Dietary Supplements

Antioxidants (made in the body)

Coenzyme Q10, N-acetylcysteine (NAC), alpha-lipoic acid

Cardiovascular System

Coenzyme Q10 (ubiquione)

• Antioxidant

• Use: statin-associated muscle symptoms (muscle pain, weakness)

• Notes: Vitamin K-like structure —> may interact w/WARFARIN

Red yeast rice

• Use: Lower LDL (cholesterol), TC, TG

• Adverse Effects: similar AEs to statins (GI effects, myalgia/muscle pain)

• Notes: avoid with statins, fibrates, CYP2A4 inhibitors, pregnancy

Fish oil

• Uses: Lower TG

• Adverse Effects: increased bleeding and atrial fibrillation

• Notes: DON’T take w/meds that increase bleeding risk (anticoagulents, antiplatelets)

Central Nervous System

Gingko biloba

• Uses: memory + dementia (not much data)

• Adverse Effects: INCREASED bleeding risk

• Notes: Caution w/anticoagulents and antiplatelets

St. John’s Wort

• Uses: mild-moderate depression, insomnia (ok efficacy)

• Adverse Effects: photosensitivity

• Notes: Potent CYP3A4 & P-gp inducer - MANY DDIs (drug-drug interactions), Serotonin syndrome w/serontonic drugs, depression should not be self-treated

Melatonin

• Uses: Jet lag, shift work, insomnia

• Adverse Effects: morning grogginess

• Notes: LOW dose = BEST results, take 1-2 hrs before sleep time

Gastrointestinal System

Ginger

• Uses: Nausea/vomiting of pregnancy, motion sickness

• Notes: caution with anticoagulents and antiplatelets, reasonable option for pregnancy nausea

N-acetylcysteine (NAC)

• Uses: antioxidant, mucolytic (breaks up mucus)

• Notes: Acetaminophen overdose antidote - NOT self-care. Avoid w/antiplatelets —> bleeding risk

Probiotics

• Uses: prevent antibiotic-associated diarrhea; IBS symptoms

• Notes: effects are statin-specific.

Endocrine System

Alpha-lipoic acid

• Uses: diabetic peripheral neuropathy; antioxidant

• Notes: may LOWER effect of thyroid hormone (caution if on thyroid meds like levothyroxine

Cinnamon

• Uses: lower blood glucose (modest, inconsistent, not good data)

• Notes: cinnamon challenge - aspiration

Berberine (like metformin; is good)

• Uses: lowers glucose & lipids; weight loss; PMOS; diabetes (good data)

• Adverse Effects: GI effects

• Notes: AVOID IN PREGNANCY, breast-feeding, newborns. (MANY DDIs)

Inositol (myo-, D-, chiro-)

• Uses: PMOS; metabolic syndrome

• Adverse Effects: GI effects

Immune Modulators

Echinacea

• Uses: colds

• Adverse Effects: allergy (ragweed/daisy family)

• Notes: caution in autoimmune disease or with immunosuppressants

Elderberry

• Uses: colds/flu symptoms

• Notes: Use commercial/cooked products ONLY; not raw. Caution in autoimmune disease or w/immunosuppressants

Kidney, Urinary Tract, and Prostate

Cranberry

• Uses: PREVENT recurrent UTIs (good data)

• Adverse Effects: kidney stones (if large amounts consumed)

• Notes: NOT for UTI treatment, may interact with warfarin/increase INR; watch sugar in juice

DHEA

• Uses: aging, sxual function, athletic peformance

• Adverse Effects: androgenic (male hormone development)—acne, hirsutism, voice deepening (F), gynecomastia (M)

• Notes: Banned in competitive sports (adrenal STEROID pre-hormone), avoid w/hormone-sensitive cancers.

Saw palmetto

• Uses: BPH/lower urinary tract symptoms (no evidence to support use; DON’T USE)

• Notes: Refer new urinary symptoms for evaluation

Musculoskeletal System

Glucosamine

• Uses: Osteoarthritis (OA) symptoms (good data)

• Notes: Caution in shellfish allergy; allow 6-8 weeks for any benefit

Chondroitin

• Uses: Osteoporosis (OA) symptoms

• Notes: Allow 6-8 weeks for any benefit

Turmeric (curcumin)

• Uses: Osteoporosis (OA), inflammatory conditions, diabetes

• Adverse Effects: Increases bleeding risk; liver injury

• Notes: Rising reports of hepatotoxicity

Women’s Health

Black cohosh

• Uses: Menopausal hot flashes, PMS (recommended to not use)

• Adverse Effects: Rare hepatotoxicity

• Notes: Mechanism unclear

Chasteberry (vitex)

• Uses: PMS, cyclic breast pain (some evidence; STOP once PREGNANT)

• Notes: May interfere w/hormonal contraceptives; may suppress lactation

Phytoestrogens (soy, red clover)

• Uses: Menopausal symptoms, bone health (ok data)

• Notes: Avoid w/hormone-sensitive cancer history (safety unknown)

Which supplements may INCREASE bleeding risk?

Fish oil, turmeric, gingko, ginger, garlic, NAC

Which supplements INTERACT w/WARFARIN?

Coenzyme Q10 and cranberry

Which supplements should you AVOID in pregnancy?

Berberine, chasteberry, red yeast rice, st johns wort