Effects of diet and nutrition on drug therapy

Foods containing biochemically active substances have been used therapeutically throughout the ages and continue to function as important adjuncts to drug therapy. But naturally-occurring substances can also have adverse effects, as can the food additives of today. Food--drug interactions can alter the effect of therapeutic agents or cause adverse reactions where none had existed. These problems are often aggravated in elderly patients, who may suffer from malnutrition (e.g., protein insufficiency) or altered food metabolism. Malnutrition in the elderly can be caused by disease, socioeconomic factors, or simply by the deterioration of eating habits. Although nutritional requirements decrease with age, the elderly still need nutrients for the repair of normal structures and for energy. The nutritional needs of the elderly remain poorly defined. Drugs can alter food metabolism, which, in turn, can affect drug action. Many food--drug interactions are well documented; drug absorption and drug elimination are often affected by an altered food metabolism. Particular problems include salicylate-induced iron deficiency, poor monitoring of vitamin metabolism and the effects of vitamin underuse and overuse, and lack of knowledge about the effects of long-term drug use on vitamin metabolism. An additional problem is the presence of potentially harmful materials in non-prescription products.