Saturday, January 03, 2004

January 2004 Newsletter

FHN Complementary Medicine Monthly Newsletter

January 2004

The other day we had a patient come into the office taking a proton pump inhibitor (Prilosec) and an SSRI (Prozac). At face value that is not all that unusual, it actually is quite common as there are no listed interactions between these drugs. She was obviously having GI and depression symptoms that her physician thought would benefit from both medications. If you look at nutrient depletions by these drugs you have another story!

Prilosec has been shown to deplete both vitamin B12 and folic acid….and prozac has been shown that it needs folic acid and B12 to activate it’s usage, thus the combination of drugs were much less efficient than they could have been. Let’s look at some of the reasons for this.

The proton pump inhibitor acts by decreasing the HCl secretions in the parietal cells of the stomach. These same cells secrete a substance called intrinsic factor, which is required for B12 absorption in the intestine.

(Which is why oral B12 supplements without intrinsic factor don’t work well.) As we decrease the HCl output we also decrease the activation and absorption of folic acid.

In several studies involving fluoxetine (Prozac) patients received 500 micrograms of folic acid (a very conservative dose) versus a placebo. The folic acid treated patients had a 26-34% increase in improvement of symptoms and a 17% reduction in side affects. Part of this may be due to the fact that folic acid is needed in the synthesis of a substance called SAMe which has been shown to help depression and mood swings.

There are several studies that show B12 levels are directly proportional to mood , depression, and anxiety levels.

We also know that folic acid is essential in reducing homocystiene which can reduce cardiovascular risks.

So if we are going to use these drugs especially in combination with each other, supplementation with B12 (with intrinsic factor or IM) and folic acid are a must.


Drs. Glenn and Julie Smith

Complementary Medicine

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