Ok here’s a gripe I’m having currently.  I have a number of patients who are taking anti-epileptic drugs (AEDs) and most of these are children who require them for seizure control.  Naturally, working alongside such serious pathology and these critical medications requires a conservative and evidence based approach to ensure the safety of any added intervention.  Fortunately, this is something I would like to think is one of my strengths.  When these patients present seeking nutritional support, I typically refer them for investigations that can help to clarify what, if any, nutrients are imbalanced because of their long-term AED use or perhaps because of other independent reasons that may compromise they’re overall wellbeing.  I feel that in such a vulnerable population I need to confirm nutritional deficiencies to check my assumptions, prove a need for supplementation and prevent against any excess or creation of further imbalance…and by doing so, I can adhere to my motto of least medicine, is best medicine.

The fact is AEDs are notoriously associated with a long list of potential negative nutrient interactions and the evidence to support this is extensive, this includes but is not limited to: folate, B12, B3, B6, zinc & vitamin D and the deficiencies potentially produced by the AEDs can be quite severe depending on a range of individual factors.  For many of these nutrients, the research goes further and has shown that correction of the deficiency leads to better drug efficacy – therefore adjunctive nutritional monitoring and correction would seem like a real ‘win win’ situation.

(Stargrove,MB. et al. Herb, Nutrient & Drug Interactions – Clinical Implications & Therapeutic Strategies. 2008)

I would have thought, these drug nutrient interactions, given the large body of evidence, would be familiar to anyone working in medicine but particularly those that have prescribing rights to these medications.  I would also like to think that when we’re dealing with a vulnerable population such as children, long term AED use would warrant regular monitoring of these ‘at risk nutrients’  – even be expected as basic risk minimisation.  Apparently not.

This situation, given the medical profession’s underplaying of the role of nutrition in patients’ health & wellbeing, is not surprising but it is disappointing.  These are vulnerable patients who have no choice but to stay on these meds long-term – surely the least we can do is educate them about these potential effects so they can personally be on the look out for clinical features suggestive of nutritional problems and offer regular screening for at-risk nutrients to boot.  Risk minimisation and improved drug efficacy?… sounds like a win-win to me.