Dietary Supplements, Natural & Complementary Medicine

complementary medicine

health care practices and products used together with conventional medicine

alternative medicine

health care practices and products used in place of conventional medicine

dietary supplements are regulated by

Dietary Supplement Health and Education Act of 1994

natural medicines

dietary supplements

DSHEA requires

• good manufacturing practices (GMPs)

• adverse event reporting to manufacturer

• proof of safety

manufacturers can/cannnot make claims that the product treats or cures a condition

cannot

health claims are limited to

nutrient content, relationship to health and impact on normal body structure or function (need disclaimer that the FDA has NOT evaluated the claim)

USP

establishes standards for dietary supplements

5 Gs of bleeding

gingko (for memory)

garlic

ginger

glucosamine

ginseng

other OTC with bleeding risk: fish oil (at high doses), vit E, dong quai and willow bark (salicylate)

AFTER release, FDA can remove a supplement if it is found to be

unsafe

St Johns Wort interactions

-Induces CYP3A4, 2C19, 2C9 and pgp --> DEC level of other drugs (avoid with oral contraceptives, warfarin and transplant drugs)

-serotinergic: do NOT use with MAO inhibitors, concurrent risk of syndrome with SSRIs, SNRIs, triptans

-photosensitivity: sun protection counseling; inc risk with diuretics, tetracyclines, sulfamethoxazole

-can lower seizure threshold

Supplements with risk of liver toxicity

• Black cohosh (used for menopausal symptoms)

• kava (used for stress)

Supplements with risk of cardiac toxicity

STIMULANTS:

• ephedra (removed from market)

• bitter orange (synephrine, isomer of phenylephrine)

• yohimbe: used to increase libido for ED

• caffeine, yerba mate, guarana

commonly used supplements for anxiety

-Valerian

-Passionflower

-Kava

-St John's Wort

commonly used supplement for cold sores

L-lysine

commonly used supplements for colds and flu

-Echinacea

-Zinc

-Vitamin C (ascorbic acid)

commonly used supplements for dementia/memory

-Ginkgo

-Vitamin E (alpha-tocopherol)

commonly used supplements for depression

-St. John's wort

-SAMe

-5-HTP

commonly used supplements for diabetes

-Alpha lipoic acid

-casia Cinnamon

-Chromium

commonly used supplements for dyslipidemia

-red yeast rice

-omega-3 fatty acids

commonly used supplements for dyspepsia

-Calcium

-Magnesium

commonly used supplements for energy/weight loss

-bitter orange

-caffeine

-guarana, green tea powder

commonly used supplements for erectile dysfunction

-ginseng

-l-arginine (will dec BP)

-yohimbe

commonly used supplements for heart failure

-Coenzyme Q10

-Hawthorn

-Omega-3 fatty acids

commonly used supplements for hypertension

-Omega-3 fatty acids

-Garlic

commonly used supplements for GI health

-Fibers

-Chamomile

-Probiotics

-Ginger (for nausea)

commonly used supplements for inflammation

-Omega-3 fatty acids

-Flax seeds/oil

-Turmeric

commonly used supplements for insomnia/sleep

-Melatonin

-Valerian

-Chamomile

melatonin dosing for jet lag

0.5-2 mg before flight and higher doses up to 5 mg after flight

commonly used supplements for liver disease

milk thistle

commonly used supplements for menopause

-Black cohosh

-Dong quai (inc INR)

-Evening primrose oil

-Soy, red clover

commonly used supplements for migraine prophylaxis

-feverfew

-butterbur

-magnesium

-riboflavin (b2)

commonly used supplements for motion sickness

ginger, peppermint

commonly used supplements for osteoarthritis

Glucosamine

Chondroitin

SAMe

Tumeric

commonly used supplements for osteoporosis

Calcium

Vitamin D

Soy

commonly used supplements for prostate health

-saw palmetto

-lycopene

commonly used supplements for skin conditions

tea tree oil

commonly used supplements for UTI

cranberry

5-HTP

precursor of serotonin, used by people who want to self-medicate for insomnia, depression and anxiety

-serotonergic

beta-carotene

an orange pigment with antioxidant activity; a vitamin A precursor made by plants and stored in human fat tissue

-INC CV mortality

bitter orange

stimulant, inc HR and BP

black cohosh

menopausal symptoms

-hepatoxicity risk

chondroitin

osteoarthritis

-bleeding risk, inc INR

dong quai

inc bleeding risk

feverfew

migraine prophylaxis

-inc bleeding risk, mouth ulceration

5 Gs should be discontinued in advance of surgery t/f

true

Hawthorn

-can be used for HF

-pos inotrope, avoid use with digoxin, dec BP

Kava

can cause liver damage

passionflower

anxiety and insomnia

-can inc QT interval

do not use _________ with statins

red yeast rice

SAMe

serotonergic

valerian side effect

sedation

vitamin C (ascorbic acid) warning

nephrolithiasis with high doses

Vitamin E risk

bleeding risk

vitamin A

Retinol

vitamin B1

Thiamine

Vitamin B12

Cobalamin

vitamin B2

Riboflavin

vitamin B3

Niacin

vitamin B6

Pyridoxine

vitamin B9

folic acid

vitamin C

ascorbic acid

vitamin D2

ergocalciferol

vitamin D3

cholecalciferol

vitamin E

alpha-tocopherol

low levels of vitamin D impairs

calcium absorption

exclusively breastfed infants or babies drinking less than 1 L of baby formula need

400 IU vitamin D daily

all prescriptions for low bone density require adequate

intake of calcium and vitamin D

Folic acid 600 mcg DFE = _____________ mcg folic acid

360

folate recommendation for adult females of childbearing age

400 mcg DFE daily

folate recommendation during pregnancy

600 mcg DFE daily

-starting at least 1 month before pregnancy

prescription prenatal vitamins typically contain how much folate

1 mg or 1000 mcg

vitamin E deficiency is uncommon and supplementation is

NOT recommended, lack of benefit

Thaimine (B1) deficiency

common in alcohol use disorder

-can cause wernickes: mental confusion, ataxia, tremor and visual changes

AAP iron recommendations for 4-6 months old

breastfed babies need 1 mg/kg from 4-6 months old and until consuming iron-rich foods

Poly-Vi-Sol

vitamin D and iron drops

amphotericin B can cause what depleted nutrient

magnesium, potassium

anti seizure medications can cause what depleted nutrient

calcium

isoniazid can cause what depleted nutrient

vitamin B6

loop diuretics can cause what depleted nutrient

potassium

metformin can cause what depleted nutrient

vit B12

methotrexate can cause what depleted nutrient

folate

orlistat can cause what depleted nutrient

beta-carotene, fat soluble vitamins

PPIs can cause what depleted nutrient

magnesium, vit B12 if > 2 years of treatment

recommended supplement for alcohol use disorder

vitamin b1, folate

recommended supplement for CKD

vitamin D

recommended supplement for goiter

iodine

recommended supplement for macrolytic anemia

vit b12 and/or folate

recommended supplement for microcytic anemia

ferrous sulfate

recommended supplement for pregnancy

folate, calcium, vitamin D, pyridoxine

recommended supplement for osteoporosis/osteopenia

calcium, vitamin D

homeopathy

treatment of disease with minute doses of a remedy that, if given in massive doses to healthy persons, would produce effects like those of the disease

homeopathic products

-law of similar

-extremely dilute

-not regulated