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Natures Medicine An Overview of Popular Supplements

Natures Medicine An Overview of Popular Supplements. Kayla Jester, RD Intern University of Virginia Health System February 27, 2013.

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Natures Medicine An Overview of Popular Supplements

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  1. Natures MedicineAn Overview of Popular Supplements Kayla Jester, RD Intern University of Virginia Health System February 27, 2013

  2. “Millions of Americans take vitamins safely every day, including me. Vitamins and mineral supplements taken in recommended doses are safe. It's the designer supplements that are worrisome” - Durbin

  3. Presentation Overview • History of herbal and dietary supplements • Definition • Regulation of dietary supplements in the United States • Common dietary supplements used today • Echinacea • Evening Primrose • Garlic • Ginger • Gingko Bilobo • Ginseng • Fish Oil • Saw Palmetto • St John’s Wort • Role of Dietitian • Take Home Message

  4. Learning Objectives • Develop a general understanding of the difference between supplements and prescription medications • Understand how supplements can affect an individual’s overall health • Have a better understanding of the popular supplements on the market today Kayla Jester UVAHS – 2/27/13

  5. History • The use of natural products for medical purposes appeared in society long before the development and distribution of pharmaceuticals. • 6,000 year old clay tablets written by the Sumerians document the use of herbs as medicine. • Hippocrates documented the use of St. John’s wort in the fifth century B.C.E. • Ancient medical texts from Egypt, Greece, Rome, China and India each contained medical uses for garlic. Kayla Jester UVAHS – 2/27/13

  6. History continued… • Plant-derived supplements were the only form of medicine for thousands of years, and are still the primary source of medicine for ~80% of the population. • ~25% of all modern day pharmaceutical drugs are derived from plants • Aspirin – White Willow Bark • Digitalis – Foxglove • Birth Control Pill – Mexican yam Kayla Jester UVAHS – 2/27/13

  7. Herbs and botanical supplements accounted for 18% of total U.S. supplement sales in 2012. Kayla Jester UVAHS – 2/27/13

  8. Definition • Herbal and dietary supplements are products that ‘supplement the diet’ and are typically taken for therapeutic reasons. • Found in many forms: • Tablets, capsules, soft gels, liquids, powders Kayla Jester UVAHS – 2/27/13

  9. Public Interest in Supplements • Supplements are a: “diagnosis, treatment, and/or prevention, which complements mainstream medicine…” • Easily accessible (no prescription needed) • Professional care is not immediately available and is often times costly and inconvenient • Gives people a sense of control • Natural = Safe Kayla Jester UVAHS – 2/27/13

  10. Fun Fact 1 The word drug originated from ‘droog’, which is the Dutch word that means ‘to dry’. This makes sense since ancient healers used dry plants as medicine. Kayla Jester UVAHS – 2/27/13

  11. Dietary Supplement Health and Education Act of 1994 • First legalized definition of dietary ingredients and new dietary ingredient • What’s the difference?! - A new dietary ingredient was not sold in the U.S. before October 15, 1994. Kayla Jester UVAHS – 2/27/13

  12. Dietary Supplement Health and Education Act of 1994 • Supplement labels are allowed to make broad health claims, but disclaimer statements must also be included. • i.e. ‘This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure or prevent disease’ • Manufacturers are not required to: • Prove safety and effectiveness of the dietary supplement before it hits the market • Ensure standardization of products Kayla Jester UVAHS – 2/27/13

  13. Can you identify the supplement? Kayla Jester UVAHS – 2/27/13

  14. Fish Oil St. John’s Wort Gingko Bilobo Echinacea Kayla Jester UVAHS – 2/27/13

  15. Echinacea • Uses • Boosts the immune system • Protects against the common cold/flu • Forms: teas, extracts, capsules, and tablets • Pharmacological action • Acts as an antioxidant • Stimulates the immune system by: • Increasing T-cell and natural killer cell proliferation and activity Kayla Jester UVAHS – 2/27/13

  16. Echinacea- Efficacy Kayla Jester UVAHS – 2/27/13

  17. Echinacea continued… • Adverse Reactions • Potential allergic reactions (rash) • Potential GI upset • Drug/Supplement Interactions • Decrease the effectiveness of immune-suppressing drugs • Cyclosporine, corticosteroids • Negative interaction with hepatotoxic medications • Anabolic steroid, amiodarone, methotrexate, ketoconazole • Food Interactions • None reported Kayla Jester UVAHS – 2/27/13

  18. Echinacea Continued… • Precautions/Contraindications • Pts with asthma/allergy to grass pollen have an increased risk of having an allergic rxn • Do NOT use > 8 weeks • May cause hepatotoxicity or immunosuppression • Avoid in pts with immune disorders • HIV/AIDs • Multiple Sclerosis • Lupus Kayla Jester UVAHS – 2/27/13

  19. Evening Primrose Gamma-Linolenic Acid • Uses • Decreases cholesterol levels • Alleviates symptoms associated with: • Rheumatoid arthritis • Mastalgia • Atopic Dermatitis • Forms: capsules • Pharmacologic Action • Gamma-linolenic acid (GLA) is thought to replace essential fatty acids that are typically reduced during disease states Kayla Jester UVAHS – 2/27/13

  20. Evening Primrose – Efficacy Kayla Jester UVAHS – 2/27/13

  21. Evening Primrose • Adverse Reactions • Belching, bloating, and nausea • Drug/Supplement Interactions • Lowers seizure thresh old when used with tricyclic antidepressants/anticonvulsant medications • Avoid when taking anticoagulant drugs • Food Interactions: None reported • Cautions/Contraindications • Should avoid if pregnant or breastfeeding Kayla Jester UVAHS – 2/27/13

  22. Garlic • Uses • Helps control blood pressure • Improves circulation • Lowers cholesterol • Cancer Prevention/Treatment • Forms: raw, powder, tablets, and capsules • Pharmacologic Action • Vasodilation • Inhibit platelet aggregation • Lipid lowering effect • Food Source • Garlic Cloves • Powder Kayla Jester UVAHS – 2/27/23

  23. Garlic - Efficacy Kayla Jester UVAHS – 2/27/13

  24. Garlic • Adverse Reactions • GI discomfort (heartburn, flatulence, etc) • Drug/Supplement Interactions • May increase bleeding if taken with other blood thinning drugs (anticoagulants, antiplatalets) • May decrease concentration of protease inhibitors • HIV drug saquinavir • Food Interactions • None reported • Precautions/Contraindications • Avoid at least 7 days prior to surgery Kayla Jester UVAHS – 2/27/13

  25. Ginger • Uses • GI Issues (stomach aches, nausea, diarrhea) • Osteoarthritis • Joint/Muscle Pain • Lowers blood pressure • Forms: dried, powder, crystallized, capsule, raw root • Pharmacological Action • Inhibition of antiinflammatory agents such as thromboxanes and/or prostaglandins • Calcium-channel blocker • Components of ginger act on 5-HT3 receptors in the ileum Kayla Jester UVAHS – 2/27/13

  26. Ginger - Efficacy Kayla Jester UVAHS – 2/27/13

  27. Ginger • Adverse Reactions • GI upset • Bloating • Diarrhea • Drug/Supplement Interactions • Anticoagulants/Antiplatelets • i.e. coumadin, warfarin • Diabetes medications • Calcium channel blocker • Food Interactions • None reported • Precautions/Contraindications • Pregnancy • Breast feeding Kayla Jester UVAHS – 2/27/13

  28. Fun Fact 2 The first medical schools were based off the use of herbs, and today over half of medical schools offer an alternative medicine course.

  29. Gingko Bilobo • Uses • Enhances/improves memory and concentration • Treats depression, anxiety and dizziness • Forms: tablets, capsules, teas • Pharmacologic Action • Increases neurotransmission • Vasodilator • Reduces blood viscosity Kayla Jester UVAHS – 2/27/13

  30. Gingko Bilobo - Efficacy Kayla Jester UVAHS – 2/27/13

  31. Gingko Bilobo • Adverse Reactions • GI upset (nausea/vomiting) • Prolonged bleeding • Headache • Allergic Reactions • Drug/Supplement Interactions • May increase bleeding if taken with blood thinning medications • i.e. warfarin, coumadin, aspirin • Increase the effect of MAOI drugs • Food Interactions • None reported • Precautions/Contraindications • Avoid taking at least 36 hrs prior to surgery • Avoid taking during pregnancy Kayla Jester UVAHS – 2/27/13

  32. Ginseng • Food Source • Root found in Asian Markets • Uses • Energy/Mood booster • Improves cognitive function • Cardiovascular benefits • Forms: dried, extracts, capsules, and tablets • Pharmacologic Action • Decreases adrenal stress hormones • Bioactive compounds (ginsenosides) have similar structure to steroids Kayla Jester UVAHS – 2/27/13

  33. Ginseng - Efficacy Kayla Jester UVAHS – 2/27/13

  34. Ginseng • Adverse Reactions • Insomnia • Nervousness • Hypertension • Headaches • GI distress (nausea, diarrhea) • Drug/Supplement Interactions • May interfere with MAO inhibitor, corticosteroids, digoxin, blood sugar medications • Avoid taking with anticoagulates/antiplatelets Kayla Jester UVAHS – 2/27/13

  35. Ginseng • Food Interactions • Use with caffeine may stimulate hypertension • Precautions/Contraindications • Do not take longer than 3 months • Don’t use if you have • Renal Failure • Acute infection • Active bleeding Kayla Jester UVAHS – 2/27/13

  36. Fish Oil Food Source Fatty Fish: mackerel, salmon, herring, tuna, anchovy 1 serving 2-3 times per week provides ~3g fish oil • Uses • Cardiovascular benefits • Decrease or inhibit the development of inflammatory diseases • Forms: oil, capsules • Pharmacologic Action • Omega-3 fatty acids (EPA & DHA) are precursor to eicosanoids, which have anti-atherogenic and anti-inflammatory effects Kayla Jester UVAHS – 2/27/13

  37. Fish Oil – Efficacy Kayla Jester UVAHS – 2/27/13

  38. Fish Oil • Adverse Reactions • Prolong bleeding time • Food Interactions: • Garlic • Drug/Supplement Interactions • Should not be taken with blood-thinning drugs • Coumadin, warfarin Kayla Jester UVAHS – 2/27/13

  39. Saw Palmetto(Seronoarepens) • Uses • Prevents prostate cancer • Increases sperm production • Improves symptoms related to enlarged prostate • Forms: dried berries, extracts, tablets, capsules, and tea • Pharmacologic Action • Inhibits 5a-reductase • Antiandrogen • Antioxidant/anti-inflammatory agent Kayla Jester UVAHS – 2/27/13

  40. Saw Palmetto – Efficacy Kayla Jester UVAHS – 2/27/13

  41. Saw Palmetto • Adverse Reactions • Mild GI discomfort (nausea, vomiting, constipation, diarrhea) • Drug/Supplement Interactions • Contraceptive drugs • Estrogen pills • Anticoagulants/Antiplatelets • Food Interactions • None reported Kayla Jester UVAHS – 2/27/13

  42. St. John’s Wort(Hypericumperforatum) • Uses • Promotes emotional well-being • Alleviates mild depression • Forms: teas, tablets, and capsules • Pharmacologic Action • Inhibits reuptake of serotonine, dopamine and norepinephrine • Reduces cortisol levels Kayla Jester UVAHS – 2/27/13

  43. St. John’s Wort - Efficacy Kayla Jester UVAHS – 2/27/13

  44. St. John’s Wort(Hypericumperforatum) • Adverse Reactions • May cause photosensitivity • Lethargy • Drug/Supplement Interactions • Do NOT combine with antidepressant meds (tricyclics, serotonin reuptake inhibitors) • Decreases effectiveness of drugs metabolized by cytochrome P450 • Ex: theophylline (bronchodilator), protease inhibitor indinavir (HIV drug), digoxin • Negative interaction with immunosuppressant cyclosporine • Food Interactions • Tyramine containing foods Kayla Jester UVAHS – 2/27/13

  45. Dosage Information

  46. Fun Fact 3 It is thought that the use of herbs is a more holistic approach to bringing harmony and balance back to the body. Today, synthetic chemical compounds are used with the inclination that the body is a ‘broken machine that needs to be fixed’. Kayla Jester UVAHS – 2/27/13

  47. Our Role as Registered Dietitians • Ask, ask, ask the patient if they are taking anything on the side other than what his/her doctor prescribes. • Communicate with MD and other health care professionals concerning the patients use of dietary supplements. • Continue to learn as much about herbal supplements as possible, and that the information you obtain comes from trustworthy sources. Kayla Jester UVAHS – 2/27/13

  48. Take Home Message Even though a supplement may be ‘natural’ does not mean that it should be considered safe and free of harm. Kayla Jester UVAHS – 2/27/13

  49. QUESTIONS? Kayla Jester UVAHS – 2/27/13

  50. References Alder R, Lookinland S, Berry J, Williams M. A systematic review of the effectiveness of garlic as an anti-hyperlipidemic agent. J Am Acad Nurse Pract. 2003;15(3):120-9. American Botanical Council. St. John’s wort. The ABC Clinical Guide to Herbs. 2002. History of Dietary Supplement. Available at: http://iml.jou.ufl.edu/projects/spring2000/kimpel/history.html. Accessed January 20, 2013. Barrett B, Brown B, Rakel D, Mundt M, Bone K, Barlow S, Ewers T. Echinacea for treating the common cold: A randomized trial. Ann Intern Med. Dec 2012; 153(12):769-777. Barry M, Meleth S, Lee J, Kreder K, Avins A, Nickel J, Roehrborn C, Crawford E, Foster H, Kaplan S, McCullough A, Andriole G, Naslund M, Williams O, Kusek J, Meyers C, Betz J, Cantor A, McVary K. Effect of increasing doses of saw palmetto extract on lower urinary tract symtoms: a randomized trial. JAMA. 306(12):1344-51. Bayles B, Usatine R. Evening primrose. Am Fam Physician. 2009;80(12):1405-8. Birks J, Grimley Evans J. Gingko bilobo for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;(1):CD003120. Boyle P, Robertson C, Lowe F, Roehrborn C. Updated meta-analysis of clinical trials of serenoarepens extract in the treatment of symptomatic benign hyperplasia. BJU Int. 2004;93(6):751-6. Brinkley TE, Lovato JF, Arnold AM, et al. Effects of ginkobiloba on blood pressure and incidence of hypertension in elderly men and women. American Journal of Hypertension. 2010;23(5):528-533. Bucher H, Hengstler P, Schindler C, Meler G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trials. AM J Med. 2002;112(4):298-304. Coon J, Ernst E. Panax ginseng: a systematic review of adverse effects and drug interactions. Drug Saf. 2002;25(5):323-44. Ding M, Leach M, Bradley H. The effectiveness and safety of ginger for pregnancy-induced nausea and vomiting: a systematic review. Women and Birth. 2013;26(1):e26-e30. Drozdov V, Kim V, Tkachenko E, Varvanina G. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. The Journal of Alternative and Complementary Medicine. 2011;18(6):583-588.

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