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Council for Responsible Nutrition
1828 L Street, NW
Suite 900
Washington, DC 20036
E-mail: jhathcock{at}crnusa.org
This book was written by a group of authors from both the nutritional and pharmacologic disciplines. The overall emphasis is on the biochemical and pharmacologic mechanisms through which nutrients and certain foods can adversely affect the functions of drugs. The effects of drug administration on nutrient functions and needs are also addressed, but with less emphasis. The mechanistic detail provides a good basis for researchers and educators to understand nutrient-drug interactions and to anticipate other interactions. The book does not provide the practical and catalogued detail needed by pharmacists and dietitians to help avoid the potential negative consequences of nutrient-drug relations. Overall, the chapters are well-referenced and are up-to-date, although a book of this size cannot be comprehensive.
Some of the contents are accurate but could be misleading to the inexperienced reader. For example, it is correctly stated in the chapter on antihyperlipidemic agents that slow-release niacin formulations are associated with a greater incidence of hepatotoxicity. Although this is correct, the most likely cause for the greater incidence of hepatotoxicity is not stated, ie, the failure of the user to reduce the dosage by 50% when switching from unmodified niacin to a slow-release product. Appropriately, however, it is suggested in this chapter that lower doses of niacin should be used in combination with other antihyperlipidemic agents. The chapter on polymorphic genes in dyslipidemias emphasizes that slow-release niacin is effective in combination with statin drugs and is safer than immediate-release products.
The chapter on nutrient intakes in conjunction with cancer therapy importantly recognizes that putting foods on a "do not consume" list because of established interactions with chemotherapeutic drugs can have harmful nutritional consequences, particularly over extended periods of treatment. In contrast, the tabular information on nutritional components with potential activity in adjuvant cancer therapy must be interpreted literally—potential activity based on in vitro or animal studies—and not as adjuvants with established clinical value. The references are quite extensive, which makes checking the source of the tabular information feasible.
The information on supplements and anesthesiology is sometimes authoritative and helpful, sometimes moot, and occasionally naïve. The discussion of neuroactive nutrients, such as magnesium, provides due caution to anesthesiologists to ascertain appropriate supplement use. The information provided about the biochemical effects of selenium is correct, if sparse; however, the relevance of these biochemical effects to the actions or metabolism of anesthetic agents is not addressed. The discussion of chromium does not include any relevance to anesthesiology, and the authors have inappropriately accepted on face value some dubious reports about the adverse effects of chromium. In particular, a case report of renal toxicity was accepted without reference to letters to the editor that noted that the patient was also taking antihypertensive agents with known renal toxicity and that the adequacy of control of hypertension was not reported. There is no other report of renal toxicity associated with dietary chromium, as picolinate or as any other form of chromium III. The discussion and tabular presentation of potential adverse interactions between anesthetic drugs and herbal supplements is helpful, but the potential enhancement of anesthetic effects in persons who regularly consume grapefruit juice is not mentioned. In contrast, the increased potency and toxicity of the statin drugs and certain other drugs in persons who regularly consume grapefruit juice is carefully considered in other sections of the book.
The nutritional antioxidants are addressed primarily from the perspective of their role as potential disease preventatives or therapies. Little attention is given to the effects of drugs on the absorption and utilization of nutritional antioxidants, which may be especially important for those that are fat soluble. The underlying roles of oxidative stress and oxidative chemical species in cancer, heart disease, and neurologic disorders are discussed in considerable detail.
The chapter on the effects of nutrients and other supplements on depression and the effects of drugs used in the pharmacotherapy of this condition is well-balanced and appropriate. The literature on St John's wort and S-adenosylmethionine is discussed in some detail, and the references provide useful lists of original sources. Overall, the book is well done and useful. I recommend it to those who want an updated review of the mechanisms of nutrient-drug interactions.
ACKNOWLEDGMENTS
The author had no conflict of interest to declare.