herbals and dietary supplements: self care: exam 1

conventional medicine

• disease focused

• treats symptoms using drugs, radiation, or surgery

alternative medicine

• used in place of conventional medicine

• treats symptoms using medications that are “closer to nature”

• not all treatments are scientifically validated

complementary medicine

• modern approach that uses both conventional and alternative medicines to diagnose and treat symptoms

  • a hybrid

natural medicine

• most commonly used in complementary and alternative therapy

  • herbals

  • vitamins and minerals

    • both categories are regulated as dietary supplements by the FDA

herbals

• products made from a plant that be be useful in treating disease or staying healthy

vitamins and minerals

• essential substances that out bodies need to develop and function normally

prescriptions/non-prescription drugs

• FDA approved

• available on the market

• she put a fill in the blank so idk the other point 😐

  • “something and something proven”

supplements

• available on the market

• not approved by the FDA for safety and effectiveness

• off the market by FDA

regulations for supplements required by law

• good manufacturing practices (GMPs)

• adverse reporting (manufactuerers)

regulations for supplements NOT required by law

• proof of effectiveness

• ANOTHER FILL IN THE BLANK???😐😐😐😐

  • “proof of something”

disease claims of supplements

• are not permitted (eg. “treats painful arthritis”)

structure/function claims of supplements

• are permitted (eg. “promotes joint function)

drugs

• active ingredient is identified

• safety and efficacy are proven by manufacturer

• purity and contents are regulated

• claims to treat, cure, or prevent diseases are made

dietary supplements

• active ingredient may not be identified

• no proof of efficacy is required

  • FDA must prove it is unsafe post-marketing

• no standards for quality or purity

  • they must follow GMPs

  • optional testing by quality assurance agencies

• no claims to treat, cure, or prevent specific diseases

types of claims that supplements can make

• health claims

  • describes a relationship between a substance and reduced risk of a disease of health-related condition

  • “adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis”

• structure function claims

  • describes the role of a nutrient or ingredient intended to affect the normal structure or function of the human body

  • “calcium builds strong bones”

• nutrient content claims

  • characterizes the level of a nutrient in a food

  • “high in calcium”

    • must have over 20% of the daily value to claim this"

DSHEA of 1994: regulations for supplements

• supplements must contain this on their labeling:

  • “This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.”

deaths due to supplements

• ma huang (ephedra)

• yohimbe

• energy drinks/products

labeling requirements for supplements

• ingredients

• quantities

• serving size

• servings per container

• calories → calories from fat, total fat and saturated fat, cholesterol

• sodium

• carbohydrate

• dietary fiber

• sugars

• protein

• vitamin A and C

• calcium and iron

seal of approval for product quality

• look for

  • Pharmacopeia (USP)

  • ConsumerLab

  • National Sanitation Foundation (NSF)

• these standards ensure that the product that was properly made contains what the label lists and is free of contaminants

  • assures compliance with cGMP

patient counseling

• encourage discussion with healthcare providers + medication reconciliation

• health claims/regulations

• effectiveness → if data/evidence is available

• quality → look for seal of approval

• drug-supplement interactions and/or contraindications

• discuss dosing of supplements → more does NOT mean better

• side effects include common and rate but serious events

interactions with prescription medications

• the 5 Gs

  • ginkgo

  • garlic

  • ginger

  • glucosamine

  • ginseng

• these decrease platelet aggregation and increase risk of bleeding!

• stop before surgery!

cardiac-related supplements

• omega-3 fatty acids

• garlic

• red yeast rice

• coenzyme Q10

diabetes related supplements

• cinnamon

osteroarthritis related supplements

• glucosamine / chondroitin

anxiety/depression related supplements

• St. John’s wort

insomnia related supplements

• melatonin

memory / dementia related supplements

• ginkgo

UTI related supplements

• cranberry

menopause related supplements

• black cohosh

prostate related supplements

• saw palmetto

cold/flu related supplements

• echinacea

weight loss related supplements

• green tea

summary of supplementations

• natural does not equal safe

• respect patients’ beliefs → proactive, nonjudgemental approach

• encourage communication with provider

• weigh in risks vs benefits

• when in doubt, recommend against use due to lack of evidence, especially in pregnant/lactating/eldery populations or people taking interacting medications

• look for seal of approval

nutritional supplements

• non-prescription products that are used to prevent deficiencies and maintain normal stores

• seeing a healthcare provider for severe nutrient deficiencies for evaluation and treatment is important

• vitamins and minerals are used for treatment of other medical conditions

• some vitamins and minerals are toxic in high doses

vitamin supplementations

• often not necessary for those with healthy/well-balanced diet

  • poor dietary status or medical conditions increase the need for supplementation

risk factors for nutrient deficiencies

• young or old age

• bariatric surgery (for obesity)

• chronic disease

• eating/swalloing disorders

• alcoholism

• pregnancy or menstruation

• medication use

• vegetarian diet

(some) vitamin names

• 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)

water soluble vitamins

• vitamin B group + vitamin C

  • units = micrograms (mcg) or milligram (mg)

• dissolves in water and readily absorbs into tissues for immediate use

• not stored in the body

• excess is excreted in urine

• needs to be replenished regularly in diet

• risk of overdose is low

fat soluble vitamins

• vitamin A + vitamin E + vitamin D + vitamin K

  • units = international units (IU)

• found in fats and oils of food

• absorbed along with fats in the diet

  • once absorbed, they are transported with fats through the lymphatic system in chylomicrons before entering the blood

• stored in the body’s fatty tissues and liver

• can become toxic if large amounts are consumed

dietary reference intake (DRI)

• a set of reference values used to plan and assess nutrient intake for healthy people

• they include several different types of reference values, including the EAR, RDA, AI, and ULs

• on the exam, ur gonna be given a table, and u just look for the right age and gender of the pt that the question is describing

estimated average requirements (EAR)

• the average daily intake level of a nutrient estimated to meet the requirements of half of the healthy individuals in a particular life stage and gender group

• it is used to assess the adequacy of nutrient intake in populations

recommended daily allowances (RDA)

• the average daily dietary intake level sufficient to meet the nutrient requirements of nearly all (about 97-98%) healthy individuals in a particular life stage and gender group

• it is based on the EAR and is set higher to cover the needs of most individuals

adequate intake (AI)

• is used when there is not enough scientific evidence to establish an EAR and subsequently an RDA

• it is the recommended average daily intake level based on observed or experimentally determined estimates of nutrient intake by a group of healthy people

  • (the values between the EAR and the UL)

tolerable upper intake levels (UL)

• the highest average daily intake level of a nutrient that is likely to pose no risk of adverse health effects to almost all individuals in the general population

• as intake increases above it, the risk of adverse effects increases

vitamin A name

• name: retinol

chief function of vitamin A

• vision → maintenance of cornea

• bone and tooth growth

• reproduction

• mucosa membrane, epithelial cells, and skin (healthy skin/tissue)

vitamin A deficiency

• rarity: rare

• vision problems

  • night blindness

  • corneal drying (xerosis)

  • blindness

• keratin lumps on skin

vitamin A toxicity

• increased activity of bone-dismantling cells, causing reduced bone density and pain

• liver abnormalities

• carotenemia: harmless yellowing of skin due to beta-carotenes

• hypervitaminosis

sources of vitamin A

• dark green, orange, red, and deep yellow vegetables

• liver

• peaches

• cantaloupe

vitamin D2 name

• name: ergocalciferol (plant sources)

vitamin D3 name

• name: cholecalciferol (animal sources)

chief function of vitamin D

• mineralization of bones and teeth

• maintains mineral homeostasis of calcium and phosphorus

vitamin D deficiency

• rarity: common, especially when you have lack of sunlight, older age, or renal disease

• abnormal bone growth

  • in children: rickets

  • in adults: osteomalacia or osteoporosis

• malformed teeth

vitamin D toxicity

• hypercalcemia (high calcium in blood)

• kidney stones

• calcification of soft tissue (eg. blood vessels)

• headache, nausea, weakness

sources of vitamin D

• sunshine!

• supplemented milk/milk fat

• salmon, tuna, sardines

• orange juice

• egg yolk

• fortified cereal

• spinach

• liver

• mushrooms

vitamin E name

• name: tocopherol

chief function of vitamin E

• antioxidant

  • protects cell membranes, regulates oxidation reactions, protects polysaturated fats

• heme biosynthesis

• steroid metabolism

• collagen

vitamin E deficiency

• rarity: extremely rare

• red blood cell breakage

• nerve damage

vitamin E toxicity

• increases the effects of anti-clotting medications

  • leads to increased risk of bleedings

sources of vitamin E

• sunflower seeds

• avocado

• bell peppers

• papaya

• cooked spinach

• green olives

• pine nuts

• dreid apricots

• cold-pressed plant oil

• red chilli powder/paprika

• almonds

• mustard greens

vitamin K name

• name: phytonadione

chief function of vitamin K

• synthesis of blood-clotting proteins and bone proteins

vitamin K deficiency

• rarity: uncommon

• hemorrhage

• abnormal bone formation

vitamin K toxicity

• opposes the effects of anti-clotting medications

  • eg. Warfarin (Coumadin)

sources of vitamin K

• kale

• brussel sprouts

• pickled cucumber

• kiwis

• green beans

• broccoli

• cabbage

• asparagus

• okra

• lettuce

interactions with fat soluble vitamins

• Orlistat

• cholestyramine

• mineral oil

  • these decrease the absorption of vitamins ADEK

  • space administration by 2 hours before and after Orlistat

  • space administration by at least 1 hour before and 4-6 hours after cholestyramine

interactions with vitamin A

• retinoids (isotretinoin)

  • it increases the risk of toxicity

  • avoid concurrent usage with these medications

interactions with vitamin E

• anticoagulants and antiplatelet medications (5 Gs!)

  • it increases the risk of bleeding

  • avoid use of this vitamin, especially doses greater than 400 IU

interactions with vitamin K

• Warfarin

  • it decreases the efficacy of Warfarin

  • monitor INR blood levels and adjust therapy as indicated

diseases that limit absorption of fat soluble vitamins

• celiac disease

• cystic fibrosis

• obstructive jaundice

• hepatic cirrhosis

• bariatric surgery

• short-bowel syndrome

function of B vitamins

• aid in metabolism and energy release from carbohydrates, lipids, and amino acids

MoA of B vitamins

• act as coenzymes or parts of coenzymes that are necessary for the proper activity of enzymes

how to remember the 8 B vitamins

• Tender Romance Never Fails with 6 to 12 Beautiful Pearls

• B1 → Thiamine

• B2 → Riboflavin

• B3 → Niacin

• etc

vitamin B1 name

• name: thiamine

chief function of vitamin B1

• part of coenzyme active in energy, metabolism

  • plays a role in myocardial function, cell function, carbohydrate metabolism

vitamin B1 deficiency

• rarity: common with alcoholism, Crohn’s disease, obesity, bariatric surgery

• beriberi with possible edema or muscle wasting

• enlarged heart or heart failure

• muscular weakness and pain

• apathy

• poor short-term memory, confusion, irritability, difficulty walking

• anorexia, weight loss

• alcohol abuse → Wernicke-Korsakoff syndrome

sources of vitamin B1

• legumes

• whole grains

• wheat

• pork

• beef

vitamin B9 name

• name: folic acid or folate

chief function of vitamin B9

• part of a coenzyme needed for new cell synthesis

  • includes protein metabolism and blood cell formation

• investigational medicinal product (IMP) for pregnant women and women of child-bearing age to prevent birth defects

vitamin B9 deficiency

• anemia

• weakness and fatigue

• red/swollen tongue

• increases the risk of neural tube birth defects

• gray hairs

• mouth sores

• forgetfulness/loss of concentration

• depression

• loss of appetite

• poor growth

vitamin B9 toxicity

• may mask vitamin B12 deficiency symptoms

sources of vitamin B9

• asparagus

• avocado

• beef liver

• enriched grain products

  • cereal

  • pasta

• spinach

• orange juice

• beans/peas

vitamin B12 name

• name: cyanocobalamin

chief function of vitamin B12

• part of coenzyme needed in new cell synthesis, especially those in the bone marrow, CNS, GI tract

• helps maintain nerve cells (formation of myelin)

vitamin B12 deficiency

• rarity: rare in healthy individuals

• may be present in vegetarians

• present in people taking metformin

• anemia

• tingling or numbness

• fatigue, memory loss, disorientation

• degeneration of nerve progressing to paralysis

sources of vitamin B12

• liver

• meat

• poultry

• dairy products

• tuna

• sardine

• almonds

vitamin C name

• name: ascorbic acid

chief function of vitamin C

• collagen synthesis

  • strengthens blood vessel walls, forms scar tissue, provides matrix for bone growth

• antioxidant

• supports immune system

• boosts iron absorption

vitamin C deficiency

• scurvy

  • need 10mg/day to prevent

• bleeding gums

• poor wound healing

• bruises

• joint pain

• fatigue

vitamin C toxicity

• rashes

• aggravation of gout or kidney stones

• megadose can cause nausea, abdominal cramps, diarrhea

sources of vitamin C

• vegetables

  • green/red peppers

  • broccoli

  • spinach

• fruits

  • citrus fruits

  • kiwi

  • strawberries

interactions with vitamin B6

• Isoniazid (INH)

  • causes vitamin deficiency when taken together

  • forms hydrazone, which is excreted in urine

  • recommend taking supplements for this vitamin while on Isoniazid, especially in pts with poor nutritional status, to prevent development of Isoniazid-induced peripheral neuritis (inflamed nerves)

interactions with vitamin B9

• Methotrexate (MTX) and Sulfamethoxazole

  • these cause vitamin deficiency

    • depends on MTX indication, but for Sulfamethoxazole, generally not a problem when taking for 1-2 weeks

    • to prevent, take vitamin supplements

interactions with vitamin B12

• proton pump inhibitors (PPIs)

  • omeprazole

  • pantoprazole

    • these interfere with vitamin absorption

    • to prevent, take vitamin supplementation

multivitamins (MVM)

• National Institutes of Health-sponsored State of the Science Conference concludes that:

  • “insufficient evidence exists to support routine usage of these supplements for primary prevention of chronic diseases”

• adjunct to balanced diet?

• potentially dangerous

  • drug interactions

  • overdoses

special populations for multivitamins

• college students

• pregnant people

pregnancy prenatal vitamins

• contains

  • folic acid: 600mcg/day

  • iron: 27 mg/day

• vitamin-teratogenic risk → avoid doses above daily recommended amounts

chief function of iron

• oxygen and electron transport

iron deficiency

• rarity: common

  • blood loss due to drug-induced injury or menstruation

• anemia

• chronic kidney disease

iron toxicity

• GI irritation

• nausea

• constipation

• abdominal pain

• darker stool

• excess in children in a medical emergency