8.4: Treatments and Nutrition

Learning Objectives

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

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

Health Assessment Considerations

Not all foods are able to provide necessary nutrients, especially for individuals with endocrine disorders. Nutrition education plays a direct role in optimal health and wellness as well as in the management of disease processes because foods can either enhance or inhibit wellness in the endocrine system. Diet instruction requires careful explanation of scientific concepts in the context of the client’s specific situation. These concepts can seem overwhelming to the client who must balance evidence-based recommendations with real-world conditions. Clients’ food choices are not just by their knowledge of nutrition, but their ability to obtain and prepare nutritious foods that align with their culture and lifestyle.

Drug–Food Interactions Associated with Treatments for Endocrine Disorders

Endocrine-related medical interventions and medications are used to manage various endocrine disorders and conditions (Campbell & Jialal, 2022). These treatment options often involve the use of medications that interact with nutrition. Certain medications used in endocrine care affect nutrient absorption, metabolism, and utilization. These medications may also have specific recommendations regarding time frames with the food interaction. Nurses must understand these interactions to educate clients to avoid complications, promote optimal treatment outcomes, and ensure overall well-being.

Diabetes

Diabetes is an endocrine disorder that involves the amount of insulin the body creates, secretes, and utilizes (Sapra & Bhandari, 2023). The medications used to manage diabetes, such as insulin and oral antidiabetic medications, require careful observation, monitoring, and coordination with meals and carbohydrate intake to ensure proper blood sugar levels (Chen et al., 2020; Gray & Threlkeld, 2019; Pancheva et al., 2021; Rasmussen et al., 2020). When individuals take insulin incorrectly such that the dosage is not appropriate for the given amount of carbohydrates consumed, the individual can enter a state of either hypoglycemia (low serum blood glucose level) or hyperglycemia (high serum blood glucose level; Sapra & Bhandari, 2023). Health care providers may prescribe antidiabetic medications such as metformin to manage type 2 diabetes (Sapra & Bhandari, 2023). These medications need to be taken with meals to limit gastrointestinal adverse effects. Studies indicate that people who take metformin are at risk for vitamin B₁₂ deficiency (American Diabetes Association [ADA], n.d.). These individuals therefore need regular laboratory testing for B₁₂ deficiency.

Clients with diabetes need to understand how alcohol consumption affects their blood glucose levels. If an individual with diabetes drinks alcohol on an empty stomach or in excess, the liver cannot release stored glucose, resulting in hypoglycemia. Alcohol also impairs the body’s capability to indicate low blood glucose levels; for example, the individual may not experience the usual signs and symptoms of low blood glucose, such as shakiness or sweating. Alternatively, alcoholic drinks that contain sugary mixes potentially increase blood glucose levels. If clients with diabetes choose to drink alcohol, strict glucose monitoring and moderate consumption are recommended because excessive alcohol use is associated with increased liver, nerve, and heart damage. Some antidiabetic medications, such as sulfonylureas or insulin, interact with alcohol and increase the blood glucose–lowering effects of the medication, leading to hypoglycemia.

Some supplements, including chromium and niacin, may interact with diabetes medications and lead to hyperglycemia or hypoglycemia (ADA, n.d.). Chromium deficiency can increase blood glucose levels. In a client with kidney disease, chromium supplementation may further damage the kidneys (ADA, n.d.). Some individuals may take niacin to increase their “good” cholesterol levels; nurses should be aware that niacin can raise fasting glucose levels (ADA, n.d.). Individuals with diabetes should consult their health care provider before adding supplements to their daily dietary intake.

Thyroid Disorders

Thyroid conditions require individuals to take thyroid medications. Some medications for treating thyroid conditions are associated with potential nutritional interactions (Wiesner et al., 2021). Levothyroxine should be taken at a consistent time in the morning on an empty stomach 1 hour before a meal. Foods that interfere with absorption include soy, calcium supplements, and some fruit juices, including grapefruit, orange, and apple juice (Wiesner et al., 2021). Some clients who are prescribed levothyroxine concurrently take calcium to avoid osteoporosis, so the nurse should advise these clients to avoid taking calcium, as well as iron, supplements within 4 hours of taking levothyroxine because these supplements also reduce absorption of the medication (DailyMed, 2023).

Parathyroid Disorder

Calcium and loop diuretics balance sodium levels (Ellison, 2019). Loop diuretics inhibit the sodium–potassium–chloride transporter and increase calcium excretion. Furosemide increases calcium excretion and plasma parathyroid hormone (PTH). This hormone is created in the four small parathyroid glands located near the thyroid. It regulates the homeostasis of calcium, vitamin D, and phosphate in the bloodstream, maintaining bone stability (Khan et al., 2022). PTH responds to low calcium levels detected in the blood and stimulates the production of vitamin D and calcitriol. The increase in calcium excretion from loop diuretics leads to the parathyroid gland decreasing the production of PTH. PTH, as the negative-feedback loop, signals the parathyroid glands to stop releasing PTH. A correlation has been noted between furosemide users and increased risk for hip fractures in the older adult female population (Mohn et al., 2018). Older adults absorb less calcium and are at an increased risk for fractures.

Thiazide diuretics affect the distal tubules, leading to increased calcium reabsorption (Mohn et al., 2018). A correlation study showed that individuals who took hydrochlorothiazide also had a decrease in urinary calcium in hyperparathyroidism, with no change in PTH observed (Mohn et al., 2018). However, more research is recommended in the field of thiazide diuretics and risk factors for fractures in the older population.