how to grow vitamin sales in your practice

How to Grow Vitamin Sales in Your Practice with Pamela Smith, M.D., MPH, MS

PRESENTED BY:

• Three nutrients for all patients • Nutritional depletions caused by

medications • Nutritional therapies for clinical conditions

Three Great Ways to Increase Nutritional Sales

Three Nutrients For All Patients

PRESENTED BY:

• Multivitamin • Probiotics • Omega-3-Fatty Acids

Three Nutrients

Nutritional Depletions Caused by Medications

PRESENTED BY:

• Pelton, R. and LaValle, J., The Nutritional Cost of Drugs. 2nd Ed. Englewood, CO: Morton Publishing Company, 2004.

• Smith, P., What You Must Know About Vitamins, Minerals, Herbs, and More. Garden City Park, NY: Square One Publishers, 2008.

• Braun, L., and Cohen, M., Herbs and Natural Supplements: An Evidence-Based Guide. 4th Ed. Volume 2. Australia: Elsevier, 2015.

References

PRESENTED BY:

• It is estimated that about 30% of side effects from medications are related to drug-induced pharmaceutical deficiencies.

Vagnini, F., et al., “Preventing pharmaceutical-induced nutrient deficiencies,” Life Extensions March 2006; p. 72-9.

Nutritional Deficiencies Caused by Medications

PRESENTED BY:

• Taking aluminum antacids may deplete the body of/increase the need for/or interfere with the activity of the following nutrients.

Vitamin A Folic acid Vitamin D Calcium Chromium Iron Magnesium Phosphorus Zinc

Aluminum Antacids

PRESENTED BY:

• Cashman, K., et al., “Optimal nutritional: calcium, magnesium, and phosphorus,” Pro Nutr Soc 1999; 58:477-87.

• Herzog, P., “Effect of antacids on mineral metabolism,” Z. Gatroenterol 1983; 21(Suppl):177-26.

References

PRESENTED BY:

• Taking this medication may deplete the body of/increase the need for/or interfere with the activity of the following nutrients.

Coenzyme Q-10 Melatonin

Atenolol/Propranolol

PRESENTED BY:

Biotin Inositol Thiamine Riboflavin Niacin

Ciprofloxacin

Vitamin B6 Vitamin B12 Vitamin K Zinc Bifidobacteria bifidum,

Lactobacillus acidophilus

PRESENTED BY:

Beta-carotene Folic acid Vitamin A Vitamin B12 Vitamin D Vitamin E Vitamin K Iron

Colesevelam (WelChol)

PRESENTED BY:

Thiamine Calcium Magnesium Phosphorus Potassium

Digoxin (Lanoxin)

PRESENTED BY:

Vitamin B6 Magnesium Phosphorus Potassium Sodium Zinc Coenzyme Q-10

Enalapril Plus Hydrochlorothiazide (Vaseretic)

PRESENTED BY:

Folic acid Thiamine Vitamin B12 Vitamin D Calcium Iron Zinc

Famotidine (Pepcid)

PRESENTED BY:

Melatonin

Fluoxetine (Prozac)

PRESENTED BY:

Vitamin A Folic Acid Vitamin B6 Vitamin C Vitamin D Vitamin K Calcium Magnesium

Fluticasone (Flonase)

Potassium Selenium Zinc Melatonin

PRESENTED BY:

Thiamine Vitamin B6 Vitamin C Calcium Chloride

Furosemide (Lasix)

Magnesium Phosphorus Potassium Sodium Zinc

PRESENTED BY:

• Zenuk, C., et al., “Thiamine deficiency in congestive heart failure patients receiving long-term furosemide therapy,” Can Jour Clin Pharmacol 2013; 10:184-88.

References

PRESENTED BY:

Folic acid Vitamin B12 Sodium Coenzyme Q-10

Glyburide and Metformin (Glucovance)

PRESENTED BY:

Glutathione Selenium

Hydrocodone and Acetaminophen

PRESENTED BY:

Folic acid Vitamin D Calcium Iron Phosphorus Zinc

Magnesium Hydroxide (MOM)

PRESENTED BY:

Beta-carotene Folic acid Thiamine Vitamin B12 Iron Sodium Zinc

Omeprazole (Prilosec)

PRESENTED BY:

Folic acid Magnesium Tyrosine Riboflavin Niacin

Oral Contraceptives That Contain Synthetic Estrogen and Progestin

Vitamin B6 Vitamin B12 Vitamin C Zinc

PRESENTED BY:

Folic acid Vitamin C Iron Potassium Sodium

Oxycodone Plus ASA (Percodan)

PRESENTED BY:

Biotin Folic acid Thiamine Vitamin B12 Vitamin D

Phenytoin (Dilantin)

Vitamin K Calcium Phosphorus Carnitine

PRESENTED BY:

Vitamin A Vitamins B6 & B12 Folic acid Vitamin C Vitamin D Vitamin K

Prednisone

Calcium Magnesium Potassium Selenium Zinc Chromium

PRESENTED BY:

Vitamin B6 Magnesium

Raloxifene (Evista)

PRESENTED BY:

Thiamine Folic acid Vitamin B12 Vitamin D Calcium Iron Zinc

Ranitidine (Zantac)

PRESENTED BY:

Magnesium Phosphorus Potassium Sodium Zinc Coenzyme Q-10

The Sartans (Micardis/Diovan)

PRESENTED BY:

Beta-carotene Vitamin E Coenzyme Q-10

Simvastatin (Zocor)

PRESENTED BY:

Biotin Folic Acid Inositol Thiamine Riboflavin Niacin Vitamin B6 Vitamin B12

Tetracycline

Vitamin C Vitamin K Calcium Iron Magnesium Zinc Bifidobacteria bifidum Lactobacillus acidophilus

PRESENTED BY:

Thiamine Vitamin B6 Phosphorus

Theophylline

PRESENTED BY:

Chromium Iron Manganese Phosphorus Folic acid

Tums (Calcium Carbonate)

Nutritional Depletions by Class of Drug

Antacids

PRESENTED BY:

• Antacids that contain magnesium and aluminum hydroxide deplete the body of calcium, phosphate, and folic acid.

D’Erasmo, E., et al., “Drug induced osteomalacia,” Recenti Prog Med 1998; 89(10): 529-33.

• Antacids that contain sodium bicarbonate deplete the body of potassium and folic acid.

Rhodes, J., “Side effects of antacids treatments,” Antacids in the Eighties. Halter F, (Ed.) Munchen, Germany: Urban & Schwarzenberg, 1982; p.99-102.

Antacids

PRESENTED BY:

• Antacids deplete the body of folic acid. Russell, R., et al., “Effect of antacid and H2 receptor

antagonists on the intestinal absorption of folic acid,” Jour Lab Clin Med 1988; 112:458-63.

Antacids (Cont.)

Antibiotics

PRESENTED BY:

• Antibiotics destroy the good bacteria in the GI tract which causes the following nutritional deficiencies

B vitamins: B1, B2, B3, B5, B6, B12, biotin, inositol, folate

Vitamin K

Antibiotics in General

PRESENTED BY:

• Isoniazid depletes the body of B3, B6, vitamin D and calcium.

• Ethambutol depletes the body of zinc and copper.

• Rifampin depletes the body of vitamin D. • Cyclosporine depletes the body of vitamins

B3, B6, B12, calcium, magnesium, vitamin K and folic acid.

• PABA depletes the body of B12.

Antibiotics That Treat TB

PRESENTED BY:

• Harkness, R., et al., “Mosby’s Handbook of Drug- Herb and Drug-Supplements Interactions. St. Louis: Mosby, 2003.

References

PRESENTED BY:

• Aminoglycosides deplete the body of the following.

Calcium

Nitrogen

Potassium

Sodium

Vitamin A & beta-carotene

Aminoglycosides

Most of the B vitamins

Vitamin K

Magnesium

Friendly GI bacteria

PRESENTED BY:

• Elliott, C., et al., “Gentamycin effects on urinary electrolyte excretion in healthy subjects,” Clin Pharm Ther 2000; 67:16-21.

References

PRESENTED BY:

• Hydroxychloroquine as hydroxyquinone given to patients that are on long-term dialysis decreases the levels of calcium and vitamin D.

Antimalarial Antibiotics

PRESENTED BY:

• Penicillins deplete the body of the following. Potassium

All B vitamins

Vitamin K

Vitamin C

Penicillins

PRESENTED BY:

• Tetracyclines deplete the body of the following nutrients.

Calcium

Magnesium

Tetracycline Antibiotics

Vitamins B6 and B12

Vitamin K

Vitamin C

PRESENTED BY:

• Trimethoprim depletes the body of folic acid.

Trimethoprim

PRESENTED BY:

• Sulfa drugs and trimethoprim deplete the body of the following nutrients.

Biotin

Folic acid

Inositol

B vitamins

Vitamin K

Sulfa Drugs and Trimethoprim

PRESENTED BY:

• Macrolides deplete the body of the following. Vitamins B1, B2, B3, B6, B12

Folic acid

Vitamin K

Biotin

Inositol

Macrolides

PRESENTED BY:

• Quinolones deplete the body of the following. Vitamins B1, B2, B3, B6, B12

Folic acid

Vitamin K

Biotin

Inositol

Fluroquinolones

Calcium

Magnesium

Potassium

PRESENTED BY:

• Cephalosporins deplete the body of the following.

Vitamins B1, B2, B3, B6, B12

Folic acid

Vitamin K

Biotin

Inositol

Cephalosporins

PRESENTED BY:

• Neomycin depletes the body of the following. Beta-carotene

Calcium

Magnesium

Potassium

Vitamin B12

Neomycin

Anticonvulsants

PRESENTED BY:

• Barbiturates depletes the body of calcium, folic acid, vitamin D, vitamin K, and biotin.

• Phenytoin depletes the body of biotin, calcium, folic acid, vitamin B1, vitamin B12, vitamin D, vitamin E, vitamin K, phosphorus, carnitine, and folic acid.

• Carbamazepine depletes the body of biotin, folic acid, vitamin D, vitamin E, and folic acid.

• Primidone depletes the body of biotin, calcium, vitamin D, vitamin K, and folic acid.

• Valproic acid depletes the body of folic acid, carnitine, copper, selenium, vitamin B6, vitamin E, zinc, and folic acid.

Anticonvulsants

PRESENTED BY:

• D'Erasmo, et al., “Drug-induced osteomalacia,” Recenti Prog Med 1998; 89:529-33.

• Kishi, et al. “Mechanism for reduction of serum folate by antiepileptic drugs during prolonged therapy,” Jour Neurol Sci 1997; 145:109-12.

• Mock et al. “Disturbances in biotin metabolism in children undergoing long-term anticonvulsant therapy,” Jour Pediatr Gastroenterol Nutr 1998; 26: 245-50.

• VanWouwe , J., “Carnitine deficiency during valproic acid treatment,” Int Jour Vitamin Nutr Res 1995; 65(3): 211-14.

References

Diabetes and Insulin Resistance

PRESENTED BY:

• Sulfonylureas deplete the body of coenzyme Q-10 and vitamin E.

Sulfonylureas

PRESENTED BY:

• Biguanides, such as metformin deplete the body of the following.

Vitamin B12

Vitamin E

Folic acid

Coenzyme Q-10

Biguanides

Zhao-Wei, T., et al., “Risk factors of vitamin B12 deficiency in patients receiving metformin,” Arch of Int Med 2006; Oct 9, p. 1975-79.

PRESENTED BY:

• Wulffele, et al. “Effects of short-term treatment with metformin on serum levels of homocysteine, folate and vitamin B12 in type 2 diabetes mellitus: a randomized placebo-controlled trial,” Jour Intern Med. 2003; 254:455-63.

• Pongchaidecha, et al., “Effect of metformin on plasma homocysteine, vitamin B12 and folic acid: a cross-sectional study in patients with type 2 diabetes mellitus,” Jou Med Assoc Thai 2004; 87:780-87.

• Wile, D., et al., “Association of metformin, elevated homocysteine, methlmalonic acid levels and the clinically worsened diabetic peripheral neuropathy,” Diabetes Care 2010; 33:156–61.

References

PRESENTED BY:

• Insulin may deplete the body of DHEA.

Insulin

Antifungal Medications

PRESENTED BY:

• Amphotericin depletes the body of calcium, magnesium, potassium, and sodium.

Antifungal Medications

Anti-Inflammatory Medications

PRESENTED BY:

Vitamin A

Vitamins B6 and B12

Folic acid

Vitamin C

Vitamin D

Vitamin K

Corticosteroids

Calcium

Magnesium

Potassium

Selenium

Chromium

PRESENTED BY:

• Lems W., et al. “Effect of low dose prednisone (with calcium and calcitriol supplementation) on calcium and bone metabolism in healthy volunteers,” Brit Jour Rheumatol 1998; 37(1): 27-33.

Reference

PRESENTED BY:

• Sulfasalazine: depletes the body of folic acid. • Indomethacin: depletes the body of iron,

vitamin C, and folic acid. • Salicylates deplete the body of vitamin C,

calcium, folic acid, iron, sodium, potassium, and B5.

• NSAIDs: deplete the body of folic acid and melatonin.

Other Anti-Inflammatory Meds

PRESENTED BY:

• Baggott, et al., “Inhibition of folate-dependent enzymes by nonsteroidal anti-inflammatory drugs,” Biochem Jour 1992; 282 (Pt 1):197-202.

• Loh, H., et al., “The effects of aspirin on the metabolic availability of ascorbic acid in human beings,” Jour Clin Pharmacol 1973; 13(11):480-6.

• Lawrence, V., et al., “Aspirin and folate binding in vivo and in vitro studies of serum binding and urinary excretion of endogenous folate,” Jour Lab Clin Med 1984; 103(6):944-8.

• Nain, et al., “Acetylsalicylic acid-induced biochemical changes in gastric juice,” Indian Jour Gastroenterol 1996; 56:421-29.

References

Anti-Parkinson Medication

PRESENTED BY:

• Levodopa depletes the body of potassium, SAMe, vitamin B6, and coenzyme Q-10.

Levodopa

Medication for Protozoals

PRESENTED BY:

• Pentamidine depletes the body of magnesium.

Medications for Protozoals

Antiviral Medications

PRESENTED BY:

• Reverse transcriptase inhibitors such as Zidovudine (AZT) and related drugs deplete the body of vitamin B12, copper, zinc, and L-carnitine.

• Foscarnet depletes the body of calcium, magnesium, and potassium.

Antiviral Medications

PRESENTED BY:

• Baum, M., et al., “Zidovudine-associated adverse reactions in a longitudinal study of asymptomatic HIV-1-infected homosexual males,” Jour Acquir Immune Def Syn 1991; 4(12):1218-26.

• Moretti, et al. “L-carnitine reduces lymphocyte apoptosis and oxidant stress in HIV-1-infected subjects treated with zidovudine and didanosine,” Antioxid Redox Signal 2002; 4:391-403.

• Dalakas, M., et al., “Zidovudine-induced mitochondrial myopathy is associated with muscle carnitine deficiency and lipid storage,” Ann Neurol 1994; 35(4): 82-87.

References

Bronchodilators

PRESENTED BY:

• Theophylline depletes the body of vitamin B6. Reynolds, Rf., et al., “Depressed plasma pyridoxal

phosphate concentrations in adult asthmatics,” Amer Jour Clin Nutr 1985; 41:684-88.

• Use the activated form of vitamin B6, pyridoxal-5-phosphate, since this medication depletes the body of the activated form of vitamin B6.

Shimizu, T., et al., “Theophylline attenuates circulating vitamin B6 levels in children with asthma,” Pharmacology 1994; 49:392-97.

Theophylline

PRESENTED BY:

• Likewise, another study revealed that supplementing with vitamin B6 reduced some of the side effects of theophylline such as headaches, sleep disorders, nausea, and irritability.

Bartel, P., et al., “Vitamin B6 supplementation and theophylline-related effects in humans,” Amer Jour Clin Nutr 1994; 60:93-99.

Theophylline (Cont.)

PRESENTED BY:

• B-adrenergic agonists deplete the body of the following nutrients.

Potassium

Phosphorus

Calcium

Magnesium

B-Adrenergic Agonists

Rakhmanina, et al, “Hypokalemia in an asthmatic child from abuse of albuterol metered dose inhaler.” Pediatr Emerg Care 1998; 14:145-47.

Cardiovascular Medications

PRESENTED BY:

• Cardiac glycosides such as digoxin deplete the body of calcium, magnesium, phosphorus, and vitamin B1.

Cardiovascular Medications

Anti-Hypertensive Medications

PRESENTED BY:

• Hydralazine containing medications deplete the body of the following.

Vitamin B6

Coenzyme Q-10

Hydralazine

PRESENTED BY:

• Loop diuretics deplete the body of the following.

Potassium

Magnesium

Calcium

Vitamin B1

Vitamin B6

Vitamin C

Sodium

Loop Diuretics

PRESENTED BY:

• Potassium sparing diuretics deplete the body of the following.

Calcium

Folic acid

Magnesium

Phosphorus

Potassium Sparing Diuretics

PRESENTED BY:

• Thiazide diuretics deplete the body of the following.

Magnesium

Potassium

Sodium

Coenzyme Q-10

Thiazide Diuretics

Pak, G., “Correction of thiazide-induced hypomagnesiumia by potassium-magnesium citrate from review of prior trials,” Clin Nephrol 2000; 54:271-75.

PRESENTED BY:

• Beta blockers deplete the body of the following nutrients.

Coenzyme Q-10

Melatonin

Beta Blockers

Kishi, T., et al., “Bioenergetics in Clinical Med XV: Inhibition of coenzyme Q-10 enzymes by clinically used adrenergic blockers of beta receptors,” Res Common Chem Pathol Pharmacol 1977; 17:157-64. Stoschitzky, K., et al., “Influence of beta blockers in melatonin release,” Eur Jour Clin Pharmacol 1999; 55(2):11-45.

PRESENTED BY:

• No depletion of chromium is known with beta blockers. However, beta blockers can lower HDL. To combat this give chromium 200 micrograms qd.

Beta Blockers (Cont.)

PRESENTED BY:

• ACE inhibitors deplete the body of zinc. • ACE inhibitors have the potential to deplete

the body of the following nutrients. Sodium

Vitamin B6

Magnesium

Phosphorus

Potassium

Coenzyme Q-10

Ace Inhibitors

PRESENTED BY:

• Angiotension II receptor blockers deplete the body of the following nutrients.

Calcium

Magnesium

Phosphorus

Coenzyme Q-10

Angiotensin II Receptor Blockers (ARB)

PRESENTED BY:

• Chlorthalidone depletes the body of zinc.

Chlorthalidone

PRESENTED BY:

• Central acting medications such as clonidine and methyldopa deplete the body of coenzyme Q-10.

Central Acting Medications

PRESENTED BY:

• Calcium channel blockers deplete the body of the following.

Vitamin D

Magnesium

Potassium

Calcium Channel Blockers

PRESENTED BY:

• Golik, et al. “Effects of captopril and enalapril on zinc metabolism in hypertensive patients,” Jour Amer Coll Nutr 1998; 17:75-8.

• Stoschitzky, K., et al., “Influence of beta-blockers on melatonin release,” Eur J Clin Pharmacol 1999; Apr; 55(2):111-15.

• Golik, A., et al., “Effects of captopril and enalpril on zinc metabolism in hypertensive patients,” Jour Am Coll Nutr 1998; 17:75-80.

• Paparrigopoulos, T., “Melatonin response to atenolol administration in depression: indication of beta-adrenoceptor dysfunction in a subtype of depression,” Acta Psychiatr Scand 2002; 106(6):440-45.

References

PRESENTED BY:

• Quamme, G., “Renal magnesium handling: new insights in understanding old problems.” Kidney Int 1997; 52(5):1180-95.

References (Cont.)

Cholesterol Lowering Medications

PRESENTED BY:

• Statin drugs deplete the body of the following nutrients.

Coenzyme Q-10

Vitamin D

Vitamin E (tocopherols and tocotrienols)

Omega-3-fatty acids

HMG CoA Reductase Inhibitors

Carnitine

Selenium

Copper

Vitamin K2

Vitamin A

Creatine

PRESENTED BY:

• Vercelli, L., et al., “Chinese red rice depletes muscle coenzyme Q10 and maintains muscle damage after discontinuation of statin treatment,” Jour Amer Geriatr Soc 2006; 54(4):718-20.

• Bargossi A., et al., “Exogenous CoQ10 supplementation prevents plasma ubiquinone reduction induced by HMG-CoA reductase inhibitors,” Mol Aspects Med 1994; 15(Suppl):S187-93.

• Langsjoen P., et al., “The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications,” Biofactors 2003;18(1-4):101-11.

• Garnett, W., “Interactions with hydroxymethylglutaryl-coenzyme A reductase inhibitors,” Amer Jour Health Syst Pharm 1995; 52:1639-45.

References

PRESENTED BY:

• Hargreaves, I., et al., “The effect of HMG-CoA reductase inhibitors on coenzyme Q10: possible biochemical/clinical implications,” Drug Saf 2005;28(8):659-676.

• Mabuchi, H., et al., “Reduction of serum ubiquinol-10 and ubiquinone-10 levels by atorvastatin in hypercholesterolemic patients,” Jour Atheroscler Thromb. 2005;12(2):111-19.

• Folkers, K., et al., “Lovastatin decreases coenzyme Q-10 levels in humans,” Proc Nat Acad Sci USA 1990; 87:8931-34.

References (Cont.)

PRESENTED BY:

• HMG CoA reductase inhibitors interfere with vitamin K and selenium.

HMG CoA Reductase Inhibitors (Cont.)

PRESENTED BY:

• Bile acid sequestrants Cholestyramine depletes the body of vitamins A, D,

E, K, B12, folic acid, beta-carotene, calcium, iron, magnesium, phosphorus, and zinc.

Colestipol depletes the body of vitamins A, D, E, K, B12, folic acid, beta-carotene, and iron.

Bile Acid Sequestrants

Harkness, R., et al., “Mosby’s Handbook of Drug- Herb and Drug-Supplements Interactions. St. Louis: Mosby, 2003.

PRESENTED BY:

• Fibrates deplete the body of the following. Vitamin E

Copper

Vitamin B12

Fibrates

PRESENTED BY:

• Gemfibrozil depletes the body of the following.

Coenzyme Q-10

Vitamin E

Gamma tocopherol

Gemfibrozil

Electrolyte Replacement

PRESENTED BY:

• Time released potassium chloride can deplete the body of vitamin B12.

Electrolyte Replacement

Female Hormones

PRESENTED BY:

• Oral contraceptives deplete the body of. Folic acid

Vitamins B1, B2, B3 (estrogen inhibits the conversion of tryptophan to niacin), B6, B12

Vitamin C

Vitamin E

Magnesium

Selenium

Tyrosine

Oral Contraceptives

PRESENTED BY:

• Kishi, H., et al. ,“Deficiency of vitamin B6 in women taking contraceptive formulations,” Res Commun Chem Pathol Pharmacol 1997; 17(2):282-93.

• Shojania, A., Can Med Assoc Jour. 1982; 126(3):244-47.

• Sanpitak, N., et al., Lancet 1974 ;May; 1(7862):836-37.

• Prasad, A., et al., Amer Jour Obstet Gynecol 1976; Aug 15; 125(8):1063-69.

• Li, X., et al., “Megaloblastic changes in the cervical epithelium associated with oral contraceptives and changes after treatment with folic acid,” Chung Hua Fu Chan Ko Tsa Chih 1995; 30(7):410-13.

References

PRESENTED BY:

• Moller, S., Neuropsychobiology 1981; 7(4): 92-200.

• Moller, S., et al. “Tyrosine metabolism in users of oral contraceptives,” Life Sci 1995; 56(9):687-95.

• Palan, P., et al., “Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants,” Amer Jour Obstet Gynecol 2006; 194(5):e35-e38.

• Nash, A., et al., “Metabolic effects of OPCs w/ 30 and 50 mcg estrogen,” Med Jour Aust 1979; Sept 22; 2(6):277-81.

References (Cont.)

PRESENTED BY:

• Estrogen replacement of any kind (natural or synthetic) deplete the body of the following nutrients.

Vitamin B6

Magnesium

Folic acid

Vitamin B12

Estrogen Replacement Therapy

PRESENTED BY:

• Muneyyirci-Delale, et al., “Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium,” Fertil Steril 1999; 71:869-72.

• Haspels, A., et al. “Disturbance of tryptophan metabolism and its correction during oestrogen treatment in postmenopausal women,” Maturitas 1978; 1(1):15-20.

• Seelig, M., “Interrelationships of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome,” Jour Amer Coll Nutr 1993; 12(4):442-58.

References

Gout Medications

PRESENTED BY:

• Colchicine depletes the body of the following nutrients.

Vitamin B12

Sodium

Potassium

Beta-carotene

Calcium

Phosphorus

Colchicine

Laxatives

PRESENTED BY:

• Laxatives that contain mineral oil can deplete the body of the following nutrients.

Fat soluble vitamins such as vitamins A, D, E, K

Beta-carotene

Coenzyme Q-10

Alpha lipoic acid

Calcium

Phosphorus

• Bisacodyl can cause potassium depletion. • Sodium phosphate enema depletes the body of

calcium and magnesium.

Mineral Oil Laxatives

PRESENTED BY:

• Clark, et al., “Serum beta-carotene, retinol and alpha-tocopherol levels during mineral oil therapy for constipation,” Amer Jour Dis Child 1987; 141:1210-2

• Ritsema, G., et al., “Potassium supplements prevent serious hypokalemia in colon cleansing,” Clin Radiol 1994; 49(12):874-76.

• Ehrenpreis, E., et al. “Symptomatic hypocalcemia, hypomagnesemia, and hyperphosphatemia secondary to Fleet’s PhosphoSoda colonoscopy preparation in a patient with a jejunoileal bypass,” Dig Dis Sci. 1997; 42(4):858-60.

References

Psychotherapeutic Medications

PRESENTED BY:

• Tricyclic Antidepressants deplete the body of the following nutrients.

Vitamin B2

Coenzyme Q-10

Tricyclic Antidepressants

PRESENTED BY:

• SSRIs deplete the body of melatonin and iodine.

Serotonin Reuptake Inhibitors (SSRIs)

PRESENTED BY:

• SARIs deplete the body of coenzyme Q-10 and vitamin B12.

Serotonin Antagonist and Reuptake Inhibitors (SARIs)

PRESENTED BY:

• Phenothiazines deplete the body of the following.

Vitamin B2

Coenzyme Q-10

Melatonin

Phenothiazines

PRESENTED BY:

• Phenelzine depletes the body of vitamin B6.

Monoamine Oxidase Inhibitors

PRESENTED BY:

• Haloperidol depletes the body of melatonin and vitamin E.

Haloperidol

PRESENTED BY:

• Lithium depletes the body of inositol.

Lithium

PRESENTED BY:

• Diazepam and alprazolam both deplete the body of melatonin.

McIntyre, I., et al. “Alterations to plasma melatonin and cortisol after evening alprazolam administration in humans,” Chronobiol Int 1993; 10(3): 205-13.

Wakabayashi, H., et al., “Effects of diazepam administration on melatonin synthesis in the rat pineal gland in vivo,” Chem Pharm Bull (Tokyo). 1991; 39(10): 2674-76.

Barbiturates

Anabolic Steroids

PRESENTED BY:

• Deplete the body of iron.

Anabolic Steroids

Thyroid Medications

PRESENTED BY:

• T4 supplementation depletes the body of the following nutrients.

Thyroid Medications

Medications for Ulcers

PRESENTED BY:

• H-2 blockers deplete the body of the following.

Vitamin B12

Vitamin D

Calcium

Folic acid

H-2 Blockers

PRESENTED BY:

• Odes, H., et al., “Effect of cimetidine on hepatic vitamin D metabolism in humans,” 1990; 46(2):61-4.

• Sturniolo, G., et al., “Inhibition of gastric acid secretion reduces zinc absorption in man,” Jour Amer Coll Nutr. 1991; 10(4):372-5.

• Russell, R., et al., “Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid,” Jour Lab Clin Med 1988; 112(4):458-63.

• Force, G., “Effect of histamine H2-receptor antagonists on vitamin B12 absorption,” Ann Pharmacother 1992; 26:1283-86.

References

PRESENTED BY:

• Proton pump inhibitors deplete the body of vitamin B12.

• PPIs also decrease the absorption of the following nutrients:

Magnesium

Calcium

Vitamin B12

Vitamin C

B-carotene

Proton Pump Inhibitors (PPIs)

Heidelbaugh, J., “Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications,” Ther Adv Drug Saf 2013; 4(3):125-33.

PRESENTED BY:

• Marcuard, et al., “Omeprazole therapy causes malabsorption of cyanocobalamin,” Ann Int Med 1994; 120:211-15.

• Valuck, R., et al., “A case-control study on adverse effects: H2 blockers or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults,” Jour Clin Epidemiol 2004; 57:422-28.

• Yang, Y., et al., “Long-term proton pump inhibitor therapy and risk of hip fracture,” JAMA 2006; 296(24):2947-53.

References

Other Medications

PRESENTED BY:

• Methotrexate depletes the body of folic acid.

Methotrexate

PRESENTED BY:

• Penicillamine depletes the body of the following.

Copper

Vitamin B6

Magnesium

Penicillamine

PRESENTED BY:

• Orlistat depletes the body of beta carotene and vitamins A and E.

Zhi, J, et al., “The effect of Orlistat, an inhibitor of dietary fat absorption, on the pharmacokinetics of beta-carotene in healthy volunteers,” Jour Clinical Pharmacology 1996; 36:152-59.

Melia, A., et al, “The effect of Orlistat, an inhibitor of dietary fat absorption, on the absorption of vitamins A and E in healthy volunteers,” Jour Clinical Pharm 1996; 36:647-53.

Orlistat

PRESENTED BY:

• Xenical depletes the body of the following nutrients.

Beta-carotene

Vitamin A

Vitamin D

Vitamin E

Vitamin K

Xenical

PRESENTED BY:

• Extended release KCL depletes the body of vitamin B12.

Palva, I., et al. “Drug-induced malabsorption of vitamin B12. IV. Malabsorption and deficiency of B12 during treatment with slow-release potassium chloride,” Acta Med Scand 1972; 191(4): 355-7.

Potassium: Extended Release

PRESENTED BY:

• Bisphosphonates deplete the body of the following nutrients.

Calcium

Magnesium

Phosphorus

Bisphosphonates

PRESENTED BY:

• Plaquenil depletes the body of the following nutrients.

Calcium

Vitamin B6

Vitamin D

Plaquenil

OTC Medications

PRESENTED BY:

• Acetaminophen depletes the body of glutathione.

Acetaminophen

Nutrients Depleted by Which Medications

PRESENTED BY:

• Cholestyramine • Colchicine • Colchicine • Colestipol

Drugs That Deplete The Body of B-Carotene

• Mineral oil • Neomycin • Orlistat • Probenicid

PRESENTED BY:

• Aminoglycosides • Cephalosporins • Chemotherapeutics • Co-trimoxazole • Fluroquinolones

Drugs That Deplete The Body Of Bifidobacteria Bifidum

• Macrolides • Penicillins • Sulfonamides • Tetracyclines

PRESENTED BY:

• Aminoglycosides • Barbiturates • Carbamazepine • Cephalosporins • Fluoroquinolones • Macrolides • Penicillins

Drugs That Deplete The Body Of Biotin

• Phenobarbital • Phenytoin • Primidone • Sulfonamides • Tetracyclines • Trimethoprim

PRESENTED BY:

• Aluminum hydroxide-containing products

• Aminoglycosides

• Amphotericin B

• Aspirin

• Barbiturates

• Bumetanide

• Carbamazepine

• Cholestyramine

Drugs That Deplete The Body of Calcium

• Cimetidine

• Colchicine

• Corticosteroids

• Cycloserine

• Digoxin

• EDTA

• Ethacrynic acid

• Estrogen

PRESENTED BY:

• Famotidine

• Fosphenytoin

• Furosemide

• HCTZ

• Magnesium-containing products

• Methotrexate

• Mineral oil

• Nizatidine

Drugs That Deplete The Body of Calcium (Cont.)

• Phenobarbital

• Phenytoin

• Ranitidine

• Sucralfate

• Tetracyclines

• Torsemide

• Triamterine

• Zonisamide

PRESENTED BY:

• Avacavir • Delavirdine • Didanosine • Lamivudine • Nevirapine

Drugs That Deplete The Body Of Carnitine

• Stavudine • Valproic acid • Zalcitabine • Zidovudine

PRESENTED BY:

• Corticosteroids

Drugs That Deplete The Body Of Chromium

PRESENTED BY:

• Acebutolol

• Acetohexamide

• Advicor

• Amitriptyline

• Amiloride

• Amoxapine

• Atorvastatin

• Benzthiazide

Drugs That Deplete The Body Of Coenzyme Q-10

• B-blockers: propranolol, atenolol, metoprolol

• Cerivastatin

• Chlorothiazide

• Chlorpromazine

• Clomipramine

• Clonidine

• Desipramine

• Doxepin

PRESENTED BY:

• Enoxacin

• Fenofibrate

• Fluphenazine

• Fluvastatine

• Gemfibrozil

• Glimepiride

• Glyburide

• Haloperidol

• Hydralazine

Drugs That Deplete The Body Of Coenzyme Q-10 (Cont.)

• Hydralazine and hydrochlorothiazide

• Hydralazine, hydrochlorothiazide, reserpine

• Hydrochlorothiazide

• Imipramine

• Indapamide

• Lovastatin

• Mesoridazine

PRESENTED BY:

• Metformin

• Methyclothiazide

• Methyldopa

• Metolazone

• Nortriptyline

• Perphenazine

• Polythiazide

• Pravastatin

• Procholorperazine

• Promazine

• Promethazine

• Protriptyline

• Quinethazone

• Simvastatin

PRESENTED BY:

• Thiethylperazine

• Thioridazine

• Tolazamide

• Tolbutamide

• Triclomethiazide

• Trifluoperazine

• Trimipramine

PRESENTED BY:

• Abacavir • Clofibrate • Didanosine • Delavirdine • Lamivudine • Stavudine • Ethambutol

Drugs That Deplete The Body Of Copper

• Fenofibrate • Nevirapine • NSAIDs • Pencillamine • Valproic acid • Zalcitabine • Zidovudine

PRESENTED BY:

• Amiloride

• Aluminum containing antacids

• Aspirin

• Barbiturates

• Carbamazepine

• Cholestyramine

• Choline magnesium trisalicylate

• Choline salicylate

• Cimetidine

Drugs That Deplete The Body Of Folic Acid

• Co-trimoxazole

• Colestipol

• Corticosteroids

• Cox-2 inhibitors

• Cycloserine

• Diflunsal

• Estrogens (conjugated)

• Ethsuximide

• Famotidine

• 5-Fluorouracil

• Fosphenytoin

PRESENTED BY:

• Hydrochlorothiazide and triamterene

• Indomethacin

• Magnesium-containing antacids

• Metformin

• Methotrexate

• Nizatidine

• NSAIDs

• Oral contraceptives

• Phenobarbital

Drugs That Deplete The Body Of Folic Acid (Cont.)

• Phenytoin

• Primidone

• Ranitidine

• Salsalate

• Sulfasalazine

• Triamterine

• Trimethoprim

• Valproic acid and related drugs

• Zonisamide

PRESENTED BY:

• Aminoglycosides • Cephalosporins • Fluoroquinolones • Macrolides • Penicillins

Drugs That Deplete The Body Of Inositol

• Sulfonamides • Tetracyclines • Trimethoprim • Zonisamide

PRESENTED BY:

• Aspirin

• Cholestyramine

• Cimetidine

• Choestipol

• Famotidine

• Indomethacin

Drugs That Deplete The Body Of Iron

• Levothyroxine

• Neomycin

• Nizatidine

• Penicillamine

• Ranitidine

• Salicylates

• Stanozolol

• Tetracyclines

PRESENTED BY:

• Leonard, J., et al., “In vitro binding of various biological substances by two hypocholesterolaemic resins: cholestyramine and colestipol,” Arzneim Forsch-Drug Res 1979; 29:979-81.

• Leenders, K., et al, “Blood in one Rheusus monkey using (Fe-52)-citrate and positron emission tomograph (PET): influence of haloperidol,” Jour Neural Transm 1994; 43(Suppl):123-32.

• Harkness, J., et al., “Penicillamine nephropathy and iron,” Lancet 1982; 2:1368-69.

• Brouwers, J., “Drug interactions with quinolone antibacterials,” Drug Safety 1992; 7(4):268-81.

References

PRESENTED BY:

• Duckes, D., et al., Applied Therapeutics: The Clinical Use of Drugs. 6th Ed. Philadelphia: Lippincott & Wilkins, 1995, p. 24-7.

• Neuvonen, P., “Interactions with the absorption of tetracyclines,” Drugs 1976; 11(1):45-54.

• Potgieter, M., et al., “Effect of oral tetracycline on iron absorption from iron (III)-hydroxide polymoltose complex in patients with iron deficiency anemia/a single-centre randomized controlled isotope study,” Arzneimittelforschung 2007; 57(6A):376-84.

References (Cont.)

PRESENTED BY:

• Shakir, K., et al., “Ferrous sulfate-induced increase in requirement for thyroxine in a patient with primary hypothyroidism,” South Med Jour 1997; 90(6):637-39.

References (Cont.)

PRESENTED BY:

• Aminoglycosides • Cephalosporins • Co-trimoxazole • Fluoroquinolones

Drugs That Deplete The Body Of Lactobacillus Acidophilus

• Macrolides • Penicillins • Sulfonamides • Tetracyclines

PRESENTED BY:

• Aminoglycosides

• Amphotericin B

• B-agonists

• Benzthiazide

• Bleomycin

• Bumetanide

• Carbenicillin

• Carboplatin

• Cetuximab

Drugs That Deplete The Body Of Magnesium

• Chlorothiazide

• Cholestyramine

• Chlorthalidone

• Cisplatinum

• Corticosteroids

• Cycloserine

• Diethylstilbesterol

• Digoxin

• Ethacrynic acid

PRESENTED BY:

• Foscarnet

• Furosemide

• Gentamycin

• Hydrochlorothizide

• Hydroflumethiazide

• Indapamide

• Metolazone

• Panitumumab

• Pencillamine

Drugs That Deplete The Body Of Magnesium (Cont.)

• Pentamidine

• Polythiazide

• Quinestrol

• Quinethazone

• Tacrolimus

• Tetracyclines

• Torsemide

• Trichlormethiazide

• Vinblastine

PRESENTED BY:

• Alprazolam • Atenolol • Chlorpromazine • Diazepam • Haloperidol

Drugs That Deplete The Body Of Melatonin

• Hydroxyzine • Metoprolol • NSAIDs • Propranolol

PRESENTED BY:

• Aluminum hydroxide-containing medications

• Cholesytramine • Colchicine • Digoxin • Magnesium-containing compounds

Drugs That Deplete The Body Of Phosphorus

PRESENTED BY:

• Acetazolamide

• Albuterol

• Aminoglycosides

• Amphotericin B

• Aspirin

• Benzthiazide

• Bisacodyl

• Bumetanide

• Chlorothiazide

Drugs That Deplete The Body Of Potassium

• Colchicine

• Corticosteroids

• Ethacrynic acid

• Foscarnet

• Furosemide

PRESENTED BY:

• Indapamide

• Levodopa

• Metolazone

• Nifedipine

• Penicillins

• Polythiazide

Drugs That Deplete The Body Of Potassium (Cont.)

• Quinethazone

• Ritodrine

• Sodium bicarbonate

• Terbutaline

• Torsemide

• Trichlormethiazide

• Verapamil

PRESENTED BY:

• Levodopa

Drugs That Deplete The Body Of SAMe

PRESENTED BY:

• Corticosteroids • Oral contraceptives • Valproic acid

Drugs That Deplete The Body Of Selenium

PRESENTED BY:

• Benazepril

• Benzthiazide

• Bumetanide

• Catopril

• Chlorothiazide

• Chlorothalidone

• Cholestyramine

• Cimetidine

• Clofibrate

• Corticosteroids

Drugs That Deplete The Body Of Zinc

• Enalapril

• Ethacrynic acid

• Ethambutol

• Famotidine

• Fenofibrate

• Fosinopril

• Furosemide

• Indapamide

PRESENTED BY:

• Lisinopril

• Metolazone

• Moexipril

• Nevirapine

• Nizatidine

• Pencillamine

• Polythiazide

• Quionapril

Drugs That Deplete The Body Of Zinc (Cont.)

• Quinethazone

• Ramipril

• Ranitidine

• Tetracycline

• Torsemide

• Trandolapril

• Triamterene

• Trichlomethiazide

• Valproic acid

• Zidovudine

PRESENTED BY:

• Ace inhibitors

• Acetazolamide

• Aminoglycosides

• Amphotericin B

• Aspirin/salicylates

• Colchicine

Drugs That Deplete The Body Of Sodium

• Indapamide

• Loop diuretics

• SSRI: Zoloft, Paxil, Prosac

• Thiazide diuretics

PRESENTED BY:

• Cholestyramine • Cholestipol • Corticosteroids • Mineral oil • Neomycin

Drugs That Deplete The Body Of Vitamn A (Retinol)

PRESENTED BY:

• Aminoglycosides

• Bumetanide

• Cephalosporins

• Ethacrynic acid

• Fluoroquinolones

• Furosemide

• Macrolides

Drugs That Deplete The Body Of Vitamin B1 (Thiamin)

• Penicillins

• Phenytoin

• Sulfonamides

• Tetracyclines

• Theophylline

• Torsemide

• Trimethoprim

• Zonisamide

PRESENTED BY:

• Acetophenazine

• Adriamycin

• Aminoglycosides

• Amitriptyline

• Amoxapine

• Cephalosporins

• Chlorpromazine

• Clomipramine

• Desipramine

Drugs That Deplete The Body Of Riboflavin (B2)

• Doxepin

• Fluphenazine

• Imipramine

• Macrolides

• Mesoridazine

• Methdilazine

• Methotrimeprazine

• Nortriptyline

PRESENTED BY:

• Penicillins

• Perphenazine

• Phenothiazines

• Phenytoin

• Prochlorperazine

• Promazine

• Promethazine

Drugs That Deplete The Body Of Riboflavin (B2) (Cont.)

• Protriptyline

• Sulfonamides

• Tetracyclines

• Theophylline

• Trioridazine

• Trifluoperazine

• Trimethoprim

• Trimipramine

PRESENTED BY:

• Bianchi, A., et al., “Role of magnesium, coenzyme Q-10, riboflavin, and vitamin B12 in migraine prophylaxis,” Vitamins Hormones 2004; 69:297-312.

Reference

PRESENTED BY:

• Aminoglycosides

• Cephalosporins

• Cycloserine

• Estrogens (esterified)

• Isoniazid

Drugs That Deplete The Body Of Niacin (B3)

• Macrolides

• Penicillins

• Sulfonamides

• Tetracylines

• Trimethoprim

PRESENTED BY:

• Aspirin and salicylates Plesofski, N., “Pantothenic acid,” Oregon: Linus

Pauling Institute, 2002.

Drugs That Deplete The Body Of Pantothenic Acid (B5)

PRESENTED BY:

• Aminoglycosides

• Bumetanide

• Cephalosporins

• Diethylstilbesterol

• Estrogens (esterified)

• Ethacrynic acid

• Furosemide

Drugs That Deplete The Body Of Pyridoxine (B6)

• Hydralazine

• Isoniazid

• Levodopa

• Macrolides

• Penicillamine

• Penicillins

• Phenelzine

• Phenobarbital

PRESENTED BY:

• Quinestrol

• Sulfonamides

• Tetracyclines

• Theophylline

• Torsemide

• Trimethoprim

Drugs That Deplete The Body Of Pyridoxine (B6) (Cont.)

PRESENTED BY:

• Miller, J., et al., “Effect of L-dopa on plasma homocysteine in PD patients: relationship to B- vitamin status,” Neurology 2003; 60(7):1125-29.

Reference

PRESENTED BY:

• Aminoglycosides

• Carbamazepine

• Cephalosporins

• Chlorotrianisene

• Cholestyramine

• Cimetidine

• Clofibrate

• Colchicine

• Colestipol

Drugs That Deplete The Body Of Cyanocobalamin (B12)

• Co-trimoxazole

• Famotidine

• Lansoprazole

• Lithium

• Macrolides

• Metformin

• Neomycin

• Nevirapine

PRESENTED BY:

• Nizatidine

• Omeprazole

• Penicillins

• Phenytoin

• Potassium chloride (time-release)

• Prednisolone

• Ranitidine

Drugs That Deplete The Body Of Cyanocobalamin (B12) (Cont.)

• Sulfonamides

• Tetracyclines

• Trimethoprim

• Zidovudine

PRESENTED BY:

• Karabiber, H., et al., “Effects of valproate and carbamazepine on serum levels of homocysteine, vitamin B12, and folic acid,” Brain Dev 2003; 25(2):113-15.

• Laine, L., et al., “Review article: potential gastrointestinal effects of long-term acid suppression with proton pump inhibitors,” Aliment Pharmacol Ther 2000; 14(6):651-58.

• Schenk, B., et al., “Atropic gastritis during long-term omeprazole therapy affects serum vitamin B12 levels,” Alimnet Pharmacol Ther 1999; 13(10):1343-46.

References

PRESENTED BY:

• Marcuard, S., et al., “Omeprazole therapy causes malabsorption of cyanocobalamin (vitamin B12),” Ann Inter Med 1994; 120(3):211-15.

• Saltzman, J., et al., “Effect of hypochlorhydria due to omeprazole treatment of atrophic gastritis on protein-bound vitamin B12 absorption,” Jour Amer Coll Nutri 1994; 13(6):584-91.

• Valuck, R., et al., “A case-control study on adverse effects: H-2 blocker or proton pump inhibitor use and risk of vitamin B12 deficiency in older adults,” Jour Clin Epidemiol 2004; 57(4):422-28.

• Lamb, J., et al., “Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency,” JAMA 2013; 310(22):2435-42.

References (Cont.)

PRESENTED BY:

• Sutterlin, M., et al., “Serum folate and vitamin B12 levels in women using modern oral contraceptives (OC) containing 20 mcg ethinyl estradiol,” Eur Jour Obstet Gynecol Repro Biol 2003; 107(1):57-61.

• Cervanties, P., et al., “Vitamin B12 and folate levels and lithium administration in patients with affective disorders,” Biol Psychiatry 1999; 45(2):214-21.

• Sahin, M., et al., “Effects of metformin or rosiglitazone on serum concentrations of homocysteine, folate, and vitamin B12 in patients with type 2 diabetes mellitus,” Jour Diabetes Complications 2007; 21(2):118-23.

References (Cont.)

PRESENTED BY:

• Dastur, D., et al., “Effect of prolonged anticonvulsant medication in epileptic patients: serum lipids, vitamins B6, B12, folic acid, proteins, and fine structure of liver,” Epilepsia 1987; 28(2):147-59.

• Frequin, S., et al., “Decreased vitamin B12 and folate levels in cerebral spinal fluid and serum multiple sclerosis patients after high-dose intravenous methylprednisolone,” Jour Neurol 1993; 240(5):305-08.

References (Cont.)

PRESENTED BY:

• Aspirin

• Bumetanide

• Corticosteroids

• Ethacrynic acid

Drugs That Deplete The Body Of Vitamin C

• Furosemide

• Indomethacin

• Sulfonamides

• Tetracyclines

• Torsemide

PRESENTED BY:

• Barbiturates

• Carbamazepine

• Cholestyramine

• Cimetidine

• Colestipol

• Corticosteroids

• Famotidine

• Fosphenytoin

• Isoniazid

Drugs That Deplete The Body Of Vitamin D

• Ketoconazole

• Mineral oil

• Nizatidine

• Phenobarbital

• Phenytoin

• Ranitidine

• Rifampin

• Valproate

PRESENTED BY:

• Cholestyramine • Clofibrate • Colestipol • Fenofibrate • Gemfibrozil

Drugs That Deplete The Body Of Vitamin E (Alpha Tocopherol)

• Haloperidol • Mineral oil • Oral contraceptives • Statin drugs

PRESENTED BY:

• Palan, P. et al., “Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants,” Amer Jour Obs Gynecol 2006; 194(5):35-8.

• Galli, F., et al., “Do statins cause myopathy by lowering vitamin E levels?” Med Hypotheses 2010; 74(4):707-09.

References

PRESENTED BY:

• Aminoglycosides • Barbiturates • Cephalosporins • Cholestyramine • Fluoroquinolones • Fosphenytoin • Macrolides

Drugs That Deplete The Body Of Vitamin K

• Mineral oil • Penicillins • Phenobarbital • Phenytoin • Sulfonamides • Trimethoprim

Nutritional Therapies For Clinical Conditions

PRESENTED BY:

• Replacement of DHEA if it is low with adrenal support

• Adaptogenic herbs • Calming herbs • Stress reduction techniques • If cortisol is high in the evening then add

phosphatidylserine 300 mg which may be taken any time of the day.

Treatment of Hyperadrenalism

PRESENTED BY:

• Nutrients (give multivitamin) Vitamin C

B vitamins

Calcium

Magnesium

Treatment of Hyperadrenalism (Cont.)

Selenium

Copper

Sodium

Manganese

Thank You! If you would like a copy of this presentation, please contact: (855) 667-1967

how to grow vitamin sales in your practice

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