Safe supplementation . . . a question for Mrs. D
 

My 78 year old father is currently taking Lanoxin, Warfarin and glyburide for heart support and diabetes. We are noticing he is now losing strength and mental capacity. His family physician of many years just shrugged when we asked about supplementation. Of course, a second opinion is out of the question, he is so afraid and stubborn about anything new . . . After researching interactions with these drugs, I feel there isn't much of anything he can take, but I was wondering about the B's, and perhaps some form of magnesium.

Does he have normal kidney functions?

The most common deficiency in the elderly is B12.
In fact the NIH recommends that all persons over 50 take a B12 supplement.

Many drugs disrupt nutrients in the body.
This site explains it:
http://www.enotalone.com/article/4624.html

I have a reference book that is more technical than the above website and looked up your father's drugs.

Digoxin affects:
calcium
phosphorus
magnesium
thiamine B1

When B1 gets low, mental functions decline. So I would focus on that first.

Glyburide depletes CoQ-10.

Low CoQ-10 impacts the heart and other muscles, and reduces energy from the mitochondria in cells. (these are the energy factories). CoQ-10 is normally made in the liver but that may fail with age, or certain drugs like statins for cholesterol.

B12 and Thiamine are what I'd start with.
Get a good activated form of B12, called methylcobalamin and take one daily on an empty stomach. You can have his B12 measured with a blood test, if his doctor is cooperative.
This form of B12 is often not in stores so we all buy it online here:
this page shows the various choices:
http://www.iherb.com/Search.aspx?kw=methylcobalamin
most of us use Jarrow, but you can choose anyone you want.
Start at 1mg daily.

The thiamine B1 is available in most stores for a very small price. I'd start him on 100mg a day, and if he perks up, increase to 300mg a day in divided doses. Thiamine gives signs when it is excreted. The urine is more yellow and has a distinctive odor--yeasty. If he excretes it quickly within 4 hrs that is a good sign of adequate kidney functions.

Both of these are easy to tolerate and are often used in the elderly.

Diabetics lose magnesium in the urine, so he will need some of this as well. But you need adequate kidney functions present. I have a magnesium thread:
http://neurotalk.psychcentral.com/thread1138.html
Until you know his kidney status, I'd use food sources for this mineral.

The use of Lanoxin implies to me a degree of heart failure.

The use of warfarin limits him tremendously in the herbal area.
Just about everything interacts with warfarin! (as you know)

This site is very good about supplements and interactions with drugs:
Here is thiamine for example:
http://www.umm.edu/altmed/articles/v...-b1-000333.htm
notice the interaction with digoxin.
It is ironic and typical of many drugs...that are used to treat a condition..end up causing it. Depletion of thiamine actually makes heart failure worse.

This is B12:
http://www.umm.edu/altmed/articles/v...b12-000332.htm

I don't see Warfarin on either monograph.

I worked in nursing home care for over 8 yrs...and just about every patient (we serviced 35,000 beds) was on B12.

The other issue with your father is a possible thyroid condition. The elderly become hypo commonly. But that requires blood work to evaluate.

Please read the links I've given. And if you have any questions don't hesitate to ask.

Thank you Mrs. Doubtfyre
 

I have read (and will continue to read) your threads regarding B-12, the Bs and magnesium- but was hesitant to suggest supplementation without your knowledge regarding those specific drugs and possible interactions.
On a different note- I want to thank you for not only for this information, but also from an earlier post this summer. I had questions about Cipro toxicities and have closely followed your nutritional/supplement suggestions. They worked! You are amazing, and this is an incredible site. You will always have my gratitude. Julie

Another question . . .
 

Mrs. D., I wanted you to know that my father is showing some positive changes in his mental functioning- we started with B-12 and B-1. Hopefully this isn't a placebo effect, and the Bs are working for him. No input/suggestions from his doctor, we just feel stonewalled, and since we can't get any guidance from him, we don't feel it is possible to start EFA's, do you agree? Also, I want to consider SAMe for him, but wondered about interactions with his other drugs. I can't find any reactions specific to the drugs he is on, but don't want to miss anything, either. If you have time, your input would be appreciated. Thanks so much. Julie

mrsD, I want you to know just how much you are appreciated by myself & obviously others! Thank, Thank you, Thank you! You make my life so much easier with your willingness to share your knowledge! :D:hug:

Oh, that is really good, that you are seeing progress so quickly!

EFAs are really food. They become "drugs" when used in high doses. The most common effect in high doses, is slight thinning of the blood. So the warfarin is a potential issue. BUT you can choose foods with EFAs in them, and this would be a modest way to increase safely. Some salmon twice a week, Omega 3 eggs,
and Smart Balance mayo and butter substitute spreads, will give some. There are Chicken of the Sea pouches of salmon now, for about $1 each, and they make a nice sandwich..mixed with Smart Balance mayo...etc. Better than tuna, which is now
more heavily contaminated with heavy metals. We use the pouches of salmon now alot, even one of my CATS is hot for it! Begs for it!

SAMe is just a fast way to do this:
B12, B6, folate make SAMe in the body. So by providing those you can do the same thing more slowly. In a very elderly person with heart issues, stimulating too fast with SAMe may cause some heart problem. SAMe donates methyl groups to make neurotransmitters in the body/brain, and one of them is norepi..which increases heart rate. So doing it the vitamin way is slower and gentler.

Make your changes and introductions slowly, and watch and see what is happening. You have to always watch patients on warfarin... this is a tough drug to take and monitor!

Thanks you so much. We will go slow and follow your suggestions.