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Flashcards in Supplements in Metabolic Disease Deck (37):

Integrative health

Healing oriented practice that incorporates the relationship between the provider and whole person (mind, body, and spirit)
-emphasizes evidence and makes use of all therapeutic approaches


What percentage of patients didn't report CAM use to health care provider?



Dietary supplement and health education act (DSHEA 1994)

-regulate the evaluation of vitamins, herbals, aa, and other botanicals
-Regulated herbal supplements more like food than medication
-Products cannot be put on same shelf as OTC or meds
-Prior to 1994: all grandfathered in.


DSHEA: Do manufacturers need to register or get FDA approval?

-They are responsible to ensure product is safe
-ensure product label information is truthful and not misleading


DSHEA: FDA action?

-take action if product is unsafe once on market
-monitors safety (ADR MedWatch reporting)
-Monitors product information: labeling, claims, package inserts, accompanying literature


Adverse event reporting

FDA medwatch reporting system
-submit online or by mail
What can be reported?
Regulated drug
Medical device
Dietary supplement


Labeling requirements

Required disclaimer ("This statement has not been evaluated...")
-May include a structure function claim (claim for its use), not required
-Label contains a supplement seal of approval (GMPs, CL, USP, NSF) if applicable
-Manufacturer follows Good Manufacture Practices:
More stringent practices
Record keeping
Quality control
Verify quality of raw materials
Increase inspecting of facilities by FDA inspectors
483 inspection report


Fish Oil/Omega 3 Indications



MOA Fish oil/omega3

-Decrease in hepatic secretion of VLDL-C, increase VLDL-C clearance, reduces TG transport
-omega 3 FA compete with arachidonic acid in COX and lipoxygenase pathways


Fish oil/omega 3 efficacy

decrease TG 20-50%
Greater TG than 500? decrease by 45%
combo with statin in lvls 200-499, decrease by 30%
LDL-C neutral effects

Primary prevention (AHA rec): 500mg qd or 2 fishy meals/wk
secondary prevention 1000 mg qd


Fish oil/omega 3 adverse reactions, drug interactions, herb rxns

adverse: fish taste, gi upset, heartburn, belching

drug interactions: anithypertensives, contraceptives, orlistat

Herb interactions: garlic, ginger, gingko, ginseng

dosage: 1-4 g qd of DHA and EPA

Tx option for pts who cannot take niacin due to gout and flushing rxn
-Limit to 12 oz per week in pregnancy
-GRAS (generally recognized as safe)

*****not effective in lowering TG or LDL-c
-increase risk of bleeding in combo with rx, OTCs or other supplements



FDA permits health claims: 51% whole grain reduce risk of heart disease
Whole wheat, whole oats, barley, corn

Blond psyllium: 10-12 g/d (decreases TGs and LDL-c modestly), more effective with food

Oat bran:
beta glucan (soluble fiber)
Delay food absorption



-decreases LDL-c and TGs
-increases HDL-c 15-35%
-Might have decreased risk of secondary MI, but not all cause mortality
-SE: HA, GI, flushing, increase blood glucose, and uric acid
-Monitor: LFT (hepatotoxicity)
Products: IM Niacin is greater than LA Niacin greater than ER Niacin
-Inositol nicotinate ("no flush niacin")


Plant sterols MOA, efficacy, adverse rxns, dosage

MOA: inhibits about 50% intestinal absorption of chol

Efficacy: decreases TG, LDL-C, no effect on HDL

Adverse rxns: nausea, indigestion, diarrhea, constipation, gas

800mg-6g qd 30 min bf low fat meals


Plant Stanols: MOA, efficacy, adverse rxns, dosage

MOA: inhibits dietary and biliary cholesterol
Efficacy: decreases LDLc (10-15%), w/ statins: decreases TG and LDLC

Adverse rxns: diarrhea, steatorrhea

Dosage: 800 mg-4g qd


Plant sterols and stanols interactions and pearls

Herbs: beta carotene and Vit E
Drugs: Zetia

Clinical pearls:
2-3 weeks bf effective
-if dc, cholesterol levels rise to baseline in 2-3 weeks
-sterols and stanols equally effective


Ephedra MOA

Alkaloid constituents of the plant: ephedrine, pseudoephedrine, and small amount of phenylpropanolamine

Ephedrine and pseudoephedrine are non-selective alpha and beta receptors agonist which stimulate nervous system


Ephedra use/efficacy, adverse rxns

-weight loss
-0.9 kg/mo up to 6 mo with


Bitter orange: MOA, adverse effects, caution in?

contains 1-6% of synephrine which is related to ephedrine
-Adverse effects: same as ephedra
-Caution in: HTN, CV pts


Bitter orange clinical pearls

-manufacturers switch to this after ban on ephedra
-often contain caffeine
-no evidence that this supplement is safer than Ephedra!!



-pts with low Ca intake often gain more weight and have a higher BMI
-Efficacy: 800-1200 mg qd Ca supplement have been shown to increase weight reduction and body fat loss
-800-900 mg qd has shown wt loss of 8-9 kg

Adverse rxns: belching, flatulence

**supplement alone does not equal to a low fat dietary intake of calcium


Alli (Orlistat) MOA, efficacy, adverse rxns

-reversible inhibitor of pancreatic and gastric lipase
-efficacy: FDA approved for long term weight loss
-effects in BMI greater than 27

Adverse rxns:
HA, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea & liver related events
Psyllium/Fibers 6g with dose or 12 qhs


Alli: dosing, drug interactions, clinical pearls

-60mg tid with each meal that contains fat
-drug interactions: anticoagulants, amiodarone, levothyroxine, and vitamins

Clinical pearls:
-take a MVI qd 2hrs before or after dose
-due to risk of liver injury, inform pt signs/sx


Diabetes tx options



Chromium MOA

Might reduce oxidative stress
Low levels are associated with impaired glucose & insulin
Chromium 0 has no activity
Chromium III found in food and supplements
Chromium VI used in welding industries & carcinogenic

Several salt forms: picolinate, nicotinate, polynicotinate, and chloride
-Chromium picolinate form most often used in studies
-caution in renal deficiency
-mixed data and effectiveness
-no reliable method to dx efficacy


Chromium adverse reactions and dosage

HA, insomnia, irritability, mood changes & sleep disturbance
Vomiting, diarrhea, and hemorrhage

Dosage: 200-1000 mcq divided doses
-0.4-2.5% absorbed and rapidly excreted in urine


interactions w/ chromium

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


MOA Vanadium

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


Efficacy of vanadium and adverse rxns

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

Adverse reactions:
GI upset, kidney toxicity, fatigue, lethargy & tongue discoloration


Vanadium interactions/pearls

Dosage: 50 mg bid of the sulfate form

Herbs: garlic, ginger, ginkgo & ginseng
Drugs: anticoagulants and antiplatelets
Disease: diabetes and renal dysfunction

Clinical pearls:
Average diet contains 6-18 mcq qd
Only 5% is absorbed


Garlic indications, MOA

indications: HTN, hyperlipidemia

Allicin is the active ingredient
Inhibits hepatic cholesterol synthesis
Activates production of endothelium-derived relaxation factor to relax smooth muscle and vasodilation


Garlic adverse rxns

Halitosis, body odor, heartburn, GI upset


Garlic drug interactions


Herb interactions:
Ginger, ginkgo and vitamin E


Standardized % allicin and clinical pearls (garlic)

Standardized to 0.65 - 1.3 % allicin

Clinical pearls:
When using fresh product needs to sit for 10 minutes chopped up prior to use for best results
Generally recognized as safe (GRAS)
Discontinue 2 - 3 weeks prior to surgery
Products marketed as odorless, may not contain allicin


Coenzyme Q-10 indications, MOA

Congestive heart failure
Preventing statin-induced myopathy

Mechanism of action:
Has antioxidant properties to stop damage and give energy to cells
Cofactor in metabolic pathways


Co Q10 efficacy, adverse rxns, drug interactions

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

Adverse rxns:
GI upset, heartburn, and appetite loss

Drug interactions: anticoaguants

Lab interactions: increase T4/T8 ratio in normal pts

Disease interactions: may lower blood pressure, cigarette smoking may deplete body stores


Clinical Pears CoQ10

Some meds can lower CoQ10 levels: statins, beta blockers, and diuretics
-take it with a fatty meal