Kelly Anne Meckling-Nutrient-Drug Interactions

351 Pages·2006·4.29 MB·English

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Nutrient–Drug
Interactions
Edited by
Kelly Anne Meckling
Boca Raton London New York
CRC is an imprint of the Taylor & Francis Group,
an informa business
NUTRITION AND DISEASE PREVENTION
Editorial Advisory Board
CAROLYN D. BERDANIER, PH.D.
University of Georgia, Athens, Georgia, U.S.A.
FRANK GREENWAY, M.D.
Pennington Biomedical Research Center, Louisiana State University,
Baton Rouge, Louisiana, U.S.A.
KHURSHEED N. JEEJEEBHOY, M.D.
University of Toronto Medical School, Toronto, Canada
MULCHAND S. PATEL, PH.D.
The University at Buffalo, The State University of New York,
Buffalo, New York, U.S.A.
KATHLEEN M. RASMUSSEN, PH.D.
Cornell University, Ithaca, New York, U.S.A.
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Carolyn D. Berdanier and Naima Moustaid-Moussa
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edited by Jatinder Bhatia
3. Soy in Health and Disease Prevention, edited by Michihiro Sugano
4. Nutrition and Cancer Prevention, edited by Atif B. Awad
and Peter G. Bradford
5. Cancer Prevention and Management through Exercise
and Weight Control, edited by Anne McTiernan
6. Nutritional Strategies for the Diabetic/Prediabetic Patient,
edited by Jeffrey I. Mechanick and Elise M. Brett
7. Nutrient–Drug Interactions, edited by Kelly Anne Meckling
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Library of Congress Cataloging-in-Publication Data
Nutrient drug interactions / edited by Kelly Anne Meckling.
p. cm. -- (Nutrition and disease prevention)
Includes bibliographical references and index.
ISBN 1-57444-915-X (alk. paper)
1. Drug-nutrient interactions. I. Meckling, Kelly Anne. II. Series.
RM302.4.N85 2006
615’.70452--dc22 2006042561
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Introduction
The idea of food as medicine has been around for millennia. However, the
acceptance of specific foods, food components, extracts, herbals and supplements
as part of conventional medical practice in industrialized countries is still a highly
controversial subject. Western medicine has largely depended on the availability
of pharmacologic agents or “drugs” for the prevention and treatment of human
disease with lesser emphasis on lifestyle and dietary habits as major contributory
factors, particularly with respect to chronic disease prevention. Furthermore, there
are many additional tools in the repertoire of complementary medical practitioners
that go far beyond what is ingested, inhaled or spread on the skin to ward off
disease or treat illness.
The goal of this volume is not to consider the entirety of complementary
medicine, but to focus on food, herbals and their chemical constituents as con-
tributors to human health through control of metabolism, primarily as they relate
to chronic disease development and treatment. More specifically, we will consider
how what is consumed affects response, whether on a population or individual
level, to pharmacologic agents that are the mainstay of chronic disease treat-
ment/prevention around the world. Many of these drugs have their history as
natural compounds isolated from flora and fauna in our environment; however
the public perception has often been that “drugs” come with significant risk and
are less safe than “foods” or “natural health products.” Promulgating this view
are vocal members of the public who perceive a conspiracy by big business and
the pharmacologic giants to protect their billion-dollar stocks by presenting alter-
native medical practice as “flawed.” Furthermore, many complementary practi-
tioners themselves will say that they usually do not consider that adverse events
may occur in response to their therapies, nor do they ask their patients to report
any side effects,1 which exacerbates the problem.
Regardless of the particular approach that is taken, patients must demand of
their practitioners that applied therapies be safe and effective. Thus, evidence-based
medical practice must continue to be the cornerstone of health care delivery for the
foreseeable future. While testing through phase I, II and III clinical trials following
extensive testing in model systems is the standard for determining the safety and
efficacy of pharmacologic agents and synthetic food additives, this has not been
the case for many “natural products.” Assumptions of safety and efficacy for natural
health products have often come from demonstration of historical use over many
years, or possibly centuries, in specific populations with specific lifestyle and
cultural practices. This limited scope of use can hardly be expected to predict the
complicated behaviors that could occur in individuals or populations following very
different lifestyles or using them in combination with other therapies.
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There have been incredible advances in our understanding of how the chem-
icals in foods and herbs we consume interact with natural and synthetic drugs
used to prevent or treat human disease. It is standard practice to examine the
effects of food consumption on the absorption and pharmacokinetics of new
drugs, but the relevant issues have become much greater than “should this med-
icine be taken with or without food.” Long-term use of many medications has
the potential to modify gastrointestinal function and alter the uptake and handling
of both macronutrients, micronutrients and many phytochemicals that we now
know have impacts on nutritional status and overall health. Manipulating the diet
or the administration of supplements, orally or systemically, can help prevent
nutritional deficiencies that could develop during chronic drug administration. A
much more difficult task is to understand the potential for the thousands of
chemical compounds found in food and natural health products to modify drug
bioavailability, biodistribution, toxicity, efficacy and metabolism. In some cases
a single food or supplement could profoundly increase or decrease the toxicity
and/or efficacy of a single drug.
A major emphasis, from a clinical point of view, has been to identify these
substances and remove them from the diets or supplement list of patients under-
going drug therapy. The focus, then, has been almost exclusively on simplifying
the drug treatment plan. An alternative approach would be to use our knowledge
of the mechanisms by which food chemicals modify drug action and to develop
adjuvant therapy protocols that use food (functional foods and nutraceuticals)
and drugs together to optimize treatment outcome. This could result in a decreased
requirement, by the patient, for expensive medications, possibly increased efficacy
with decreased toxicity toward normal or uninfected tissues, and the maintenance
of a food substance with multiple healthful components.
In this collection of reviews, these major issues will be addressed by experts
in their relevant disciplines. The organization of the book will place the focus on
the ailment being treated or prevented and, thus, on the targets of therapy. Within
each section a comprehensive examination of macronutrient, micronutrient and
phytochemical impacts on drug action will be undertaken. Where a given drug
affects nutritional status, the appropriate diet modification or supplement will be
suggested. The major focus of each section will be on the molecular mechanism(s)
by which the food or chemical is thought to modify disease process and drug
behavior. Where specific active chemicals have been identified, their precise
molecular targets, including regulation of gene expression, will be described. The
book will finish with a description of the roles of genetic variation and polymor-
phism in determining nutrient/drug responses, and how individuals might be
“profiled” in future to identify those likely to demonstrate specific interactions
and who would benefit most from adjuvant or complementary therapies.
Kelly Anne Meckling, Ph.D.
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REFERENCE
1. Abbott, A., Survey questions safety of alternative medicine. Nature, 436 (7053):
898, 2005.
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The Editor
Kelly Anne Meckling, Ph.D., completed an Honors B.Sc. with Distinction in
Biochemistry with a minor in psychology from the University of Calgary in 1984,
and her M.Sc. with Dr. Tony Pawson from the University of British Columbia.
She then transferred to the University of Toronto to complete her Ph.D. in medical
biophysics in 1989, examining the signaling pathways unique to human leukemia
and normal blood cell development.
Dr. Meckling’s travels took her to the University of Alberta in Edmonton in
1989, where she examined the role of growth factors and cancer development on
transport of chemotherapeutic drugs. In 1991, she became a faculty member in
the Department of Nutritional Sciences at the University of Guelph, with no
formal nutrition training. She rapidly acquired this knowledge through reading,
attending undergraduate and graduate lectures and through her teaching activities.
Since that time, she has continued as an active researcher in the area of nutrient
signaling and the prevention/treatment of chronic diseases, including cancer,
cardiovascular disease and obesity.
Dr. Meckling currently is associated with the Natural Sciences Engineering
Research Council of Canada and the Breast Cancer Society, where she carries
out both in vitro studies in model systems and human clinical intervention trials.
She teaches undergraduate biology to 2000 students per year as well as advanced
courses in nutrition and the metabolic control of disease. Also, Dr. Meckling is
academic advisor to students majoring in nutritional and nutraceutical sciences.