Non-vitamin/mineral dietary supplements

what items are non-vitamin/mineral dietary supplements?

herbs, botanicals, amino acids, enzymes, and live microbials

which dietary supplements are used for cardiovascular benefits?

Coenzyme Q10, fish oil, garlic, red yeast rice

which dietary supplements are used for CNS benefits

Ginko, Melatonin, and St. John’s Wort

which dietary supplements are used for GI benefits

Giner, milk thistle, peppermint, and pre/probiotics

which dietary supplements are used for physical performance benefits

green tea

which dietary supplements are used for endocrine benefits

Cinnamon

which dietary supplements are used for immune function benefits

Echinacea and elderberry

which dietary supplements are used for urogenital benefits

cranberry, saw palmetto

which dietary supplements are used for musculoskeletal system benefits

glucosamine, chondroitin, SAMe, and tumeric/curcumin

which dietary supplements are used for women’s health benefits

black cohosh and evening primrose oil

uses for Coenzyme Q10 (CoQ10)

statin associated myopathy and heart failure (improved endothelial function and C-reactive protein)

ADRs of CoQ10

is well tolerated but may slightly lower BP

what are Omega-3s composed of?

docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)

T/F: US diets are high in omega-3s

false

uses for omega-3s

hypertriglyceridemia, cardiac health, and inflammatory arthritis

what are omega-3s made from

fish (skin) or algae

what are the prescription products for omega-3s

Lovaza and Vascepa

ADRs of omega-3s

fish burps (enteric coated helps and freezing capsules may help) and possible increased risk of bleeding

uses for garlic

hyperlipidemia and HTNA

ADRs of garlic

reflux, heartburn, garlic breath, increased bleeding risk

what is red yeast rice

yeast that grows on fermented rice and contains monacolins that may help lower cholesterol levels.

what is red yeast rice used for

hyperlipidemia - works well to lower LDL similar to statin reductions

ADRs of red yeast rice

well tolerated, less myopathy than statins, yeast can generate citrinin (nephrotoxin)

what is ginko biloba used for

memory (improves vascular perfusion and has neuroprotective antioxidant effects) - has shown benefit when combined with conventional dementia medications

T/F: ginkgo biloba has demonstrated to be effective in preventing cognitive decline

false

ADRs of ginkgo biloba

well tolerated but increased bleed risk

what is melatonin sythnesized from

tryptophan - regulates sleep and circadian rhythm but does not cause sleepiness

what is melatonin derived from

bovine pineal gland or synthetic (CHOOSE SYNTHETIC)

uses of melatonin

insomnia and jet lag

ADRs of melatonin

avoid in adolescents due to possible hormonal effects on sexual development

uses of St. John’s Wort

depression <3

what does St. John’s Wort induce:

CYP3A4 (POTENT), other CYP enzymes, and may induce P-gp

uses of ginger

N/V (pregnancy, motion sickness) - more effective on nausea than vomiting

ADRs of ginger

may affect platelet function

uses of milk thistle

liver health (silymarin) - antioxidant, antifibrotic, anti-inflammatory, immunostimulant, stimulates liver regeneration of hepatocytes

ADRs of milk thistle

none - well tolerated

uses of peppermint oil

irritable bowel syndrome (IBS) - included in ACG guidelines as a treatment option

ADRs of peppermint oil

heartburn (causes relaxation of lower esophageal sphincter)

what are probiotics

non-pathogenic, living organisms that must endure processing, storage, and delivery to the colon

what are the most common probiotics

Lactobacillus, Bifidobacterium, and Sacchromyces sp.

what are prebiotics

things the probiotics eat for food and breakdown for digestion in the colon - typically inulin-type fructans (fiber)

T/F: the gut is sterile at birth

true

what factors determine the gut microbiome

diet, intestinal pH, and transit time

what factors disrupt gut flora

medications, infections, aging, and poor nutrition

how do probiotics help the body?

GI health and immunity

what are the GI health benefits of probiotics

mediate epithelial cell turnover, reduce apoptosis, maintain tight epithelial cell junctions, inhibit inflammatory cytokines that can increase EC permeability, and increase mucin productionw

what are the immunity benefits of probiotics

decreased luminal pH, produce bacteriocins, competitively inhibit binding sites on EC cells, bind to pathogen microorganisms preventing them from interacting with the ECs, increased defensin secretion from Paneth cells, increase NK T-cell activity, inhibit unregulated T-cell activation, and activates macrophages (increase antigen presenting to B-cells)

what are probiotics good for?

IBS, possible role in ulcerative colitis, C. difficile, antibiotic associated diarrhea, and gastroenteritis (saccharomyces boulardii has the best data)

who should not use probiotics

patients on immunosuppressants or who are immunocompromised because they can develop serious infections from the bacterial strains in the probiotics (sepsis, endocarditis)

uses for cinnamon

diabetes (increased insulin sensitivity, anti-inflammatory actions, small effect on fasting blood glucose and A1C)

how is cinnamon best given

aqueous extract or powder in capsules or sprinkled into food - NOT the same as cinnamon oil used for cooking

T/F: you should always choke down a spoonful of cinnamon powder in the morning :)

false b :(

what can happen if cinnamon drug powder is ingested

coughing, burning, and aspiration

uses of echinacea

immune support (shortens the duration of illness: colds, upper respiratory infections)

when does echinacea have the best efficacy

when it is taken at the first sign of illness

which part of echinacea has the best clinical data

E. Purpurea

ADRs of echinacea

avoid in asthmatics or severe ragweed/chrysanthemums and avoid in patients taking immunosuppressants (possible immunostimulant activity)

what portion of elderberries are useful as antioxidants flavonoids, vitamins, anti-viral/bacterial properties

flowers and berries

which portion of elderberry contains a cyanogenic glycoside

bark, leaves, seeds, and unripe/raw fruit

uses of elderberry

immune support (colds, influenza, and upper respiratory illnesses)

side effects of insufficiently cooked or unripe berries/stems/leaves of elderberry

N/V, dizziness, weakness, stupor can occur

uses of cranberry

prevention and management of UTIs (may block bacteria from adhering to bladder, kidneys, and urethra)

T/F: unsweetened cranberry juice/concentrated tablets were used in studies not sweetened cranberry cocktail juice

True

ADRs of cranberry

increased risk of kidney stones

uses of saw palmetto

benign prostatic hyperplasia (hypertrophy), hair growth, and inhibits 5-alpha-reductase and androgen binding

which population is saw palmetto contraindicated in

Pregnancy

side effects of saw palmetto

bleeding but is better tolerated than finasteride and tamsulosin

uses of glucosamine and chondroitin

joint health

T/F: when glucosamine and chondroitin are used together, they have synergistic effects but can also be used individually

true

how long does it take for glucosame/chondroitin take to work

6-8 weeks: patients should d/c is no effects are seen within 8 weeks

side effects of glucosamine/chondroitin

none- well tolerated

uses of SAMe

arthritis and depression

ADRs of SAMe

can have CNS effects (insomnia, cognitive impairment, mania, or hypomania) typically with higher doses used for depression (avoid doses > 800 mg a day)

what is the active ingredient in turmeric

curcumin

which DS has a low bioavailability that increases when cooked with or dissolved in oil

turmeric/curcumin

uses of turmeric

arthritis (anti-inflammatory activity through inhibition of: arachidonic acid pathways COX and lipoxygenase, TNF-alpha, and interleukins)

ADRs of turmeric

well tolerated - inhibits platelet aggregation

what is the active ingredient in green tea

Epigallocatechin-3-gallate (EGCG) - catechins, flavonoids, phenolic acids (antioxidant effects)

uses of green tea

performance enhancer - stimulant activity from caffeine (weight loss)

forms of green tea

tea, dried leaf capsule form?

side effects of green tea

caution with other stimulatory agents, can blocker folic acid absorption, and large doses can have antiplatelet effects

uses of black cohosh

menopause symptoms but does not appear to have activity on breast, uterus, or endometrium, or hormone levels

side effects of black cohosh

GI, rash, bradycardia (at high doses)

which DS is not recommended for use beyond six months due to lack of daya

black cohosh

uses of evening primrose oil

Mastaglia - PMS, menopause

what is the primary component of evening primrose oil

linoleic acid - deficiency in this acid contributes to breast sensitivity to hormones

side effects of evening primrose oil

seizures and antiplatelet effects

what is piperine aka Piper nigrum

the main alkaloid in black pepper

why should we be concerned about piperine being in products?

has nonspecific CYP450 inhibition, strong inhibition of P-gp

what compound can cause increased absorption of many medications

piperine

what is BioPerine

a patented product used to increase absorption and increase effects in dietary supplements