Most of our Marfan children are required by standard of care AMA medicine to be on one of these. I have my many concerns with long term use of these on our small children who do not have elevated blood pressure. I do find if we mitigate the deficiencies, keep as low as dose possible, (or none) & add in Naturopathic Medicine… Nature’s OG regenerative medicine . We steer clear of many side effects or all!
1. Angiotensin II Receptor Blockers (ARBs). What is it?
ARBs are used in children primarily for hypertension, heart failure, and certain kidney conditions (e.g., proteinuria in diabetic nephropathy). Common ARBs include losartan, valsartan, and candesartan. Main issue to also include here is this pharmaceutical company can’t learn their lesson. They’ve been pulled off the market 3x in recent years for the same issue! A cancer causing additive called NMBA. ugh!!
Main Side Effects in Pediatrics:
- Hypotension – Risk of dizziness, fatigue, or syncope, especially with dehydration.
- Hyperkalemia – Elevated potassium levels, which may lead to arrhythmias.
- Renal Dysfunction – Risk of worsening kidney function, particularly in children with pre-existing kidney disease.
- Angioedema – Rare but potentially life-threatening swelling of the face, lips, and airway.
- Fatigue and Dizziness – Common in initial use or dose adjustments.
- Cancer risk increase- Studies in 2023, 2011 and more have connected an increase risk of cancer in anyone who used these over 4.5yrs
2. Beta Blockers
Beta blockers are prescribed for hypertension, arrhythmias, heart failure, and certain congenital heart diseases in children. Common beta blockers include propranolol, atenolol, metoprolol, and carvedilol.
Ugh, the pharmaceuticals are just not makin’ the cut for my family and I!….more reasons why below~
Side Effects in Pediatrics:
- Bradycardia – Decreased heart rate, which may be problematic in some children.
- Hypotension – Can cause dizziness or fainting, especially in active children.
- Fatigue and Weakness – May affect energy levels and participation in physical activities.
- Hypoglycemia – Particularly in neonates and infants, beta blockers can mask hypoglycemic symptoms, increasing the risk of severe episodes.
- Bronchospasm – More common with non-selective beta blockers (e.g., propranolol), posing a risk in children with asthma or reactive airway disease.
- Sleep Disturbances and Nightmares – More common with lipophilic beta blockers like propranolol. More studies needed, one was irreversible 🙁
- Depression and Mood Changes – but reported in some pediatric cases. Only a small number of studies here, but panic attacks were noted.
Considerations in Pediatrics
- Dosing adjustments are essential based on weight and renal function.
- Monitoring of blood pressure, heart rate, electrolytes (for ARBs), and kidney function is recommended.
- Caution in asthma – Beta blockers, especially non-selective ones, should be used carefully in asthmatic children.
Cardiovascular Management
Cardiovascular complications, particularly aortic root dilation and aortic dissection, are the most serious concerns in Marfan syndrome.
Rx Medical Therapy…why:
- Beta Blockers (e.g., Atenolol, Propranolol, Metoprolol)
- Reduce heart rate and aortic wall stress, slowing aortic dilation.
- First-line therapy unless contraindicated (e.g., asthma).
- Angiotensin II Receptor Blockers (ARBs) (e.g., Losartan, Valsartan, Irbesartan)
- Shown to reduce aortic root growth, often used alone or in combination with beta blockers.
- Preferred in cases where beta blockers are not tolerated.
- Calcium Channel Blockers (if beta blockers and ARBs are not tolerated).
- Used selectively, as they may have variable effects on aortic dilation.
Nutrient Requirements for the Metabolism of ARBs, Beta Blockers, and Common Marfan Syndrome Medications
The metabolism of ARBs, beta blockers, and other medications used in Marfan syndrome involves various enzymes, primarily in the cytochrome P450 (CYP) system in the liver. Certain nutrients act as cofactors for these enzymes, supporting proper drug metabolism.
1. Angiotensin II Receptor Blockers (ARBs)
(e.g., Losartan, Valsartan, Irbesartan, Candesartan)
- Metabolism:
- CYP2C9 & CYP3A4 (Losartan) – Primarily in the liver
- Phase II conjugation (Glucuronidation & Sulfation)
- Key Nutrients Required:
- Magnesium & Zinc – Essential for CYP enzyme activity
- B Vitamins (B2, B6, B12, Folate, Niacin) – Involved in phase I & II metabolism
- Glutathione – Required for detoxification and protection against oxidative stress
💡 Nutritional Consideration:
- ARBs can increase potassium levels, so dietary potassium intake should be monitored.
2. Beta Blockers
(e.g., Atenolol, Metoprolol, Propranolol, Carvedilol)
- Metabolism:
- CYP2D6 (Metoprolol, Propranolol, Carvedilol) – Main enzyme for beta-blocker metabolism
- Renal Excretion (Atenolol) – Less reliance on liver metabolism
- Key Nutrients Required:
- Magnesium & Zinc – Essential for CYP2D6 activity
- Vitamin C – Helps with detoxification and supports drug clearance
- Selenium & Glutathione – Protect against oxidative stress from prolonged beta-blocker use
- Coenzyme Q10 (CoQ10) – May be depleted with beta-blockers, leading to fatigue and muscle weakness
💡 Nutritional Consideration:
- Beta blockers can deplete CoQ10, which is essential for heart function. Supplementing with CoQ10 or increasing dietary intake (nuts, fish, meat) may help.
3. Common Supportive Medications for Marfan Syndrome
A. Calcium Channel Blockers (if used instead of ARBs/Beta Blockers)
(e.g., Amlodipine, Verapamil, Diltiazem)
- Metabolism: CYP3A4 (Liver)
- Key Nutrients Required:
- Magnesium & Zinc – Required for enzyme function
- Vitamin D – Regulates calcium balance in the body
💡 Nutritional Consideration:
- May alter calcium metabolism, so maintaining a proper magnesium-to-calcium ratio is important. We can check this easily with a mineral analysis!
B. Pain & Inflammation Management (NSAIDs, Acetaminophen, etc.)
- Metabolism: CYP2E1 & Glucuronidation (Liver)
- Key Nutrients Required:
- Glutathione & Vitamin C – Protect liver from oxidative stress
- B Vitamins (B6, B12, Folate) – Support detoxification pathways
💡 Nutritional Consideration:
- Chronic NSAID use can deplete glutathione, so consuming antioxidant-rich foods (leafy greens, berries, cruciferous vegetables) is beneficial.
Overall Nutritional Summary for These Medications
| Nutrient | Function in Drug Metabolism | Food Sources |
| Magnesium | CYP enzyme cofactor, supports drug metabolism | Nuts, seeds, spinach, whole grains |
| Zinc | Supports liver detoxification enzymes | Meat, shellfish, legumes, nuts |
| B Vitamins (B2, B6, B12, Folate, Niacin) | Required for phase I & II detoxification | Leafy greens, eggs, dairy, fortified cereals |
| Vitamin C | Antioxidant, supports drug clearance | Citrus fruits, bell peppers, broccoli |
| Glutathione | Detoxification, protects liver cells | Avocados, asparagus, spinach, whey protein |
| Coenzyme Q10 (CoQ10) | Prevents beta blocker-induced fatigue | Fatty fish, organ meats, nuts |
| Selenium | Protects against oxidative stress | Brazil nuts, seafood, eggs |
Key Takeaways
- Beta blockers can deplete CoQ10, potentially causing fatigue—consider supplementation or dietary sources.
- ARBs & Beta Blockers require magnesium, zinc, and B vitamins for metabolism.
- Glutathione & Vitamin C support detoxification and protect against liver stress from medication use.
- Electrolyte balance (Potassium & Magnesium) should be monitored, especially for those on ARBs.
Dietary Recommendations for a Child on ARBs and Beta Blockers (Marfan Syndrome Management)
To support optimal drug metabolism, heart health, and overall well-being, a child’s diet should focus on:
✅ Nutrients that aid drug metabolism
✅ Heart-protective foods
✅ Electrolyte balance & hydration
✅ Avoiding foods that may interfere with medications
1. Key Nutrients & Food Sources
🔹 Magnesium (Supports CYP Enzymes, Muscle & Heart Function)
- Why? Needed for drug metabolism and helps regulate heart rhythm.
- Foods:
- Dark leafy greens (spinach, kale) 🥬
- Nuts & seeds (almonds, pumpkin seeds) 🌰
- Whole grains (quinoa, brown rice, oats) 🌾
- Legumes (lentils, chickpeas, black beans)
🔹 Zinc (Supports Liver Detox & Enzyme Function)
- Why? Helps break down medications & supports immune function.
- Foods:
- Lean meats (chicken, turkey, beef) 🍗
- Shellfish (shrimp, crab, oysters) 🦐
- Beans, lentils, nuts, and seeds 🌰
🔹 B Vitamins (Support Liver Metabolism & Energy Production)
- Why? B2, B6, B12, and folate help metabolize ARBs & beta blockers.
- Foods:
- Eggs 🥚
- Dairy (yogurt, cheese) 🥛
- Whole grains (fortified cereals, brown rice)
- Leafy greens (spinach, romaine) 🥗
🔹 Vitamin C (Liver Detox & Antioxidant Protection)
- Why? Helps detoxify medications & prevent oxidative stress from beta blockers.
- Foods:
- Citrus fruits (oranges, lemons, kiwi) 🍊
- Bell peppers 🌶️
- Berries (strawberries, blueberries) 🍓
🔹 Glutathione (Detox & Liver Support)
- Why? Protects the liver from medication side effects.
- Foods:
- Avocados 🥑
- Cruciferous vegetables (broccoli, Brussels sprouts, cauliflower) 🥦
- Garlic & onions 🧄
🔹 Coenzyme Q10 (Counteracts Beta Blocker Fatigue, Heart Support)
- Why? Beta blockers can lower CoQ10, leading to fatigue.
- Foods:
- Fatty fish (salmon, mackerel, sardines) 🐟
- Organ meats (liver, heart)
- Nuts (pistachios, peanuts)
2. Electrolyte Balance & Hydration
🔸 Potassium (Monitor Intake if on ARBs)
- ARBs can increase potassium, so high-potassium foods should be moderated.
- Limit excessive intake of:
- Bananas 🍌
- Oranges 🍊
- Potatoes 🥔
- Tomatoes 🍅
- Dark leafy greens 🥬
- Coconut water 🥥
💡 Choose moderate-potassium options instead: Apples, grapes, berries, white rice, carrots.
🔸 Sodium (Monitor for Blood Pressure Control)
- High-sodium foods can worsen hypertension in Marfan patients.
- Limit:
- Processed foods (chips, canned soups, fast food) 🍟
- Packaged snacks 🍿
- Deli meats 🥪
💡 Choose fresh, whole foods with natural seasonings (herbs, lemon juice).
🔸 Hydration (Essential for Blood Pressure Stability & Medication Metabolism)
- Encourage adequate water intake (~6–8 cups daily, more if active).
- Avoid excess caffeine (sodas, energy drinks) as it can affect heart rate.
3. Foods to Avoid or Limit (Medication Interactions)
🚫 Grapefruit & Grapefruit Juice – Can slow down ARB & beta blocker metabolism.
🚫 Licorice (Black Licorice, Herbal Teas with Licorice) – Can interfere with blood pressure medications.
🚫 High-sugar Processed Foods – Can worsen inflammation and cardiovascular risk.
4. Sample Daily Meal Plan
🍽️ Breakfast
✅ Scrambled eggs with spinach & whole-grain toast 🍳
✅ Greek yogurt with berries & a sprinkle of nuts 🍓
✅ Oatmeal with cinnamon & flaxseeds 🌾
🍽️ Lunch
✅ Grilled chicken with quinoa & roasted vegetables 🥗
✅ Lentil soup with whole-grain crackers 🍲
✅ Turkey & avocado wrap with a side of carrot sticks 🥙
🍽️ Snack
✅ Almonds & dark chocolate square 🌰🍫
✅ Hummus with cucumber & bell pepper slices 🥒
✅ Apple slices with peanut butter 🍏
🍽️ Dinner
✅ Salmon with brown rice & steamed broccoli 🐟
✅ Stir-fried tofu with vegetables & whole-grain noodles 🍜
✅ Lean beef or turkey chili with beans 🍛
💡 Hydration: Water throughout the day, herbal tea, or diluted fruit juices.
Final Recommendations
✅ Prioritize magnesium, zinc, B vitamins, and CoQ10-rich foods.
✅ Monitor potassium intake carefully (especially with ARBs).
✅ Hydrate well & avoid processed foods high in sodium.
✅ Avoid grapefruit & licorice to prevent medication interactions.
Hope this helps out many parents who have low energy children on these Rx’s. If I can be of more assistance to you and your families journey toward managing Marfan’s or similar please reach out love to share my services from consultation, education to a course for those to really learn and manage their Marfan syndrome from a Naturopathic Physician who is a primary care doctor.
Reach out at calypsonaturalclinic@gmail.com, (503) 472-5500
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