What to ask your pharmacist about supplements

Dr Sarah Brewer, GP, author of ‘Do You Need a MultiVitamin?’ published today by Amazon advisee what questions one should ask your pharmacist about supplements.

If you are taking prescribed or over the counter medicines, it’s important to check with your pharmacist what supplements you can, or can’t, take with them. Interactions can occur when both the drug and supplement are absorbed by the same mechanism, act on the same cell receptors or interact with the same enzymes. The drugs most likely to cause interactions are anticoagulants (eg warfarin, aspirin), sedatives, antidepressants and some medicines prescribed to treat heart problems, diabetes, high blood pressure and epilepsy. Although most interactions are only theoretical or not serious, it is advisable to err on the side of caution.

Not all interactions are harmful, of course. In some cases, taking a supplement may boost the effectiveness of your treatment, or help to reduce the chance of side effects.

If you are on a statin, should you take plant sterols?

Statin drugs lower cholesterol through a direct effect on the liver. Because they work in a different way to plant sterols, the two can be used together to lower cholesterol levels even further. In fact, adding sterols to statin medication is more effective than doubling the statin dose. The combination of a statin plus a plant sterol supplement can therefore reduce the dose of statin needed to reduce the risk of side effects. For optimum cholesterol-lowering benefits, an intake of 2g per day is ideal. Taking more than 3 g/day is not recommended as there is no evidence of additional healthy benefits with larger amounts, and there is a possibility that higher doses may decrease absorption of some fat soluble vitamins and carotenoids.

Your pharmacist can advise on other things that can help when you are taking statins, such as the need to avoid grapefruit juice with some. Check the in-pack Patient Information Leaflet, too.

If you are on a statin, should you take Co-enzyme Q10?

Statins reduce cholesterol production by inhibiting a liver enzyme which is also needed to make co-enzyme Q10iv. As a result, taking a statin can halve circulating levels of co-enzyme Q10 within just 2 weeks. CoQ10 is needed for oxygen processing in cells – especially muscle cells, and low levels can affect muscle function. This may explain why as many as one in ten people taking a statin experience some form of muscle-related side effects such as muscle aches, pains or weakness. Taking a co-enzyme Q10 supplement helps to maintain blood levels of this important muscle nutrient while you are taking a statin, Importantly, taking co-enzyme Q10 does not affect the cholesterol-lowering action of statin drugs.

Some pharmacists may not know as much as about supplements as they do about medicines, but they will be able to double-check for interactions for you, if necessary.

If you are on pain killers for osteoarthritis, can you take glucosamine?
Taking glucosamine may help to reduce the number of painkillers you need to take, which can reduce some of the side effects associated with non-steroidal anti-inflammatory drugs, and paracetamol. In fact, a recent international study involving over 600 people, found that glucosamine hydrochloride plus chondroitin sulphate supplements were just as effective in treating severe knee osteoarthritis as the prescribed anti-inflammatory painkiller, celecoxib. One group took glucosamine hydrochloride (1500mg daily) plus chondroitin sulphate (1200mg daily) and another group took celecoxib for 6 months. After 6 months, the response rate for both treatments (glucosamine was identical (79%). Both groups showed a greater than 50% reduction in symptoms of pain, stiffness, swelling and joint effusions.

Visit www.nutritionexpert.healthspan.co.uk for further information.

Follow Sarah’s nutritional medicine blog at www.drsarahbrewer.com, and her nutritional tweets at www.twitter.com/DrSarahB