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The Whole-Life Connection
Wholistic Health and Well-Being Centre |
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Telephone: +61 2 9727 5794
Facsimile: +61 2 9754 2999 |
Email:
wholelifeconnexion@iprimus.com.au |
Address:
P.O. Box 7120
Bass Hill NSW 2197
Australia |
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Nutritional Depletion as a Side Effect of Anticonvulsant Medications |
Anticonvulsant medications such as barbiturates, phenytoin, carbamazapine, primidone, and valporic acid are known to deplete vital nutrients. Each of these is outlined below along with the vitamins and minerals they are known to deplete.
Barbiturates such as Phenobarbitol or Phenobarbitone can cause depletion of calcium, folic acid, vitamin D, vitamin K, and biotin.
Phenytoin such as Dilantin can deplete a wide range of nutrients including biotin, calcium, folic acid, vitamin B1, vitamin B12, vitamin D and vitamin K.
Carbamazepines such as Tegratol, Teril, Carbium can deplete biotin, folic acid and vitamin D.
Primidone in Mysoline can deplete folic acid and biotin.
Valporic acid in Epilim and Valpro can cause depletion of folic acid, carnitine, copper, selenium and zinc.
Health Implications as a Result of Nutrient Deficiency
Vitamin B1 (Thiamine)
B vitamims act as coenzymes, helping enzymes to perform their function properly. The B vitamins help to maintain the health of nerves, skin, eyes, hair, liver and mouth as well as healthy muscle tone in the gastrointestinal tract and proper brain function. Only those B vitamins depleted by anticonvulsant medications will be mentioned here.
Thiamine enhances circulation and assists in blood formation, carbohydrate metabolism, and the production of hydrochloric acid (needed for proper digestion). Thiamine also optimises cognitive activity and brain function and is needed for proper muscle tone of the intestines, stomach and heart. Thiamine also acts an antioxidant protecting the body from the degenerative effects of aging, alcohol consumption and smoking. A vitamin B1 deficiency results in beriberi, constipation, edema, enlarged liver, fatigue, forgetfulness, gastrointestinal disturbances, heart changes, irritability, laboured braething, loss of appetite, muscle atrophy, nervousness, numbness of the hands and feet, pain and sensitivity, poor coordination, tingling sensations, weak and sore muscles, general weakness, and severe weight loss.
Vitamin B12 (Cyanocobalamin)
Vitamin B12 is needed to prevent anaemia. It aids folic acid in regulating the formation of red blood cells and helps in the utilisation of iron. This vitamin is also required for adequate digestion, absorption of foods, the synthesis of protein, and the metabolism of carbohydrates and fats. It helps cell formation and cellular longevity. Additionally, vitamin B12 prevents nerve damage, maintains fertility and promotes growth and development by maintaining the fatty sheaths that cover and protect nerve endings. Vitamin B12 is used in the production of acetylcholine, a neurotransmitter that assists learning and memory. It also enhances sleep patterns, allowing for a more restful and refreshing sleep. A deficiency of vitamin B12 can be caused by malabsorption, which is common in digestive disorders. Deficiency can cause abnormal gait, bone loss, chronic fatigue, constipation, depression, digestive disorders, dizziness, drowsiness, enlargement of the liver, eye disorders, hallucinations, headaches (including migraines), inflammation of the tongue, irritability, laboured breathing, memory loss, moodiness, nervousness, neurological damage, palpitations, pernicious anaemia, ringing in the ears (tinnitus), and spinal cord degeneration.
Folic Acid (Pteroylglutamic acid- PGA)
Folic acid is considered a brain food and is needed for energy production and the formation of red blood cells. I also strengthens immunity by assisting in the proper formation and functioning of white blood cells. If functions as a coenzyme in DNA and RNA synthesis and is necessary for healthy cell division and replication. All anticonvulsant drugs deplete folic acid. In women, this can lead to serious health problems. A deficiency in folic acid disrupts DNA and RNA metabolism, thus producing abnormal cells. This problem is particularly acute in cells with the most rapid turnover- red blood cells, leukocytes, and epithelial cells of the stomach, intestine, vagina, and uterine cervix. There is a higher need for folic acid during pregnancy and this deficiency is associated with birth defects such as anencephaly and spina bifida. Folic acid deficiency can cause anemia, cervical dysplasia (leading to hysterectomies), headaches, fatigue, depression, hair loss, growth impairment, anorexia, insomnia, diarrhea, nausea, apathy, memory loss, paranoia, increased infections and elevated homocysteine levels,. Elevated homocysteine levels is now recognised as a serious independent risk factor for atherosclerosis (hardening of the arteries due to the accumulation of fatty plaques). Even moderate levels of homocysteine substantially increase the risk for plaque build-up and blood clots. Folic acid is needed with adequate amounts of vitamin B6 and B12 to convert homocysteine to non-harmful amino acids in the body. A folic acid deficiency is also associated with increased risk of developing breast cancer and colorectal cancer.
Biotin
Biotin aids in cells growth; fatty acid production; in the metabolism of carbohydrates, fats and proteins and in the utilisation of the other B-complex vitamins. It also promotes healthy sweat glands, nerve tissue, and bone marrow. In addition it also helps to relieve muscle pain. Biotin deficiency can result in hair loss, depression, anaemia, insomnia, loss of appetite, muscular pain, nausea, soreness of the tongue, inflammation or pallor of the skin and mucous membranes, and an elevation of blood glucose and cholesterol levels.
Carnitine
Although considered an amino acid, carnitine is more related to the B vitamins. Unlike true amino acids, carnitine is not used for protein synthesis or a neurotransmitter. Its main function in the body is to facilitate the transport of long-chain fatty acids to the mitochondria where they are burned to provide energy. This is a major source of energy for the muscles. Studies have shown decreased carnitine levels in people suffering from chronic fatigue syndrome. Carnitine works with the antioxidants vitamins C and E to help slow the aging process by promoting the production of acetyl-transferase, an enzyme in the mitochondria of brain cells that is vital for the production of cellular energy there. Unless there is an inherited defect in carnitine synthesis, the body normally makes adequate levels of carnitine provided there are sufficient amounts of iron, vitamin B1, vitamin B6, vitamin C and the amino acids lysine and methionine available. Administration of valporic acid (Epilim) can create a carnitine deficiency, which can cause fatigue, confusion, muscle weakness, cramps, heart pain and obesity.
Calcium
Since anticonvulsant medications decrease the intestinal absorption of calcium, individuals taking these medications are at increased risk of developing a calcium deficiency. Simple calcium supplementation will not solve this problem because the calcium deficiency is the result of a vitamin D deficiency, and vitamin D is necessary for calcium absorption. Vitamin D supplementation is therefore necessary to increase the absorption of calcium. The well known results of calcium deficiency are skeletal problems such as rickets (softening and bending of the bones) in children and osteoporosis (porous, brittle bones) or osteomalacia in adults. Additionally, calcium deficiency can lead to high blood pressure, muscle cramps, heart palpitations, tooth decay, back and leg pains, insomnia, and nervous disorders.
Vitamin D
Vitamin D deficiency can cause skeletal problems because not enough calcium phosphate is deposited in the bone matrix. In children, the bones are not strong enough to withstand the ordinary stresses of weight-bearing, which can result in muscle weakness, pain, knock-knees, bowed legs, spinal curvature, pigeon breast, disfiguring of the skull, and tooth decay and dental problems. In adults, it leads to osterporosis.
Vitamin K
Vitamin K is needed for the production of prothrombin, which is a necessary for blood coagulation. Recent research indicates that vitamin K is also necessary for bone formation and repair because it is necessary for the synthesis of osteocalin, the protein in bone tissue on which calcium crystallizes. It also plays an important role in the intestines and helps to convert glucose into glycogen for storage in the liver. It is also thought to increase resistance to infection in children and help prevent cancers that target the inner linings of the organs. Since Vitamin K regulates blood clotting mechanisms, a deficiency can lead to coagulation problems resulting in bleeding and hemorrhage in internal organs and a disruption in normal bone growth and repair. The majority of this vitamin’s supply is synthesised in the body by the "friendly" bacteria normally present in the intestine. Hence probiotics are important for anyone on anticonvulsant medications, particularly those on Phenobarbitol and Dilantin.
Copper
Among its many functions, copper aids in the formation of bone, haemoglobin and red blood cells, and works in conjunction with zinc and vitamin C to form elastin, an important skin protein. Additionally, it is essential for the formation of collagen (protein) used in bones, skin and connective tissue. It is involved in the healing process, energy production, hair and skin colouring and taste sensitivity. A copper deficiency can lead to anemia, baldness, diarrhea, general weakness, elevated levels of serum cholesterol, impaired respiratory function and skin sores.
Selenium
Selenium is a vital antioxidant, especially when combined with vitamin E. It protects the immune system by preventing the formation of free radicals that can damage the body. It’s Principal function is to inhibit the oxidation of lipids (fats) as a component on the enzyme glutathione peroxidase. It also plays an important role in regulating the effects of the thyroid hormone on fat metabolism. Selenium and vitamin E act synergystically to aid in the production of antibodies and to help maintain a healthy heart and liver. This trace element is needed for pancreatic function and tissue elasticity. Research has also indicated that it prevents the formation of certain types of tumours (lung, prostrate, colorectal). Selenium deficiency has been linked to cancer and heart disease. It is also associated with exhaustion, growth impairment, high cholesterol levels, infections, liver impairments, pancreatic insufficiency, and sterility.
Zinc
Zinc is an important mineral for a healthy immune system. It is required for protein synthesis and collagen formation and promotes the healing of wounds. It is a constituent of insulin and many vital enzymes. Sufficient intake and absorption of zinc is vital to maintain the proper concentration of vitamin E in the blood. Zinc also prevents acne and regulates the oil glands; allows for the acuity of taste and smell; protects the liver from chemical damage; and is vital for bone formation. A zinc deficiency may result in a loss of the senses of taste and smell, cause fingernails to become thin, peel and develop white spots. Other signs of a zinc deficiency include acne, hair loss, growth impairment, delayed sexual maturation, fatigue, high cholesterol levels, impaired night vision, impotence, increased susceptibility to infection, infertility, memory impairment, a propensity to diabetes, prostrate problems, recurrent colds and flu, skin lesions and slow wound healing.
A plethora of vitamin supplements is available over-the counter in health food shops in Australia. However, they come in various forms, combinations and amounts and many do not deliver what they promise. They are available in tablet, capsule, gel-capsule, powder, sublingual, losenge and liquid forms. Some can also be administered by injection. How quickly they are absorbed and assimilated into the body (bio-availablity) depends on the form they are in, whether they are synthetic (laboratory manufactured) or natural (nature’s unprocessed food sources) and the ingredients used as fillers. It is highly unlikely that you will find one supplement or brand to cater for all of your needs. For this reason, caution is suggested when buying over-the counter supplements and the need for qualified nutritional advice is paramount.
References:
Pelton, R & LaValle (2000): The Nutritional Cost of Prescription Drugs- How to maintain good nutrition while using prescription drugs. P 24-40. Morton Publishing Company
Balch, P.A. & Balch, J.F., (2000): Prescription for Nutritional Healing (3rd edition), Avery Books, New York
The above information is for educational purposes only. Recent research has shown that few generic brands fulfil the need for high quality product. It is therefore vital that you discuss your unique needs with your health care professional.
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For further information, please contact:-
Gregory de Montfort
and Rosemary Boon
