Question I
I have encountered multiple incidences wherein a patient undergoing pharmacologic therapy using a certain drug manifested reactions after ingesting and or being exposed to foods that contain nutrients that created a conflict with the pharmacologic agent. Prior to the incident, I have been made aware, through course readings and discussions, about the different possibilities of nutrient to drug interactions. The nutrient to drug interaction I encountered involved an arthritic patient who was complaining about the localized dull aching pain on his left foot. The physician prescribed him with an NSAID (Non-Steroidal Anti Inflammatory Drugs). What the physician failed to note was that the patient was a chronic alcohol beverage drinker.
NSAIDs are often used by and prescribed to patients who have been diagnosed with a medication condition that includes inflammation in its list of manifestations. Arthritis, for the record, is a metabolic disease that is usually characterized by pain on a specific joint or joints coupled with symptoms of inflammation .
Normally, it is safe for people taking regular NSAID medications to simultaneously drink alcohol. The level of alcoholic beverage consumption should, however, be on moderate levels. Moderate levels of alcoholic beverage consumption can be somewhere around three to four units of alcohol a day for men; for women, two to three units is what is considered as moderate .
The patient will often start to show symptoms of a possible nutrient to drug complication when the patient starts to consume alcoholic beverages beyond the normal limits. One of the side effects of NSAIDs is direct and indirect gastrointestinal irritation. GI irritation occurs because the acidic properties of the molecules present in NSAIDs irritate the gastric linings and mucosa; the factors COX 1 and COX 2 become inhibited leading to increased secretion of gastric acid, diminished mucus-serves a protective function, secretion, and diminished bicarbonate secretion, all of which eventually lead to GI tract irritation .
One of the adverse effects of alcohol consumption is GI irritation as supported by the fact that the GI tract is the main site where alcohol gets absorbed by the body and gets delivered into the blood stream. When the alcohol comes in contact with the GI mucosal linings, metabolic changes that lead to GI irritation, and in cases of excessive and frequent alcohol intake GI bleeding, occurs.
Undergoing NSAID medication in conjunction with chronic and excessive alcohol intake may lead to excessive GI irritation and in worse cases, GI bleeding . In the patient’s case, the physician failed to ask the patient whether he is a chronic alcoholic beverage drinker or not. As a result, the patient showed signs of GI irritation, not bleeding. The NSAID medication therapy was temporarily stopped and the patient was instructed not to take the prescribed NSAID simultaneously with alcoholic beverages.
Question II
I looked in premium databases about the most common adverse effects of NSAIDs and alcoholic consumption. I was able to discover that NSAIDs often cause GI irritation, in most cases; and that alcohol too has the same adverse effect. The combined adverse effects of these two may lead to worse adverse effects for the patient such as GI bleeding.
Question III
Individuals who do not have any medical or pharmacological background about common Nutrient to Drug interactions often depend on the availability of information on the internet to answer their questions. While most of these sources are based on literatures, it cannot be guaranteed that they are one hundred percent reliable since there is no monitoring body that moderates and ensures the reliability of information on it. In determining the reputability of a source, I often check the citations they used and whether those citations are based on real-life trials or evidences, or are mere speculations. Naturally, I would consider citations based on evidences and experimental studies and trials as more credible than those that are based merely on speculations.
Question IV
I do not think that medical and healthcare professionals have met the challenge of helping people find suitable nutritional supplements mainly because of the sheer number of people resorting to self-prescription of nutritional supplements and in worse cases, self-prescription of medication for whatever common medical condition they may have. Socioeconomic status often play a big role with regards to this issue in a way that those in the upper class are usually the ones who are more informed and have access to more credible resources about nutrient to drug interactions while the opposite goes for those in lower socioeconomic classes. In an event that someone needs to determine if nutrient status was being compromised as a result of an interaction, tests may not be necessary as careful observation and physical examination done by a physician with a good comprehensive knowledge about the different pharmacologic drugs and agents and their side effects may suffice.
References
Andreasson, S., & Allebeck, P. (2005). Alcohol as medication is no good. More risks than benefits according to a survey of current knowledge. Lakartidningen.
Lee, A., Cooper, M., Craig, J., Knight, J., & Keneally, J. (2007). Effects of Nonsteroidal Anti Inflammatory Drugs on Postoperative Renal Function in Adults with Normal Renal Function. Cochrane Database of Systematic Reviews.
NHS. (2014). Anti-Inflammatories, Non-Steroidal Interactions. NHS.
Witter, J., & Dionne, R. (2004). What can Chronic Arthritis Pain Teach About Developing New Analgesic Drugs. Arthritis Res. Ther., 279.
