Skip to ContentGo to accessibility pageKeyboard shortcuts menu
OpenStax Logo
Nutrition for Nurses

18.3 Treatments and Nutrition

Nutrition for Nurses18.3 Treatments and Nutrition

Learning Outcomes

By the end of this section, you should be able to:

  • 18.3.1 Identify drug–food interactions for their impact on treatments used for gastrointestinal disorders.
  • 18.3.2 Identify treatments and medications that can cause nutritional deficiencies in clients with gastrointestinal disorders.

Drug–Food Interactions Related to Treatments for Gastrointestinal Disorders

Medications used to treat Crohn’s disease and UC are in the anti-inflammatory and immunosuppressant classes. The most frequently used medications for Crohn’s disease treatment are azathioprine and mercaptopurine. A client with UC is most often prescribed balsalazide, mesalamine, olsalazine, or sulfasalazine. For diverticulitis, antibiotics are needed; the most commonly used are ciprofloxacin plus metronidazole, trimethoprim-sulfamethoxazole plus metronidazole, amoxicillin-clavulanate, and moxifloxacin.

Drug–food interactions are a concern when prescribing these drugs, so clients must be educated about specific interactions to avoid adverse effects (Table 18.4).

Food Food Interaction
Azathioprine
  • Avoid raw or half-cooked foods (can cause foodborne illness).
Mercaptopurine
  • Take 1 hour before or 2 hours after ingestion of milk or dairy products (reduces absorption when taken with food).
Balsalazide
  • Swallow right away if taken with food as an open capsule (mixing with food can cause staining of the tooth enamel).
  • Review medication insert for information on mixing medication with applesauce.
Mesalamine
  • Take this medication on an empty stomach—at least 1 hour before meals or 2 hours after meals when taking specifically the Asacol HD version of this medication.
Olsalazine
  • Drink plenty of water with this medication to protect the kidneys.
  • Avoid smoking (decreases medication effectiveness).
Sulfasalazine
  • Avoid alcohol and spicy foods (increases risk for indigestion).
Metronidazole
  • Avoid alcohol during and 24 hours before and after treatments (can cause serious adverse effects).
Sulfamethoxazole-Trimethoprim
  • Avoid alcohol (can cause serious adverse effects).
Amoxicillin- Clavulanate
  • No interactions.
Moxifloxacin and Ciprofloxacin
  • Avoid dairy products (can make less effective).
  • Avoid vitamins containing iron, magnesium, calcium, or zinc within 4 hours before and after taking this medicine (can make the drug and the vitamins less effective).
Table 18.4 Foods to Avoid When Taking Certain Drugs (sources: Cancer Research UK, 2022; Mayo Clinic, n.d.; Mayo Clinic, 2023; NHS, 2021; Offices of Disease Prevention and Health Promotion, 2023; PeaceHealth, 2023)

Treatments and Medications That Can Cause Nutritional Deficiencies

Avoiding certain foods is not the only concern that needs to be addressed regarding treatments. Many of the medications already described can also cause nutritional deficiencies. The client must know which foods they can increase in their diet to prevent deficiency (Table 18.5).

Drug Nutrient Deficiency Foods to Replace Nutrients
Azathioprine
  • Niacin (vitamin B3)
  • Red meat, poultry, fish, brown rice, nuts, seeds, legumes, bananas
Mercaptopurine
  • Hypoglycemia in children younger than 6 years old when administered in a liquid form
  • Complex carbohydrates, along with monitoring of glucose levels
Balsalazide
Olsalazine
Sulfasalazine
Mesalamine
  • Folic acid can reduce adverse effects of the medication
  • Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver
Ciprofloxacin
Moxifloxacin
  • Bifidobacterium bifidum
  • Lactobacillus acidophilus
  • Biotin
  • Folic acid
  • Inositol
  • Vitamin B1 (thiamin)
  • Vitamin B2 (riboflavin)
  • Vitamin B3 (niacin)
  • Vitamin B6 (pyridoxine)
  • Vitamin B12 (cobalamin)
  • Vitamin K
  • Kefir, sourdough bread, sauerkraut, kimchi, other fermented vegetables
  • Milk enriched with acidophilus, yogurt containing live L. acidophilus cultures, miso, tempeh
  • Legumes, egg yolks, organ meats, nuts, seeds, mushrooms, avocados, sweet potatoes
  • Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver
  • Whole-grain bread and bran, prunes, cantaloupe, citrus fruits, beans, peas, almonds, peanut butter, liver
  • Fortified breakfast cereals, pork, fish, beans, lentils, green peas, enriched cereals, breads, noodles, rice, sunflower seeds, yogurt
  • Dairy milk, yogurt, cheese, eggs, lean beef and pork, organ meats (beef liver), chicken breast, salmon
  • Red meat, poultry, fish, brown rice, nuts, seeds, legumes, bananas
  • Fish, beef liver and other organ meats, potatoes and other starchy vegetables
  • Fish, meat, poultry, eggs, dairy products
  • Kale, collard greens, broccoli, spinach, cabbage, lettuce
Metronidazole
  • Calcium
  • Carbohydrates
  • Beta-carotene
  • Fats
  • Folic acid
  • Iron
  • Magnesium
  • Potassium
  • Sodium
  • Vitamin A
  • Vitamin B12 (cobalamin)
  • Vitamin D
  • Vitamin K
  • Dairy products, soybeans, dark green leafy vegetables, calcium-fortified foods, canned salmon, figs
  • Grains, fruit, dairy products, legumes
  • Yellow, orange, and green fruits and vegetables
  • Fish, avocados, seeds, nuts, olive oil, eggs
  • Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver
  • Nuts, dried fruits, iron-fortified breads and cereals, legumes, oats, tofu
  • Smoked, cured, salted, or canned meat, fish, or poultry; frozen breaded meats; frozen processed foods such as burritos and pizza; canned entrees (like canned pasta in tomato sauce); salted nuts
  • Leafy green vegetables, orange and yellow vegetables, tomatoes, red bell peppers, cantaloupes, mangos, beef liver, fish oils, milk, eggs
  • Fish, meat, poultry, eggs, dairy products
  • Cod liver oil, salmon, swordfish, tuna, sardines, beef liver, vitamin D–fortified orange juice and dairy and plant milks
  • Kale, collard greens, broccoli, spinach, cabbage, lettuce
Sulfamethoxazole-Trimethoprim
  • Vitamin K
  • Calcium
  • Magnesium
  • Vitamin B12 (cobalamin)
  • Kale, collard greens, broccoli, spinach, cabbage, lettuce
  • Dairy products, soybeans, dark green leafy vegetables, canned salmon, figs
  • Pumpkin seeds, chia seeds, almonds, boiled spinach, cashews, peanuts, soy milk
  • Fish, meat, poultry, eggs, dairy products
Amoxicillin- Clavulanate
  • Vitamin K
  • Vitamin B12 (cobalamin)
  • Folic acid
  • Potassium
  • Vitamin B2 (riboflavin)
  • Kale, collard greens, broccoli, spinach, cabbage, lettuce
  • Fish, meat, poultry, eggs, dairy products
  • Dark green leafy vegetables, beans, peanuts, sunflower seeds, whole grains, liver
  • Dried fruits, beans, lentils, potatoes, winter squash (acorn, butternut), spinach, broccoli, beet greens, avocados
  • Fish, meat, poultry, eggs, dairy products
  • Milk, yogurt, cheese, eggs, lean beef and pork, organ meats (beef liver), chicken breast, salmon
  • Kale, collard greens, broccoli, spinach, cabbage, lettuce
Table 18.5 Nutritional Deficiencies Caused by Pharmacologic Therapies and Foods to Replace Those Nutrients (sources: Kaiser Permanente, 2015; Mayo Clinic, 2023; Naeini et al., 2021; Peace Health, 2015; Prescott et al., 2018; Ratajczak, et al., 2021)
Citation/Attribution

This book may not be used in the training of large language models or otherwise be ingested into large language models or generative AI offerings without OpenStax's permission.

Want to cite, share, or modify this book? This book uses the Creative Commons Attribution License and you must attribute OpenStax.

Attribution information
  • If you are redistributing all or part of this book in a print format, then you must include on every physical page the following attribution:
    Access for free at https://openstax.org/books/nutrition/pages/1-introduction
  • If you are redistributing all or part of this book in a digital format, then you must include on every digital page view the following attribution:
    Access for free at https://openstax.org/books/nutrition/pages/1-introduction
Citation information

© Mar 7, 2024 OpenStax. Textbook content produced by OpenStax is licensed under a Creative Commons Attribution License . The OpenStax name, OpenStax logo, OpenStax book covers, OpenStax CNX name, and OpenStax CNX logo are not subject to the Creative Commons license and may not be reproduced without the prior and express written consent of Rice University.