Herbs for Mood

A positive mental attitude reflects a healthy brain. A diet high in fruit, vegetables and oily fish provides antioxidants and omega-3 fatty acids, which have known brain cell–protective effects. And certain herbs can augment these effects too. It is not surprising then, that herbs, such as ginkgo biloba, which have been shown to improve cognitive function, have also been found to counter low mood.

Fatigue
People with low mood and anxiety usually experience abnormal fatigue. Iron deficiency, or deficiency of any nutrient, can cause fatigue. Hence, before thinking about herbs, it is wise to check your diet and take action accordingly.

Adaptogenic herbs speed up your recovery from fatigue. The term ‘adaptogen’ means supporting the body’s adaptation to stresses of various kinds, whether heat, cold, sleep deprivation, psychological stress etc... Chinese ginseng, or Panax ginseng, is the classic adaptogen. For example, it was shown to counter low mood and enhance well-being and vitality in a study of 625 young, stressed-out city dwellers.¹.

Anxiety
Valerian, used by many as an aid to sleep, also reduces anxiety because of its relaxant effects. A small scientific study found that valerian may produce calming effects in healthy volunteers under stressful social situations.^2.

Commonly used to reduce menopausal sweating, sage was found to combat anxiety and improve mood and cognitive performance in one small study.³. In folk medicine this herb was associated with longevity and there are accounts of traditional use for depression, memory loss and anxiety.

Low mood
While small scientific studies have shown anti-depressant effects of ginkgo⁴., it is St. John’s Wort which has been most studied for this effect. In fact, there have been well over 30 clinical trials on the effects of St. John’s Wort for mild-to-moderate depression. Almost all have shown positive effects, but at dosages higher than those sold over-the-counter in the UK. Taking all the studies together, Dr Linde and co-workers concluded, in a prestigious article in the British Journal of Psychiatry, that good quality St. John’s Wort extracts can have similar effects to standard anti-depressants.

Mood swings
Women are particularly prone to mood swings due to changes in hormone levels, either in the premenstrual phase of the menstrual cycle or in the menopause. While some of the herbs described above may be helpful to stabilise mood, specific ones to re-balance hormone levels include agnus castus and soy isoflavones.

Dr Ann Walker

Dr Ann Walker is Senior Lecturer in Human Nutrition at The University of Reading. She is a member of the national Institute of Medical Herblists and of the College of Practitioners of Phytotherapy. She is the author of several books on human nutrition.

Accidents will happen

Urinary incontinence remains a taboo subject, both socially and medically, even in the 21st century. It’s estimated to affect a staggering 5 million women in England and Wales, yet despite this, it is thought a third of women still suffer in silence with many women being too embarrassed to seek help, or possibly not realising that effective treatments exist.I am going to look at what women can do for themselves, but I must stress that if you have a problem, it is critical you see your GP or practice nurse to allow it to be fully assessed.

Whilst there are a number of common disorders of the urinary tract, this remains a complex area that needs a proper assessment to give an accurate diagnosis and allow a discussion about possible treatments.

What are common causes of urinary incontinence?

Stress incontinence:

This is the most common cause of incontinence and accounts for about 60% of all cases. It occurs when there is leakage on exertion, such as coughing, sneezing or running. It is also associated with childbirth, however nearly 5% of women who have not had children also suffer. This compares to 7% of women who gave birth by caesarean section and 12% who gave birth vaginally.

Urge incontinence

Also known as ‘overactive bladder syndrome’ where the bladder muscles contract before the bladder is full. This is where a person feels the need to urinate often and without much warning. If you feel a strong need to pass urine and cannot stop yourself, this is urge incontinence. Overactive bladder syndrome is caused by the bladder muscle contracting before the bladder is full.

It is also possible to have a mixed picture with both stress and urge incontinence occurring together. Whilst these represent the more common causes of urinary incontinence, there are a number of others, including urinary infection, which is why it is important to have an accurate diagnosis.

How can you reduce your risk of urinary incontience?

The pelvic floor, which supports the bladder that sits above it, is made of collagen and muscle. And like all muscles in the body, when they are trained, they get stronger and when ignored they will get weaker. Pelvic floor exercises (PFE) are normally first talked about in antenatal classes, but in reality it would be best to teach them from puberty. These exercises increase both the strength and endurance of the muscles and this increases the resting tone in the area, which makes it less likely that incontinence will develop. Pelvic floor contractions are achieved by lifting and tightening the muscle as if to prevent the passing of wind. For women who have been sexually active the tightening would also squeeze a finger placed in the vagina. Up to 30% of women cannot perform a voluntary contraction and may require specialist tuition. The contractions need to be repeated 8 to 10 times and practiced several times a day for life, as part of an exercise programme. Unlike other forms of exercise though, you don't have to get changed or go anywhere special to do them!

Just like the tissues in the rest of your body, if you abuse them they are more likely to let you down. To avoid developing a problem in the first place I would strongly recommend avoiding smoking. Not only does the smoke reduce your collagen formation, but a chronic cough will also put an increased strain on the pelvic floor. A diet rich in antioxidants, particularly vitamin C, will support collagen formation, so choose to eat a wide variety of coloured vegetables. Just as coughing increases the pressure in the abdomen which can result in leakage, the more weight you carry, the more pressure you put on the pelvic floor and the more likely it is to fail. This is definitely an area where prevention is much better than cure. Avoid becoming overweight and if you are, consider losing weight.

Additional support
Finally it is important to remember that you are not alone and that this is an extremely common problem. There are a number of very good support groups in existence (for example www.continence-founda- tion.org.uk), so it might be worth looking at one in your area.

What can you do if you already suffer?

If you suffer from any form of urinary incontinence, the first course of action must be to get a diagnosis. However, whatever the form you are diagnosed with, there are several changes to your lifestyle which may help improve your condition. These include:

Limit your fluid intake
to 1.5 litres a day. It is useful to keep a fluid intake diary to know exactly how much you are drinking.

Lose weight
if you are overweight. This can be difficult as you may not be able to exercise comfortably, but don’t underestimate the value of walking at least 10,000 steps each day together with a good diet.

Avoid drinking caffeinated drinks
like tea and coffee. Reduce or avoid alcohol.

Do pelvic floor exercisesIf you have stress incontinence then pelvic floor exercises have been found to cure 65% of sufferers and offer improvement to a further 23%. Only 12% of individuals get no benefit, so this would seem to be very worthwhile trying.

Dr Adam Carey

Dr Adam Carey is Director of Nutrition for the England Rugby Football Union and has spent 19 years in the NHS. He is nutritionist for Celebrity Fit Club, Scientific Editorial Director for Nutrition Practitioner and Nutrition Director for Focus on Food.

5 Easy Ways to Lower Cholesterol

Cholesterol gets a bad press, but we do need some of it to manufacture cells, produce certain hormones and for digestion. What we don’t need though is too much of it! Specifically, we don’t want too much ‘bad’ cholesterol, because this ‘furs up’ the arteries, preventing healthy blood flow and making heart attacks and strokes more likely.

Leap to low fat

Up to a third of the cholesterol in your body comes from what you eat, so an essential step in lowering cholesterol is reducing the total amount of fat consumed. Reducing saturated fat, found in animal products, is particularly important as it increases ‘bad’ cholesterol levels. Trans-fats also increase ‘bad’ cholesterol levels so should be avoided.However, unsaturated fat, found in avocado, sunflower and olive oil, seeds, walnuts and almonds, helps to lower cholesterol, so more of this in the diet is a good idea. Plant sterols from supplements can also reduce 'bad' cholesterol levels.

Fill up with fibre

Soluble fibre-rich foods such as porridge oats, lentils, beans and nuts, can help lower cholesterol. Soluble fibre binds to cholesterol, removing it from the body. Start the day with a bowl of porridge, snack on oatcakes, and add a portion of beans or lentils to a meal each day. A fibre supplement may help too. Fruits and vegetables are rich in soluble fibre and contain antioxidants needed to stop cholesterol creating fatty plaques that narrow, or ‘fur up’, the arteries.

Enjoy exercise
Exercise reduces levels of ‘bad’ cholesterol and increases ‘good’ cholesterol levels, and this is what the body wants. I recommend at least 30 minutes of moderately intensive exercise, at least five days a week.

Go for garlic

Garlic may help to lower cholesterol, make blood less likely to clot and lower blood pressure. All these effects can help keep the heart and circulation healthy. Although the debate continues about just how beneficial garlic is with regards to lowering cholesterol, it’s worthy of consideration. It’s unlikely to do any harm, and may well do a great deal of good.

Opt for omega 3

The body can’t make essential fatty acids, so our diet or a supplement needs to provide them. By lowering cholesterol, lowering blood pressure, making blood less likely to clot and preventing irregular heart rhythms, they protect the heart and circulation. Oily fish are a rich source of omega 3 and one or two portions a week are recommended. If preferred, omega 3 is found in good quality supplements.

Dr Rob Hicks

Dr Rob Hicks is a part time GP and clinical assistant in sexual health medicine. He is the Classic FM radio doctor and columnist for the Metro newspaper. He believes that prevention is better than cure and keeping healthy should be fun, not hard work.

Eye Spy

If you have blurred vision, sore eyes or trouble with everyday tasks like reading, you may be one of the many sufferers of age-related eye problems. Developments in research over recent years has further substantiated the link between degenerative eye conditions and lifestyle. With many people living for longer and computers playing a dominant role in everyday lives, looking after our eyes now and for the future could not be more important.

How damage occurs

Throughout our life our eyes are put under continual pressure with little opportunity for repair. Access to the correct nutrients to make recovery from wear and tear as rapid and effective as possible is essential and this supply relies heavily on the correct diet. Especially important are a group of nutrients called antioxidants. Found in foods antioxidants help to maintain healthy cells and tissues in the eye and other organs. These antioxidants function to neutralise damage by compounds called free-radicals. Free-radicals can be the result of exposure to pollutants such as cigarette smoke or environmental pollution but are also a natural by-product of metabolism. If they are not neutralized by an antioxidant, they can, over time, damage vital lipids, proteins and tissue of the eye’s lens. For some of us this damage is in its mildest form and results in the simple need for reading glasses, however for many it may result in a number of conditions such as macular degeneration or cataracts.

Common Conditions

Cataracts
Cateracts are a cloudiness of the lens in the eye. They occur as a result of ageing changes but are more common in diabetics or after trauma, as well as in those on medication such as steroids.

Macular degeneration
The most common cause of sight loss in the western world. This is an ageing change in the centre of the eye and causes a slow loss of the central vision.

Glaucoma
Glaucoma causes an increase in the pressure in the eye. Left untreated the retina and nerves are damaged and sight gets worse.

Vascular disease
As with the rest of the body, damage to the fine blood vessels in the eye can cause sight loss. Certain conditions, such as diabetes or high blood pressure, make this damage more likely.

Eye strain
This means a sensation of tired eyes, which may be accompanied by increasing difficulty focusing or seeing, dryness, headache and general discomfort.

Floaters
These small, dark, floating marks are usually harmless but may become a bit of a nuisance on bright days.

Many of us are aware that eating a healthy diet can support our general health but how can it directly support our eyes?

Inside the eye’s lens are high levels of the antioxidant vitamins C and E, in particular the caretonoids lutein and zeaxanthin. Studies on visual health have shown that a diet rich in these carotenoids are associated with a reduced risk of developing conditions such as macular degeneration 1,2,3 and cataract development4,5,6. Lutein-rich foods include the leafy green vegetables kale and spinach, and spring greens and zeaxanthin-rich foods being yellow and orange fruits and vegetables such as carrots, sweet potatoes, apricots and peaches. So granny was right when she told us that carrots could help us see in the dark…

Bilberries, blueberries, cranberries, cherries and blackcurrants are all high in antioxidants and are great for maintaining the health of your eyes. For decades bilberries have been associated with eye health and good vision. The most effective use for bilberry extract appears to be strengthening and protecting the veins in the eyes in particular, thereby improving night vision and short-sightedness. The flavonoid abundant within bilberries, known as anthocyanoside, has shown to improve blood flow and the delivery of oxygen to the eyes. Anthocyanoside is also thought to regenerate Rhodopsin, the purple pigment in the retina that is required for good night vision. Indeed it has been reported that RAF pilots during the Second World War noticed a marked improvement in their night vision after eating Bilberry jam!

More recently studies have supported the importance of fatty acids in eye health, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found in the Omega 3 group of essential fatty acids. According to the American Journal of Clinical Nutrition7. eating oily fish just once a week could be enough to halve your chances of developing age-related macular degeneration (AMD). Others who eat more than one portion of oily fish a week are up to 70 percent less likely to develop AMD. This supports an earlier study published in the journal Nature Medicine8. last year which suggested that omega-3 fatty acids could protect your eyes against the deterioration of the retina (or retinopathy), another leading cause of blindness.

Remember too that there are also some foods which must be limited. Processed foods, fried foods, foods with trans-fatty acids such as those found in margarine, sugar, aspartame and excessive amounts of alcohol all accelerate eye damage so watch your consumption of these carefully. Instead it would seem that an abundance of warming fish pie, a side order of green leafy vegetables, and a steaming bowl of mixed berry crumble is the ticket to a bright future for your eyes this winter.

Lifestyle Tips

* Eat a plentiful variety of fruit and vegetables to boost your antioxidant stores.
* Wear sunglasses in bright sunlight.
* Take a regular lutein and/or bilberry supplement.
* Keep alcohol to a minimum. This too can accelerate damage by reducing blood flow to the eyes.
* Take a break from your computer every 30 minutes to give your eyes a rest.
* Read, knit or watch television in good light so as not to strain the eyes.

Henrietta Norton

Henrietta Norton is a qualified nutritional therapist and member of the British Association of Nutritional Therapists.

How old are you really?

Whilst we are unable to completely halt our physical decline, we can slow the rate of attrition. Here I’ll show you why exercise and a healthy diet are the key elements in any anti-ageing programme, which will hopefully lead to improved quality and length of life.

How old am I on the inside?

Health is defined by our habits, genes, environment and health history. To that end, our age is a poor predictor of health. A more accurate way of defining it, along with our physical capacity, is through our physiological age, sometimes termed ‘biological’ or ‘functional’ age.

There is a direct relationship between your fitness level and the risk of succumbing to a number of health issues associated with cardiovascular disease and general mortality. In other words, the fitter we are, the healthier we are – and therefore, the ‘biologically’ younger we are! Adopting the positive health habits of exercise and a balanced diet can significantly reduce your physiological age. So it is true that a 70 year old can have the health and physical capacity of a 40 year old.

Why is exercise harder now I'm older?

As we move into our third decade and beyond, our co-ordination, flexibility, strength, speed and endurance de-cline. Our maximum aerobic capacity – how fit we are – declines at a rate of 8-10% per decade. This is a result of reduced output from body systems – including the heart and also reduced muscle mass – and is a condition termed ‘sarcopenia’, which appears to accelerate more rapidly after the age of 50.

So why do our bodies age?

One theory is that ‘free radicals’ are responsible for this age-related damage. This suggests that interventions aimed at targeting free radicals [antioxidants] may help slow the rate of physical decline. Exercise is an excellent way of improving our antioxidant defences, reducing the free-radical damage that is associated with ageing. In addition, studies have suggested that antioxidant supplements – such as vitamin E – may offer a helping-hand in the fight against free-radical damage. Thus, exercise combined with a diet high in antioxidant-rich foods, can combat the ravages of age and help maintain physical capacity and quality of life.

All is not lost!

In moderately active individuals, the rate of physical decline is reduced from 10% to 4-5% – and in highly active individuals, the rate of decline is as low as 2%! It is in fact resistance training which reduces the rate of ‘sarcopenia’, meaning muscle mass, strength and functional capacity are all maintained. Furthermore, a combination of resistance training and a diet high in antioxidants appears to play a crucial role in limiting the effects of ageing.

It is also generally agreed that moderately increasing the level of protein in your diet may enhance muscle and reduce the rate of muscle mass loss. Studies have also shown that the addition of conjugated linoleic acid (which is widely available as a supplement) may enhance the beneficial effects of resistance training.

Don't forget about your bones...

In addition to a reduction in physical capacity, ageing leads to a gradual reduction in bone mineral density, which increases the potential risk of bone fractures. Implementing weight-bearing exercise to reduce the rate of mineral loss, along with balance training to decrease the risk of falls, are both important elements in any exercise programme, particularly in later life. Recent evidence also supports the role for vitamin D and calcium supplementation alongside exercise to reduce the age-related decline in bone mineral density.

Do I need to lose weight?

Practical recommendations for weight management in later life are challenging. Despite a reduction in appetite and calorie consumption in older individuals, our body composition changes in favour of a decrease in muscle mass and an increase in fat mass. The increasing prevalence of obesity in later life is often termed the ‘obesity paradox’ and is strongly associated with a reduction in physical activity.

Prioritise...

As we get older we become increasingly concerned with our financial security. However, concentrating on our ‘fiscal fitness’ is only part of the story, as making sure we maintain our physical fitness is crucial if we are to enjoy our financial investments. In line with fiscal fitness, the sooner you start investing in your future by making exercise and a healthy diet part of your daily life, the greater the interest you will make on your investment. The best time to start is now and it’s never too late!

Professor Greg Whyte

Greg is Professor of sport and exercise science at Liverpool John Moores University. A former olympic athlete and a consultant physiologist, he is one of sport’s foremost research scientists.

Weighing up your chances...

Ingredients that should be eaten only occasionally have, for many of us, become part of our staple diet and with them come sinister health risks. As we enter the New Year
is it worth looking again at some of the things we do every day and thinking if 2009 is not the year for change?

The 21st Century Epidemic

Over the last ten years we have been bombarded with statistics about the rising incidence of obesity. In 2004 it was reported that 65% of men and 55% of women were either overweight or obese. By 2010 these figures were to have risen to 75%. However, in 2008, a number of reports have already suggested that we have reached the 2010 figures. It would appear that we are ahead of the obesity curve. For many,
being what is called ‘overweight’ is in fact ‘normal’. This normalization of a health problem is a big concern for healthcare professionals as it is appearing to have the effect of reducing the perceived need or desire to consider changing. It may even mean that less people believe it is actually possible to change. One of the reasons for this might be that being overweight, for many, does not seem to cause an apparent problem. But there is a problem, as Diabetes UK has been advertising in their ‘Beware the silent assassin’ campaign. The problem is the explosion of the incidence of Type 2 diabetes and its consequences.Diabetes is a condition caused by a lack, or a reduced effectiveness, of the hormone insulin which controls the level of sugar in the blood. There are three types of diabetes: Type 1, where the pancreas fails to produce enough insulin; Type 2, where the body becomes resistant to the message insulin sends; and gestational diabetes, which occurs in pregnancy. There are about 250,000 Type 1 diabetics in the UK and the numbers diagnosed each year are fairly stable. There are currently just over 2 million Type 2 diabetics and it is estimated that there are as many as a further 1 million undiagnosed individuals. There has been a doubling of the incidence of Type 2 diabetes in the last three decades and it is estimated that the number of diagnosed sufferers will double again to 4 million by 2025, or 1 in 15 of the population. A figure that never fails to stagger me is that 1 in 3 babies born today will become diabetic – unless we change!
The consequences of this hidden epidemic are terrifying. Being diagnosed with Type 2 diabetes takes 10 years off your life expectancy and it is associated with multiple long term complications that eat away at your quality of life. These include heart disease (80% of diabetics die from cardiovascular complications), kidney disease, blindness and amputations, to name but a few. The financial costs are not small either. It is estimated that 10% of the NHS budget is spent on diabetes, which is £9 billion each year, or £1million an hour! It is these costs and their inevitable escalations that means the NHS will struggle to manage in the years to come. The incidence of Type 2 diabetes is rising because of changes in our lifestyles. For a large majority of people, Type 2 diabetes is a lifestyle disease, and remains a choice.

What is causing the development of Type 2 diabetes?

The cells that listen to the message insulin sends appear to become hard of hearing or less responsive. Insulin is known as the ‘hormone of storage’ and the message it give the cells is to take sugar (glucose) from the blood and store it away or metabolize it. Glucose can be stored in the liver and muscles as glycogen (the human equivalent of starch). Once this store is full, any excess glucose is stored by converting it into fat. We now believe that consuming foods that release their sugars quickly – high glycaemic index foods or refined carbohydrates (like white breads, white rice, white
pasta, confectionary and pastries) – cause the body to make large amounts of insulin, more than would have been made if the same number of calories had been eaten
from a lower glycaemic index food or unrefined carbohydrate (like vegetables, salads, beans and lentils or whole grain products). As the cells in the body get bombarded
by insulin, they gradually reduce the number of receptors they express, becoming less responsive to the message. So, to have the same effect, the pancreas has to produce even more insulin. Eventually the pancreas finds it cannot keep up with the insulin
required to keep the blood glucose under normal control and at this point the individual becomes a diabetic. Unlike many diseases, as you develop diabetes and your pancreas fails, you often don’t notice much to begin with. It is not uncommon for a diabetic to take many years before presenting with a problem that leads to a diagnosis. This explains why so many people are wandering around yet to be diagnosed. During this time there is a process of ongoing damage to the body, particularly to the smaller blood vessels, which causes problems in the eyes, kidneys and heart.

Make the Change

The good news is it is possible to reverse this insulin resistance and make the body more sensitive to the insulin message. This can not only reduce the risk of
developing Type 2 diabetes, but it also represents the ideal mainstay of management of those who have been diagnosed. As we go into 2009 it is worth remembering that choosing to make small changes to your day-to-day life can have a staggering
effect on wellbeing, without stopping you from enjoying the occasional celebration – it just shouldn’t be a way of life.

Dr Adam Carey

is Director of Nutrition for the England Rugby Football Union and has spent 19 years in the NHS. He is nutritionist for Celebrity Fit Club, Scientific Editorial Director for Nutrition Practitioner and Nutrition Director for Focus on Food.

Your supplement prescription

Are you taking any prescribed medication? If so, it’s important to check with your dispensing pharmacists for potential interations between the drug and your chosen supplements. Interactions occur when both the drug and supplement act on the
same receptor sites in the body, or interact with the same metabolic enzymes. The drugs most likely to cause interactions are anticoagulants (e.g. warfarin and aspirin), sedatives, antidepressants and some medicines prescribed to treat heart problems,
diabetes, high blood pressure and epilepsy. Most interactions are not serious, but it is advisable to err on the side of caution.I

In many cases, however, supplements have a beneficial action that can boost the effects of prescription medicines, or replenish nutrient levels that are depleted by
certain drugs.
CARDIOVASCULAR DRUGS

A number of drugs used to treat cardiovascular problems can interact with supplements. However, some drugs lower blood levels of nutrients which need replacing:
Statins & Co-enzyme Q10

Statins lower cholesterol levels by inhibiting a liver enzyme called HMG-CoA reductase. This enzyme is also needed to make co-enzyme Q10 – an important substance needed for energy production in cells. It is especially important for muscle
cells – including those in the heart – which are actively contracting. Statins can halve blood levels of Co Q10 within 2 weeks and lack of this nutrient is thought to contribute
to the muscle aches and pains that can occur in people taking a statin drug. Co-enzyme Q10 supplements (60mg – 100mg daily) replenish blood levels of this important nutrient without affecting the cholesterol-lowering action of the statin drug.
ACE inhibitors & Zinc

The long-term use of ACE inhibitor drugs to treat high blood pressure or heart failure appears to deplete zinc levels and can lead to a zinc deficiency, especially when used
together with diuretic tablets. Lack of zinc can lead to changes in taste sensation and reduced immunity. A multi-vitamin and mineral supplement that includes zinc is therefore a good idea.
ANTI-INFECTIVE TREATMENTS

Antibiotics are life-saving drugs, and you should always finish the course exactly as prescribed. Bear the following in mind, however:
Antibiotics & probiotics

Broad-spectrum antibiotics kill beneficial probiotic bacteria in the gut as well as those causing infections. This can lead to diarrhoea and has been linked with the development of irritable-bowel syndrome. Taking a probiotic supplement during and after taking an antibiotic helps to replenish these friendly digestive bacteria, reducing
the risk of side effects.
Antibiotics & Bromelain

The action of antibiotics is boosted by bromelain, an enzyme that has additional anti-bacterial and anti-viral actions of its own. Bromelain increases blood levels
of the penicillin drug, amoxicillin, and improves its ability to penetrate tissues and reach areas of infection. In one study involving 53 people hospitalised with infections such as pneumonia, bronchitis and abscesses, 22 out of 23 people who had not previously responded to antibiotic treatment did so once bromelain was added to
their regime.
Anti-fungal creams & Echinacea

Anti-fungal creams are effective for treating fungal infections such as Candida and athlete’s foot. Echinacea helps to boost immunity against infections and, in women
with vaginal Candida, taking echinacea tablets at the same time as the cream was found to reduce the rate of recurrence.
PAIN-KILLERS
Paracetamol & vitamin C

Many over-the-counter painkillers contain vitamin C as it has been shown to prolong the amount of time paracetamol stays in the body. Taking paracetamol with a vitamin C tablet may help you spread doses further apart so you need to take less of the drug to maintain pain relief.
Paracetamol & Milk Thistle

People taking paracetamol for regular pain relief may benefit from taking milk thistle extracts as well. Paracetamol lowers levels of a liver chemical called ‘glutathione’, which is one of the ways in which paracetamol can damage the liver. Milk thistle extracts contain a substance called ‘silymarin’ which raises levels of glutathione.
Aspirin, vitamin C & zinc

Taking aspirin long term can lower blood levels of both vitamin C and zinc. Those on long-term aspirin therapy may benefit from taking vitamin C and zinc supplements.
IMMUNE SUPPRESSANTS
Corticosteroids, calcium & vitamin D

People taking long-term corticosteroid therapy to damp-down immune-related conditions are at increased risk of osteoporosis. Good intakes of calcium and vitamin D are vital to help maintain bone density and protect against bone thinning, and are often prescribed together with these medications.

Dr Sarah Brewer