Polypharmacy and Nutraceuticals in veterans: 1 partners in crime?

Multi-morbidity and resulting polypharmacy are very common in veterans and represent a clinical patient safety issue. In fact, if on one hand a suitable polypharmacy can extend life expectancy and maintain the quality of life, on the other hand it can be associated with a high probability of prescribing a potentially detrimental drug. The most worrisome consequence of polypharmacy is the occurrence of therapeutic failures, adverse drug withdrawal events and drug-drug interactions. Despite the efficacy of herbal preparations and nutraceuticals remains controversial, users who are in favor of personal health control often have strong beliefs that herbal preparations and dietary supplements are natural and with fewer side effects. Actually, US data indicate that potential interactions can occur in case of co-administration of drugs and herbal/nutritional supplements or mineral-fortified foods and fruit juices. Veterans who receive primary care in the Veterans Affairs health system have a high burden of chronic disease, with a high prevalence of cardiovascular diseases and clinical risk factors, such as obesity. Facilitating healthy diets, physical activity and weight management in the veteran population is an important public health challenge. Although the Mediterranean Pyramid could be the basis for integrative medicine for veterans with disabilities, patient-centred and interprofessional approaches (including physical medicine and rehabilitation clinicians, pharmacologists and nutritionists) and interventions are needed in order to prevent malnutrition, self-prescription of CAM and food-drug and/or nutraceutical-drug interactions and to achieve optional rehabilitation.