Nutrition and Oral Medicine (Nutrition and Health)

Chapter 6 / Medications, Nutrition, Diet, and Oral Health 876 Impacts and InterrelationshipsBetween Medications, Nutrition,Diet, and Oral HealthMiriam R. Robbins1. INTRODUCTIONLong-term medication therapy is common, allowing increasing numbers of people tocontrol chronic illnesses and achieve improved quality of life. However, use of medicationsis rarely without side effect or risk, making prevention and management of medicationcomplications more challenging. As patients with chronic illness age, it is morecommon to encounter multiple medications directed at multiple organ systems, compoundingthe challenge of managing the adverse effects of, and interactions among,multiple medications. Drug–nutrient interactions and nutritional deficiencies are a potentialprimary problem with many medications, which can also lead to secondary oral healthcomplications. Likewise, medications can affect primarily the oral environment and havesecondary nutritional and diet consequences. This chapter reviews common drug-inducednutrient deficits and their mechanisms, drug-induced adverse oral conditions, and selectedinterrelationships between medications and nutritional and oral health.2. DRUGS AND NUTRITIONAL STATUSDrug-induced nutritional deficiencies may develop through various mechanisms,occurring through different physiologic pathways. Drugs can interfere with synthesis ofnutrients and alter the ability to transport, store, or metabolize nutrients. Nutrient depletioncan result either by preventing nutrient absorption, enhancing nutrient elimination,or both. Drugs, even in therapeutic doses, can interfere with nutrient utilization, especiallywhen the intake of nutrients is less than the demand or when nutrient stores are depleted(1). Vitamin and mineral deficiencies can result from poor nutrient absorption caused bybinding of nutrients to drugs, increased excretion, or impaired utilization. The inhibitionof gastrointestinal (GI) absorption of vitamins by cholestyramine; the enhancement ofpotassium, magnesium, and zinc excretion by thiazide diuretics; and the acceleration ofvitamin D metabolism and calcium depletion by anticonvulsants such as phenytoin andphenobarbital are well-documented examples (2).From: Nutrition and Oral MedicineEdited by: R. Touger-Decker, D. A. Sirois, and C. C. Mobley © Humana Press Inc., Totowa, NJ87