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Q: Too many dietary supplements? ( No Answer,   3 Comments )
Question  
Subject: Too many dietary supplements?
Category: Health > Medicine
Asked by: pratapchatterjee-ga
List Price: $75.00
Posted: 10 Jul 2004 10:15 PDT
Expires: 09 Aug 2004 10:15 PDT
Question ID: 372330
I am diabetic, hypertensive and have have osteoarthristis of the knee
joints. I take each day:Glucosamine 1500mg/Chondroitin 1200 mg+Grape
Seed Extract 200mg+Evening Primrose Oil(for GLA equivalent to
300mg)+Alpha Lipoic Acid 800mg+Fish Oil(Salmon Oil)2000mg. I have to
take usual antihypertensive medicines like
Atenolon+Amlodipine+Enalapril plus anti-diabetic medicines like
Metformin and Glicazide twice daily.
Plus vitamin supplements. Please advise about possible adverse
interactions and/or what changes if any is required to be made.My
blood gcucose level is around 140mgdl(fasting). I am not very strict
about dieting. Overweight.Lipid profile within normal limits. Liver
function tests satisfacory.  I am 53 years old.

Clarification of Question by pratapchatterjee-ga on 12 Jul 2004 20:26 PDT
I am taking all anti-hypertensive medications as per advise of physicians.

Clarification of Question by pratapchatterjee-ga on 12 Jul 2004 20:27 PDT
And I am not being treated for congestive heart failure.
Answer  
There is no answer at this time.

Comments  
Subject: Re: Too many dietary supplements?
From: dr_bob-ga on 12 Jul 2004 12:17 PDT
 
First, I'm not a real doctor, I just play one on google answers.  I
don't know much about nothin.  I am not a google answer guy.  I do
this for free, so you got what you paid for.


1.) The first thing that I see that distresses me is the use of
multiple medications for controlling your blood pressure. I believe
there is something that you are not sharing.  Are you currently being
treated for congestive heart failure? Many of these come with fun side
effects, adding all of them together in my hands, I honestly believe
would have me walking around feeling dizzy all day.

2.) Beta-blockers(atenolol) are generally believed to raise blood sugar levels.
http://diabetes.about.com/cs/hyperglycemia/p/blbetablockers.htm  Ask
your doctor why you're taking beta-blockers when it likely makes it
harder for you to control blood sugar levels.

3.) Amlodipine is a calcium chanel blocker.  If you are taking a
handful of pills each morning, and one of them is calcium, there is
significant evidence that you may be diminishing it's effects.  As
such, you may want to take your vitamin suppliments at a different
time than your medications.

4.)  Fish oils seem to be good for diabetic conditions, heart
problems, and osteoarthritis. Too much fat, can be a bad thing.  The
amount you're taking seems reasonable.

5.) Glucosamine had been implicated in some diabetic difficulty, but a
controlled study found no ill effects.
http://www.diabeteslibrary.org/news/news_item.cfm?NewsID=99
Glucosamine has not been shown to raise blood sugar levels.

5.) Too much crap is hard on your kidneys and liver. Maintaining an
electrolyte balance is important.  Talk to your doctor about salt
intake.  Drink enough water.  That means WATER.  Not soda, not tea,
not fruit juice or beer.  8 glasses a day--at least.

6.) If you are on this kind of medication, and you are overweight, and
not worried about your diet, perhaps you should be.  Eating a diet
rich in fresh vegetables will help your metabolism.  The right kind of
exercise will stabilize your blood glucose and help your blood
pressure immeasurably as well as improving overall quality of life.

7.) Above all, do not stop taking any medications unless directed by
your doctor and consult with him/her before beginning any strenuous
exercise program(especially if your blood sugar levels are very high).
Subject: Re: Too many dietary supplements?
From: purkinje-ga on 14 Jul 2004 15:47 PDT
 
Hey, I love these kinds of questions. (I?m just a 1st year med student
by the way.) Very insightful of you to wonder about drug interactions.
Now, just remember A) I?m not a doctor, and B) I?m not your doctor, so
I don?t know you, your history, etc.

There are at least three reactions that you should be on the look-out for: 
1) rash and itchiness, a result from your atenolol and enalapril.
2) weakness caused by hyperkalemia, also a result from your atenolol and enalapril.
3) Nausea from the fish oil and metformin.

All of these are explained better below. Let me go through each drug
so that you can relate each to your medical history, while I discuss
interactions.

Atenolol is a beta1selective antagonist, meaning that it mainly causes
the heart to not pump so hard and also blocking the release of a
hormone called renin (and without causing bronchoconstriction if
you?re asthmatic).  This reduces strain on the heart. The drug
accumulates in patients with renal failure. Dosage should be between
50 and 100 mg. Effective in hypertensice with a diuretic, but you?re
not taking diuretics because they can?t be given to diabetics.

Amlodipine is a calcium channel antagonist, which prevents calcium
from entering the smoot muscle cells that surround arteries. It is
more specific to smooth muscle than other drugs of this type, causing
less side effects on the heart. This prevents the muscle from
contracting too much, and lowers peripheral blood pressure (also
reducing strain on the heart.) These drugs were thought to be great in
theory, but in practice they have not been as successful as thought.
Amlodipine has shown improvement in patients with severe heart
failure, but no significant improvement in patients with nonischemic
cardiomyopathy. Drugs of this type are usually most effective in
treatment of heart failure from diastolic dysfunction, but are usually
not first-line therapy, and are usually reserved for patients who
can?t tolerate ACE inhibitors (like enalapril) or other vasodilators.
Usually 10 mg dose daily.

ACE (angiotensin converting enzyme) inhibitors such as enalapril are
very effective medicines with few side effects, esp. for diabetics
because they slow glomerulopathy (kidney disease). This works by
stopping the release of a hormone that constricts blood vessels, and
again lowering the strain on the heart. This is the preferred
first-line treatment for patients with left ventricular hypertrophy.
These types of drugs also enhance the effects of diuretics, but you
are not taking those, so no chance for interaction there.
ACE-inhibitors can increase potassium levels slightly, and this can be
enhanced by betablockers, so you may be experiencing hyperkalemia,
which you would notice as muscle weakness. This can be enhanced even
more if you take non-steroidal antiinflammatories like aspirin or
ibuprofen. Also, if you experience any signs of angioedema (swelling
and rash, itchiness) you should stop taking enalapril (and this
sometimes can be enhanced by the betablocker). This drug is given as
2.5-5 mg doses at first, and after time up to 40 mg daily.

Metformin is a biguanide drug, and is often given with a sulfonylurea
(which is what gliclizide is). It does not cause release of insulin
glucagons, cortisol, or anything. Instead, it decreases liver glucose
production and enhances insulin effects in muscle and fat, so it is
considered an antihyperglycemic. It rarely has been associated with
lactic acidosis, and should not be used if you have had cardiac
failure, renal disease, lung disease, or liver disease. Side effects
of this drug are diarrhea, nausea, metallic taste, and anorexia. Take
the drug with meals to reduce these effects, and don?t go long periods
without food. The drug inhibits absorbtion of vitamin B12 and folate,
but with calcium supplements the absorbtion of vitamin B12 is
normalized. Without B12 your blood cells slow their reproduction rate,
and this can have severe impairment of the nervous system, but this
would be rare with this drug. However, B12 is necessary for using odd
# fatty acids, which can be found in marine animals, such as the fish
oil you are taking. Without B12 you might have a buildup of
L-methylmalonyl CoA, which could possibly mimic the effects of
methylmalonyl academia (MMA) disorder (similar to ethylene glycol
poisoning). I?m not sure this has ever happened though; I?d have to
look into it more. Maximum dose is 2.5 g daily.

Gliclazide is a potent hypoglycemic. It works by stimulating insulin
release from the pancreas. Best when taken 30 minutes before eating.
Sulfonyl drugs can have lots of interactions with other sulfonyl
drugs, and can be kept in the body longer if taken with aspirin or
alcohol. Side effects of the drug include nausea and vomiting,
jaundice, anemia, skin reactions, and agranulocytosis. This drug
should not be used with type I diabetes, pregnancy, lactation, or
hepatic or renal insufficiency. Because of its short half-life (time
in the body) it should not cause the problem of causing hypoglycemia.

If you want I could look into how all these drugs interact with each
other and with liver enzymes (since many of these drugs have liver
cautions), but that would take a lot more time. Anyway, I hope this
helps! Too bad I?m not a google answer guy though!
Subject: Re: Too many dietary supplements?
From: purkinje-ga on 14 Jul 2004 15:50 PDT
 
Oh yeah, the fourth interaction, which I only slightly mentioned, is
from any anti inflammatories that you're taking for osteoarthrities,
which would enhance effect #2).

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