It is absolutely amazing to me how much people spend on herbal remedies and supplements over the counter, when they can barely meet their bills. Some folks cannot afford prescription medications even at Wal-Mart prices of $4 a month for most generics, but will pay good money for moderate- to high-priced supplements.

Maybe it’s the idea of making one’s own decisions about what to take for each ailment, but sometimes the choice of medications and supplements, instead of prescription medication that goes through rigorous experimentation and government approval, is scary. Unregulated supplements are taken for everything from diabetes to high blood pressure to high cholesterol by the general public. My concern is that these are serious health conditions that require careful monitoring.

Even a very close relative of mine tried several herbs before he would commit to high blood pressure medication. Yes, once you start a blood pressure medication it must be continued in almost all cases. However, not starting the medication when it is needed does not prevent the complications that will come from untreated or inadequately treated hypertension such as stroke, heart attack and congestive heart failure.

I am not against using well-known herbs or supplements that have been researched and that have some quality control measures to guarantee the dosage is as listed on the label. Quite a few herbs are used in Europe and have been researched over many years there. Yet I often see articles that report tests on these supplements in the US in a controlled study where the herb or supplement is found to only have placebo benefits, i.e., people think they are better and so they are.

Reports of research on herbs and supplements may be found in the media varying from those that relate cases of healthful effects of a supplement for a few people to massive scientifically controlled experimental studies.

I personally have seen some people report relief from arthritis pain with the over-the-counter formula glucosamine-chondroitin and so I am glad to recommend that it at least be tried, even though it is difficult to find many studies supporting its effectiveness.

Cinnamon was found to lower blood sugar a little, and studies verified that, however it is not effective enough to replace diabetes medication or even lower blood sugar for everyone according to a most recent report. Reports are conflicting.

Lately you can find various new vitamin supplements that according to their manufacturer are needed to replace losses due to cholesterol-lowering drugs. Manufacturers state that cholesterol-lowering drugs cause loss of an enzyme that protects muscles from aches and painful spasms and the vitamin formulation can correct the deficit. So the bottle states this vitamin supplement is for people on Lipitor, Zocor and Pravachol.

Recently other vitamin supplements have emerged which claim to restore the body to normal chemical balance for persons taking Lexapro, Prozac, Zoloft and Effexor.

Still other vitamin supplements are said to be required for patients with diabetes; and another formulation is offered for people taking acid reducers such as Pepcid, Nexium, Prilosec and Prevacid.

According to Prescriber’s Letter, these vitamin supplements are inexpensive, but are really no substitute for the common daily multivitamin. While the above supplements do not cause any problems, they do not provide all the daily vitamins that we do need, and their benefit is “likely to be marginal.”

Still, the “nutrition depletion” idea is a good one. There are times when supplements are required because prescription medication actually depletes some vitamins and chemicals that the body needs. This is what I would like to focus on this month. There is such a condition described as “Drug-Induced Nutrient Depletion.” The most common problems are listed below.

Many antacids contain aluminum hydroxide which can bind phosphate and leach calcium out of bones; then these minerals are excreted out of the body through urine. Prolonged use of large amounts of antacids such as amphogel can cause deficiencies in calcium and phosphorus, both important minerals for bone health. Maalox and Mylanta are simethicone and do not have this side effect. If you have a question about your antacid show it to your health care provider.

Aspirin and anti-inflammatories such as the ibuprophens Motrin and Advil can cause damage to esophagus, stomach and intestinal lining resulting in slow, continuous blood loss and anemia. Try not to take too much of these medications and when they are needed on a frequent basis such as in arthritis, watch for signs of anemia such as low energy and pale skin. Iron rich foods can work better for correcting anemia since iron pills are often irritating to the stomach.

Certain common anti-convulsants can cause loss of vitamin D and thus slow absorption of calcium. This can result in bone loss. It is a good idea to have a vitamin D and calcium level checked when on long-term anti-convulsants such as Carbetrol, Dilantin, and primidone (Mysoline). Supplements may be needed.

Longterm use of corticosteroids has long been known to cause many metabolic problems, while providing relief from arthritis, breathing conditions, and various autoimmune diseases. Short bursts of the medication for allergy flares, rashes, and asthma attacks are not problematic, unless a person has uncontrolled high blood pressure. Steroids can cause loss of calcium through the kidneys and intestines. Persons taking 7.5 mg a day or more of steroids need to be taking 1500 mg of calcium a day and a vitamin D supplement of 800 units a day. Often these come together in the same tablet. Check the label on your supplement.

People on medications that block production of acid in the stomach for a long period of time, where the dose is in the higher range can lose Vitamin B12 by just not absorbing it, even though it is in the diet. Periodically the level of B12 and a blood count should be checked to assure persons are not becoming anemic. These are all simple blood tests.

Diuretics are used for blood pressure control, swelling, congestive heart failure, and fibrocystic breast disease if it is severe. They cause increased excretion of magnesium and potassium in higher doses especially if used on a daily basis. Often these medications are prescribed with a potassium supplement. Over-the-counter potassium supplements are not sufficient. The best way to determine if the supplement is needed is by checking the potassium and magnesium levels through basic blood testing.

Many diabetics are on Metformin. This important drug for controlling blood sugars and preventing complications in diabetes can result in less absorption of vitamin B12 and possibly folic acid. People taking this drug need a B12 level checked every 2-3 years. Folic acid levels can be checked less often. (Blood tests)

Xenical is now over-the-counter and people choosing this medication to help them lose weight must read the manufacturer’s recommendation to take a multivitamin supplement at least 2 hours before or after their dose of Xenical or (Alli). Since this drug causes dietary fat to be eliminated rapidly through the gastrointestinal tract, fat soluble vitamins are washed out with it. These are vitamins A, D, E, and K plus beta-carotene.

Some people suffering from ulcerative colitis, other types of inflammatory bowel disease or rheumatoid arthritis take sulfasalazine. This medication can also cause depletion of folic acid over a prolonged use in high doses (above 2 grams a day). The replacement of the folic acid can be with a supplement of foods high in folates.

Folates are found in fresh green, leafy vegetables, fruits, organ meats such as liver, enriched cereals and breads. Vitamin B12 is found in meats, fish, poultry, eggs, fortified cereals, milk and milk products. Vitamin D is found in fortified milk, fish liver oils, butter, egg yolks and liver, however sunshine is our best and main source for vitamin D. The body stores folates in only small amounts and can become depleted in a matter of a few months.

Iron is found in many foods except for dairy products. Larger amounts are in eggs, beans, peaches, raisins, beef, soybean flour, and clams.

Potassium is found in many foods including whole and skim milk, bananas, oranges, prunes, raisins and meats.

Calcium is found in milk and dairy products, meat, fish, eggs, cereals, beans, fruits, vegetables.

Magnesium is found in green leaves, nuts, cereals, sea foods and grains.  Phosphorus is found in milk, cheese, meat, poultry, fish, cereals, nuts and legumes.

While a healthy diet can provide good nutrition for normal daily needs, taking medications that deplete these vitamins, elements, and minerals requires more concentrated doses in the form of a supplement. Your health care provider can tell you which ones can be taken safely from over the counter.

Clinic items: If you are around Marathon on Thur., April 17, please come and help the staff and board of Marathon Health Center celebrate our 10th anniversary. There will be an ice cream social for all our patients, friends, past board members, and supporters from 3 to 5 PM.

The Marathon Health Center (432-386-4316) will have some schedule changes over the next few months. So if you are coming from a distance, please call to set up your visit and verify times and dates. These changes are as follows: closed Thursday April 10 to allow JoAnn to attend a Pediatric Advanced Life Support class; however, we will be open the next day, Friday April 11th from 8 to 11 AM . April 24th (Thursday) and 28th (Monday) JoAnn attends a retreat in Las Cruces with her husband as part of his final preparation of the last four years for ordination as a deacon in the Catholic Church May 31st. The clinic will be closed June 2 (Monday) and 5th (Thursday) in celebration of the ordination. Your patience with these changes is appreciated.

Doctor’s Week is March 31st to April 4th so if you see Dr. Luecke, please remind him how much we all appreciate him for his service to the Big Bend especially as supervisor at the Marathon Health Center.

JoAnn Lister is a Family Nurse Practitioner Certified, at both the Marathon Health Center and Alpine Family Health Care Services. The Marathon Health Center is open Mondays & Thursdays, 8:30 a.m. - noon, 1:00 - 5:30 p.m. for appointments and walk-ins. Located at South First at Post Road in Marathon. Phone: 432/386.4316. Alpine Family Healthcare Services is located at 910 East Lockhart Street in Alpine. Phone: 432/837.1541.