon diagnosis of low B12 status, typically comprise high dose injections until levels are within acceptable range, and then the intervention is changed …

Potential research topicsTwenty years ago, this was a very short list! Of necessity this list has grown as there has been minimal research to address these and other questions. This is the first of a monthly 3-part series.Research topicsNutrition research, including pharmaconutrition, is an interesting and challenging field, with an added dimension that is not …

Mechanisms and consequencesMetformin and proton pump inhibitors both decease vitamin B12 absorption, and decrease thiamine availability.Metformin is the fourth most commonly prescribed medicine in the world, and was discovered and developed in the late 1950’s; the evidence that it negatively impacts vitamin B12 status has also been consistently published since the late 1950’s. Even after …

Mechanisms and consequencesThis trifecta has been prescribed since admission and likely before then; in this instance the trifecta refers to a proton pump inhibitor (PPI) plus frusemide and digoxin. This trifecta significantly impacts magnesium status by:PPI inhibition of magnesium absorption,frusemide and digoxin both increasing magnesium excretion.Magnesium replacement quantity unknownWe do not know how much magnesium …

Mechanisms and consequencesCommonly the pre-breakfast BSLs may be the only routine monitoring strategy for those with long term diabetes and deemed relatively stable and further daily monitoring is rarely considered. Therefore, people with diabetes and who are also prescribed prednisolone may be experiencing regular afternoon hyperglycaemia and no-one is aware. Prednisolone has a time to peak …

Mechanisms and consequencesMedication Advisory Committees (MACs) are an ideal forum for addressing a range of issues that have a medication:nutrition interface. MACs activities include:addressing immediate administration issues that may compromise the care of the resident,the development of policies and procedures to improve drug management issues, andeducation of Committee members and facility staff.Medication Advisory Committees issuesDrugs …

Mechanisms and consequencesIron supplements are generally prescribed if serum iron levels are low and there is rarely any further intervention if iron status does not improve. Apart from possible “bleeds” we do not typically consider other causes of low iron status.Common causes of low iron levels1. Lack of nutrients necessary for haemoglobin formation. Examples include …

Mechanisms and consequencesMembrane transportersMembrane transporters are euphemistically called “drug transporters” however their primary role is to move physiological substances to sites requiring their presence. There is a lot of drug company interest in transporters for 2 reasons, being – US FDA now requires this information to be included in drug discovery submissions, and drug companies consider they …

Welcome!Welcome to the first edition of our weekly email – and thank you for your interest in pharmaconutrition. The content format is based on a short editorial plus a case study – questions and comments are welcome.Perceived value of research format “I am not interested in any research that is not randomized, blinded and includes a …