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Flashcards in supplements in metabolic disease Deck (66):
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1. Define complementary and alternative medicine (CAM).

• Complementary Medicine = Medicine is used together with conventional western medicine.
• Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
• Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
• Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
• Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
• Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.

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2. Explain the purpose of Dietary Supplement and Health Education Act (DSHEA) 1994.

Evaluates vitamins, herbals, aa and other botanicals and regulates supplements more like food rather than meds. Products cannot be put on the same shelf as OTC or meds. Prior to 1994 all products were grandfathered in

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responsibilities of manufacturers of supplements

Ensure product is safe and product label is truthful and not misleading. Do NOT need to register or get FDA approval

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responsibilities of FDA in supplements

Take action in product is unsafe once on the market. Monitor safety (adverse event reporting system), product labeling, claims, package inserts and accompanying literature.

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3. Distinguish a higher quality supplement due to product labeling.

• Required Disclaimer – “This statement has not been evaluated by the FDA. This products is not intended to diagnosed, treat, cure, or prevent disease” • Structure-function claim – What the product can be used for • Follow Good Manufacture Practices • Supplement seal of Approval (GMP’s, CL, USP, NSF)

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List CAMs used for dyslipidemia

fish oil/omega 3 fatty acid (very safe and effective) , plant sterols and stanols (very safe and effective), fiber (very safe and effective),

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fish oil indications and MOA

Indicated for hypertriglyceridemia. Decreases hepatic secretion of of VLDL-C, increase VLDL-C clearance, reduces TG transport. Omega 3 fatty acids compete with arachidonic acid in the cycloxygenase and lipoxygenase pathways

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Fish oil efficacy

Decreases TG by 20-50%. If TG >500mg/dl, decreases by 45%. If TG is 200-499mg/dl and fish oil is combined with statin, TG decreases by 30%. Neutral effects on LDL-C

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Fish oil doses

Primary prevention: 500 mg qd or 2 fishy meals a week. Secondary prevention (CHD): 1000 mg qd

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Fish oil adverse effects and DDIs

Adverse rxns: fish taste, GI upset, heartburn, belching. DDI: Antihypertensives, contraceptives, Orlistat, Anticoagulants/Antiplatelets.

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Fish oil herb interactions

garlic, ginger, ginkgo and ginseng

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fish oil safety

generally recognized as safe (GRAS)

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Which fish should be avoided in pregnancy

shark, swordfish and tilefish

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Fiber benefits

FDA permits health claims: 51% whole grain reduce risk of heart disease.

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Blond Psyllium benefits

decreases total cholesterol 3-14% and LDL-C 5-10%

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Niacin benefits

Decreases LDL 5-25% and TG 20-50%. Increases HDL 15-35%. May lower risk of scondary MI but no significant decrease in all cause mortality.

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Niacin side effects

HA, GI, flushing, increase blood glucose and uric acid. Monitor LFT due to hepatotoxicity risk

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Efficacy of niacin

IM > LA > ER

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MOA of plant sterols vs stanols

sterols: Inhibits about 50% intestinal absorption of cholesterol. Stanols: Inhibits dietary and biliary cholesterol

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Plant sterols efficacy

Decreases total cholesterol, and LDL. NO effect on HDL. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.

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Plant stanols efficacy

Decreases LDL 10-15%. When combined with statin therapy, decreases total cholesterol 3-11% and LDL 7-16%. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.

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Plant sterols adverse rxns

•Nausea, indigestion, diarrhea, constipation & gas

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Plant stanols adverse rxns

diarrhea and steatorrhea

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Plant sterols and stanols interactions

Herbs: Beta carotene and Vit. E. Drugs: Zetia®

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Plant sterols vs stanols efficacy

equally effective

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Atkins diet

high fat, low carb (max 40 g per day). First 10 days of ketosis result in rapid weight loss

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macrobiotic diet

•Low fat, emphasizing whole grains, vegetables & restricting fluid intake

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Ornish diet

Only 10% calories from fat. Allow fruits and veggies

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south beach diet

low carb, glycemic index, allow good carbs and fats, limit bad saturated and trans fats

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zone diet

•40 % carbohydrates, 30 % protein, and 30 % fat

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Mediterranean diet

whole grains,fruits and veggies, olive oil, fish and seafood, lean meats, herbs and spices, fresh unprocessed foods, portion control, healthy lifestyle, glass of wine with meal

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ephedra MOA

•Ephedrine and pseudoephedrine are non-selective alpha and beta receptor agonists which stimulate nervous system

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ephedra efficacy

•Weight loss of 0.9 kg/month up to 6 months with ≤ 30 % of dietary fat intake with moderate exercise

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ephedra adverse reactions

Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death

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ephedra uses

risk outweighs benefits-

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Bitter orange MOA

•Contains 1-6% of synephrine which is related to ephedrine

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Bitter orange adverse effects

Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death

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Bitter orange uses

There is no evidence that this supplement is safer than ephedra, yet it is generally recognized as safe (GRAS). Manufactures use it instead of ephedra

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Benefits of calcium

Patients will low calcium intake often gain more weight and have a higher BMI.

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Calcium adverse rxns

belching and flatulence

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Alli (orlistat) MOA

•Reversible inhibitor of pancreatic & gastric lipase

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Alli adverse reactions

•HA, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea & liver related events. Risk of liver injury

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Alli DDI

•Anticoagulants, amiodarone, levothyroxine, & vitamins

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Alli uses

FDA approved for long term weight loss. Patients with BMI of 27 or more have seen benefits.

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Hoodia gordonii efficacy

Side effects (nausea and skin sensation, elevated BP, pulse, HR, bilirubin, alk phosph) and does not change body weight, body fat or energy intake

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Chromium MOA

Might reduce oxidative stress. Low levels are associated with impaired glucose and insulin so may be used for diabetes. Decreases fasting blood glucose, A1C and total cholesterol

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compare types of chromium

Chromium 0 has no activity. Chromium III found in food and supplements. Chromium VI used in welding industries & carcinogenic

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Chromium adverse rxns

•HA, insomnia, irritability, mood changes & sleep disturbance. Vomiting, diarrhea, hemorrhage. Caution in renal dysfunction

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chromium DDI

Herbs: bilberry, brewer yeast, iron, Vit. C & zinc. Drugs: insulin, levothyroxine, NSAIDs & corticosteroid. Disease: diabetes, renal dysfunction

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forms of chromium

•Picolinate, nicotinate, polynicotinate and chloride

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Vanadium MOA

Activates insulin receptor proteins, stimulates glucose oxidation & transport. Liver: stimulates glycogen synthesis. Adipose: inhibits lipolysis. Skeletal muscle: promotes glucose uptake

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Vanadium efficacy

High does of 100 mg qd may improve insulin sensitivity and possibly reduce blood glucose levels. Effective in Type 2 but not Type I diabetes

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Vanadium adverse rxns

•GI upset, kidney toxicity, fatigue, lethargy & tongue discoloration. Risk of bleing when used in combo with RX, OTC or supplments

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vanadium interactions with herbs, drugs, labs and diseases

Herbs: garlic, ginger, ginkgo & ginseng. Drugs: anticoagulants & antiplatelets. Labs: blood glucose & serum creatinine. Disease: diabetes & renal dysfunction

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List dietary herbs used for diabetes

bitter melon, cassia cinnamon (caution in liver dz), magnesium (decreases risk for T2DM), prickly pear cactus, stevia, chia, fruit

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Garlic indications and MOA

HTN and hyperlipidemia. Allicin is th active ingredient and it inhibits hepatic cholersterol synthesis and activates production of endothelium derived relaxation factor to relax smooth muscle and vasodilation

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garlic adverse rxns

•Halitosis, body odor, heartburn, and GI upset

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garlic interactions- drugs, herbs, diseases

drugs: Anticoagulant, antiplatelet, CYP3A4 and 2E1. Herbs: ginger, ginkgo and Vit E. Diseases: diabetes, HIV or AIDs

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garlic clinical pearls

Fresh garlic needs to sit for 10 mins after being chopped up. Discontinue 2-3 weeks prior to surgery. Products marketed as odorless may not contain allicin

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CoQ 10 indications

CHF (possibly effective), Preventing statin-induced myopathy (Insufficient Reliable evidence)

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CoQ10 MOA

Has antioxidant properties to stop damage and give energy to cells. Cofactor in metabolic pathways

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CoQ10 efficacy

No evidence when taken as monotherapy, possibly useful with prescription treatment for HF. No significant benefit for myopathy or statin tolerability

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CoQ10 adverse rxns

GI upset, heartburn, appetite loss

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CoQ10 interactions- drugs, labs, diseases

drugs: anticoagulants. Labs: Increases T4/T8 ratio. Diseases: may lower BP, cigarette smoking may deplete body stores

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Meds that can lower CoQ10 levels

statins, beta blockers, diuretics

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list CAMs that are proved effective

EPA, fish oils, fiber, niacin, plant sterols and stanols,