supplementing your dietary supplement iq · archives of internal medicine ... flaxseed oil (ala)...
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Supplementing Your Dietary Supplement IQ
Chris D’Adamo, Ph.D. Assistant Professor
Department of Family & Community Medicine Department of Epidemiology & Public Health
Center for Integrative Medicine
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Presentation Outline Overview of Dietary Supplements Definition Regulation
Supplements to Consider Multivitamin Vitamin D Omega-3 Fatty Acids Probiotics
Supplements to Avoid Potential for tainting with pharmaceuticals
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Presentation Outline Supplement & Drug Interactions
Supplements for Special Situations People taking statins, beta-blockers, acid-blocking drugs Vegetarians Pregnant women
Other Popular Supplements by Health Concern Immune System Joint Health
Checklist: Informed Supplement Consumer
Digestion Depression
Liver Health Heart Health
Sleep
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Dietary Supplements Defined What is a dietary supplement? 1994 Dietary Supplement Health and Education Act (DSHEA) A product (other than tobacco) intended to supplement diet Contains one or more dietary ingredients and taken orally Vitamins, minerals, herbs or other botanicals, amino acids
Vitamins Minerals Herbs Amino Acids
Immune System
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Regulation of Dietary Supplements Federal Regulation of Dietary Supplements Food and Drug Administration (FDA) Supplements regulated as food
Pre-DSHEA assumed safe, post-DSHEA provide safety evidence Labeling and claims requirements
Ingredient names & amounts, directions for use, no health claims, etc. 2007 Good Manufacturing Practices (GMP)
Quality standards for manufacturing, preparation, storage, facility
Federal Trade Commission (FTC) Regulate marketing of supplements
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Regulation of Dietary Supplements Federal Regulation of Dietary Supplements No universal regulation of supplement content “Don’t know what you’re getting”… in many cases, true!
Many dietary supplement companies hire 3rd party laboratories for product purity certification Contains specified ingredients No contaminants Dissolves properly GMP compliant NSF-certified gold standard!
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Supplements to Consider
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Multivitamin: Overview Most common dietary supplement 33% of Americans take multivitamin Usually contain at least 13 vitamins &
15 minerals most important to nutrition
How multivitamins are used Generally capsule or tablet orally once per day Powders, liquids, multiple daily doses less common
Best taken with meal Many of nutrients lipid-soluble, need fat for absorption
Why multivitamins are used Energy, promote health & wellness, insurance against poor diet
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Multivitamin: Types RDI-centric RDI of most important vitamins/minerals Reference Daily Intake – replaced RDA in 1997 Prevent micronutrient deficiency in most people % Daily Value on food and supplement labels
Widely available & inexpensive
High potency Exceeds RDI for many vitamins/minerals Why? RDI prevent deficiency disease… not to promote optimal health!
Often higher in vitamin D, B-vitamins, vitamin C, etc. Pharmacies, health stores, Amazon & variable price Between $0.25/day - $2.00/day
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Multivitamin: Favorable Research Improves nutritional status
2000 Journal of American College of Nutrition, 2009 European Journal Clinical Nutrition
Reduces risk of birth defects 2001 Epidemiology, 2002 Epidemiology, 2002 Pediatrics, 2003 Pediatrics
Associated with weight loss & decrease in body-fat % 2010 International Journal of Obesity Research
Reduced risk of macular degeneration & cataracts 2007 American Journal of Clinical Nutrition, 2008 Ophthalmology
Reduces risk of heart attack 2010 American Journal of Clinical Nutrition
Reduces risk of colon cancer 2002 Cancer Epidemiology, Biomarkers, & Prevention
Reduces risk of all-cause mortality and cancer mortality 2011 European Journal of Nutrition
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Multivitamin: Unfavorable Research No benefit in some studies No reduction in risk of cancer or cardiovascular disease
2009 Archives of Internal Medicine
No reduction in risk of breast cancer 2010 Public Health Nutrition, 2010 American Journal of Clinical Nutrition
Slight increase in non-cancer, non-CVD mortality Lots of media coverage… but study flawed and over-interpreted
2011 Archives of Internal Medicine Direct conflict with 2011 European Journal of Nutrition Study!
Why discrepancy? Poor adjustment in observational studies
Other dietary factors, healthy lifestyles, “sick user effect”, etc. Clinical trials/many people use suboptimal products
Synthetic and poorly absorbed forms, inadequate potency
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Multivitamin: Recommendations Does brand make a difference? YES! Cheap brands use cheap vitamin/mineral forms Affects absorption and effectiveness Natural vitamin forms better absorbed than synthetic
Natural vitamin E twice absorption of synthetic Certain binding salts better absorbed than others
Magnesium sulfate much better absorption than magnesium oxide Certain vitamin forms more effective than others
Vitamin D3 superior to vitamin D2
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Multivitamin: Recommendations How to choose a good brand? Comparative Guide to Nutritional Supplements
Lyle MacWilliam, biochemist, commissioned by Canadian Minister of Health Scientific analysis of 510 multivitamins available in US & Canada
14 quality comparison criteria
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Multivitamin: Recommendations
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Multivitamin: Recommendations Choose capsule if possible
Capsules absorbed better than tablets May need to take more capsules per day
Always consume with meal Important fat-soluble nutrients Poor absorption in absence of fat
Be an informed consumer! Choose/avoid the following… Vit E: d-alpha tocopherol (natural) NOT dl-alpha tocopherol (synthetic) Vitamin D3 NOT vitamin D2 Methylcobalamin form of B12 NOT cynacobalamin form of B12 Avoid oxide binding salts (magnesium citrate NOT magnesium oxide) Avoid iron for men and postmenopausal women
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Vitamin D: Overview A uniquely important vitamin Hormone-like activity (secosteroid) Controls expression of over 200 genes
Vitamin D active in most biological systems Musculoskeletal system
Classically emphasized role Endocrine system Nervous system Cardiovascular system Digestive system Immune system
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Vitamin D: Sources Sun exposure UVB light converted to vitamin D3 in skin D3 transported to liver, metabolized to 25(OH)D
Also called calcidiol… measured most vitamin D blood tests
25(OH)D converted to calcitriol in kidneys Calcium metabolism… remaining calcitriol & calcidiol → health benefits
20,000 international units (IU) from 30 minutes sun exposure Only spring and summer if north of Atlanta
Limited amount from foods D3 from oily fish, eggs, butter, cheese, fortified milk/cereals
Vitamin D is fat-soluble… needs fat for absorption 10-100 IU: depending upon source
Supplements deliver much higher doses… up to 5,000+ IU per pill
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Vitamin D: Reference Daily Intake Current RDI varies Up to age 50: 200 IU Age 51-70: 400 IU 70 and older: 600 IU
Amount to prevent vitamin D deficiency Rickets
Softening of bones → deformities, fractures, etc. Most common in children… rare in United States Also occurs in adults… called osteomalacia
Amount to prevent chronic disease… much higher! Call to substantially increase RDI to at least 1,000 IU Explosion in vitamin D research
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Vitamin D: Favorable Research Prevents bone disorders (osteoporosis, fractures, etc.)
2009 Cochrane Systematic Database Review
Reduced risk of cancers (breast, colon, prostate, etc.) 2004 American Journal of Clinical Nutrition, 2009 Cancer Epidemiology
Reduced risk and better control of diabetes 2010 Diabetes, Obesity, & Metabolism, 2010 Diabetes Care
Reduced risk of obesity 2010 Obesity, 2010 Diabetes, 2009 Journal of American Dietetic Association
Help weight loss & improve cardiovascular risk factors 2012 British Journal of Nutrition
Reduced risk of cardiovascular disease 2009 Archives of Internal Medicine, 2010 American Journal of Cardiology
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Vitamin D: Favorable Research Improve depression & Seasonal Affective Disorder
2008 Journal of Internal Medicine, 1999 Journal of Nutrition, Health, & Aging
Reduced risk of Crohn’s disease, rheumatoid arthritis, multiple sclerosis and other auto-immune disorders 2010 Journal of Rheumatology, 2007 American Journal of Clinical Nutrition
Stimulate immune system to prevent infection 2010 American Journal of Clinical Nutrition
Decreased risk of all-cause mortality 2008 Archives of Internal Medicine
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Vitamin D: Unfavorable Research No risks of high serum vitamin D in observational studies Unless extremely high concentrations over 100 ng/mL
Increased risk of atrial fibrillation “excess” 25(OH) D > 100 ng/mL Vitamin D increases calcium absorption… too much calcium in blood?
No evidence of harm from typical vitamin D supplements Fat-soluble, but safe at even at very high intake
Acute D3 toxicity intake ≈ 176,000,000 IU… 440,000 400 IU capsules Only toxic cases manufacturing mistakes (extremely rare)
Vitamin D supplementation not beneficial in some trials Breast cancer – 2009 Breast Cancer Research and Treatment Heart attack – 2007 Circulation
Between 200 – 400 IU vitamin D used… very low dose
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Vitamin D: Recommendations Convincing evidence: recommend 25(OH)D test to everyone! Vitamin D inadequacy extremely common Between 36-100% depending on group, 2006 Mayo Clinic Proceedings
Supplementation most important for people who… Live north of Atlanta in fall & winter
Cannot synthesize from sun
Have darker skin tone Less efficient synthesis in skin
Are aging Greater risk of osteoporosis & other chronic diseases
Avoid sun or wear sunscreen Most vitamin D from sun exposure
Have low serum 25(OH)D Everyone should have vitamin D tested… inexpensive and major risk-factor!
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Vitamin D: Recommendations Not much difference by price or brand
Gel capsule preferable to tablet Vitamin D fat-soluble… better absorption
Take with food Vitamin D fat-soluble
Vitamin D3 preferable to D2 D3 (cholecalciferol) more effective than D2 (ergocalficerol)
2004 Clinical Endocrinology & Metabolism
Serum 25(OH)D target range ≈ 40 ng/mL (100 nmol/L) More research needed for optimal threshold… most people low!
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Omega-3 Fats: Overview Class of polyunsaturated fatty acids (PUFA) Common structure (C=C in n-3 position)
Three nutritionally important omega-3 fats Alpha-linolenic acid (ALA)
One of two essential fatty acids “Short-chain”… converts to “long-chain”
Eicosapentaenoic acid (EPA) Long-chain omega-3
Docosahexaenoic acid (DHA) Long-chain omega-3
Health benefits of EPA and DHA most studied Precursor to eicosanoids… anti-inflammatory effects
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Omega-3 Fats: Sources Vary by type of omega-3
ALA Nuts, seeds, vegetables
Flaxseeds, flaxseed oil, walnuts, leafy greens
EPA/DHA Oily fish
Salmon, sardines, mackerel, tuna, etc.
Other animal products Depends on animal's diet… grass-fed beef and pastured eggs
Seaweed Generally DHA only
Fortified foods Milk, yogurt, cereals, etc.
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Omega-3 Fats: Rationale Reason 1: Convincing research evidence
1970’s… ecologic studies Low disease among populations consuming high omega-3
Nordic (fatty fish), Asians (seaweed), Eskimos (whale blubber)
1990’s… observational studies Omega-3 fat intake associated with less disease
Cancer, cardiovascular disease, depression, etc.
2000’s… clinical research RCT’s revealed improvement/decreased risk many diseases!
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Omega-3 Fats: Rationale Reason 2: Standard American Diet low in Omega-3
Evolved on diet with ≈ even omega-6 : omega-3 (1:1) Fish, grass-fed meat, nuts, vegetables, fruits, etc. Both omega-6 & omega-3 necessary
Linoleic acid (omega-6) an EFA Imbalance affects inflammatory cascade… especially if too much omega-6
Standard American Diet… 20:1 omega-6:omega-3!
MUCH higher in many cases Recent changes… industrialization of food supply
Grain-fed beef, soybean oil, corn oil, etc. Thought to play role in auto-immune & inflammatory conditions
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Omega-3 Fats: Favorable Research More clinical research than any vitamins
All studies below RCT’s or reviews of RCT’s
Improved many auto-immune conditions Rheumatoid arthritis, Irritable Bowel Syndrome, asthma, etc.
2009 Cochrane Systematic Review, 2005 Nutrition, 2000 American Journal of Clinical Nutrition, 2000 European Respiratory Journal
Reduced blood pressure 2002 Journal of Hypertension
Lowers triglycerides 2009 Nutrition and Health
Decreased cardiovascular disease events and mortality 2006 American Journal of Clinical Nutrition, 2008 British Medical Journal,
2009 Clinical Cardiology, 2009 Annals of Internal Medicine
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Omega-3 Fats: Favorable Research Helps treat depression
2009 & 2010 Journal of American College of Nutrition
Helps manage bipolar disorder 2009 European Journal of Clinical Nutrition
Prevention of psychotic disorder among high-risk 2010 Archives of General Psychiatry
Reduction in ADHD symptoms 2009 Journal of Attention Disorders
Decreased cognitive decline in older adults 2011 Journal of Nutrition, Aging, and Health
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Omega-3 Fats: Unfavorable Research No clinical studies showing harm But be aware of potential interaction with anticoagulants
Some clinical trials found no benefit ADHD
2001 Journal of Pediatrics Cognitive performance 2008 Neurology
Schizophrenia 2001 American Journal of Psychiatry
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Omega-3 Fats: Recommendations Convincing evidence: recommend to most people Not recommended for people on anticoagulant drugs
Coumadin, etc. Omega-3 supplements can thin blood
Most important for people who… Don’t eat fatty, cold-water fish
Vegetarians/vegans… ALA poorly converted to DPA/EHA Flounder, catfish, etc. no omega-3
Have autoimmune or chronic inflammatory conditions Have or are at high risk for heart disease Have high triglycerides Eat Standard American Diet
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Omega-3 Fats: Recommendations Supplement with ALA or DHA/EPA? Flaxseed oil (ALA) vs. fish oil (EPA/DHA)
Fish oil superior to flaxseed oil ALA conversion to EPA/DHA very poor! Only 8 to 20% ALA converted to EPA/DHA
2008 Nutrition Reviews Most omega-3 benefits from EPA/DHA
Krill oil another good source of EPA/DHA If vegetarian/vegan Consider algae-based EPA/DHA supplement
Flax seed has other benefits Fiber, improve lipids, etc.
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Omega-3 Fats: Recommendations All omega-3 fats prone to oxidation PUFA’s health-promoting, but unstable → easily rancid
What to look for in fish oil Dark bottles Light can cause oxidation
Added vitamin E/antioxidants (ex. rosemary) Antioxidants slow oxidation
What to look for in flaxseed oil Dark bottles Refrigeration ALA even more unstable than DHA/EPA!
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Probiotics: Overview Probiotics defined: World Health Organization “Live micro-organisms… administered in adequate
amounts, confer beneficial health effect on the host”
Probiotics can be bacteria or yeasts Bacteria much more abundant… play bigger role in health Primarily colonize gastrointestinal tract
Why are gut bacteria important? Over 100 trillion bacteria in gut Ten times the amount of cells in human body!
500 different species of bacteria in gut Play critical role in metabolism and immune system
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Probiotics: Important Varieties Three classifications of probiotics Genus – broadest Species – more specific Strain – most specific Probiotic supplements usually classified by genus & species only
Lactobacillus One of most common bacterial genera in gut Convert lactose & other sugars to lactic acid Can help some with lactose intolerance Acidic environment inhibits harmful bacteria
Over 100 species Indicated by L. _______ Some of most important: L. acidophilus, L. casei, L. reuteri, L. brevis
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Probiotics: Important Varieties Bifidobacterium Another common bacterial genera in gut Inhibit pathogenic bacteria Competes for resources & produces lactic acid
29 species identified Indicated by B. _______ Some of most important: B. longum, B. breve, B. animalis
Saccharomyces Common fungal genus in gut Most yeast damage gut, e.g. Candida Albicans
Some species compete with pathogens Indicated by S. _______ S. Boulardii prevents/treats GI disorders
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Probiotics: Dietary Sources Fermented Foods Component of most traditional diets
Asian Miso and Natto
Fermented beans/grains… often soy L. acidophilus (miso) & B. natto (natto)
Kimchi Fermented cabbage, radishes, etc. L. kimchii
Kombucha
Fermented tea S. cerevisiae
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Probiotics: Dietary Sources European Yogurt
Fermented dairy Cow, goat, sheep milk
L. bulgaricus & Streptococcus thermophilus
Kefir
Also fermented dairy More probiotic species than yogurt L. rhamnosus, B. longum, S. florentinus, etc.
Sauerkraut
Fermented cabbage L. plantarum, L. mesenteroides, etc.
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Probiotics: Dietary Sources African Ogi
Fermented grains… often corn L. brevis, L. acidophilus, etc.
Currently in United States… Primarily yogurt Traditional products available health food stores
Kefir, Kimchi, Kombucha, etc.
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Probiotics: Supplement Rationale Americans consume few fermented foods!
Commercial yogurt not optimal source Often high in sugar… feeds yeast & pathogens Relatively low bacterial count 100 million lactic acid bacteria per serving… 100 trillion bacteria in gut
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Probiotics: Favorable Research Most clinical research of all dietary supplements All clinical trials or reviews of clinical trials Major species listed for each outcome
Regulates bowel function Effective against diarrhea… especially antibiotic-associated
L. rhamnosus GG, S. Boulardii, L. Bulgaricus and many others 2006 Lancet Infectious Diseases
Effective against constipation B. lactis, L. casei 2010 World Journal of Gastroenterology
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Probiotics: Favorable Research Effective treatment for some Inflammatory Bowel Disease Ulcerative Colitis
B. Animalis, B. Breve, L. Acidophilus and combinations 2010 Proceedings of the Nutrition Society, 2010 Annals of Pharmacotherapy
Crohn’s Disease Evidence not as convincing… some success with L. Rhamnosus 2009 Current Pharmaceutical Design
Effective treatment for Irritable Bowel Syndrome L. Acidophilus, B. Breve, B. Bifidum, S. Boulardii and combinations 2010 Journal of Nutrition
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Probiotics: Favorable Research Effective treatment for other autoimmune conditions Eczema and allergic rhinitis
L. Acidophilus, B. Lactis, L. Sakei 2010 American Journal of Clinical Dermatology, 2010 Pediatric Pulmonology
Improve immunity in healthy individuals Reduces risk of common cold L. paracasei, L. plantarum, L. Bulgaricus Younger adults
2010 European Journal of Nutrition Older adults
2010 British Journal of Nutrition
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Probiotics: Unfavorable Research No evidence of harm Not necessarily harmless… more research needed
Ineffective in some trials for certain conditions Crohn’s Disease 2008 Digestive Disease and Sciences
Pancreatitis 2008 Lancet
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Probiotics: Recommendations Recommend to people eating Standard American Diet Usually not necessary if consume variety of fermented foods Don’t usually need to take on an ongoing basis
Cycle on and off occasionally... few times a year or specific situations
Most important for people who… HAVE BEEN ON ANTIBIOTICS! Critical to replenish flora & prevent side-effects
Have digestive problems and/or food intolerances Will be travelling out of the country Prevent diarrheal disorders
Have an autoimmune condition Are at risk for infections Especially useful during flu season
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Probiotics: Recommendations Core product: contains variety of genus & species Especially Lactobacillus & Bifidobacterium Occasionally rotate products for increased variety
Specific conditions: single-species okay S. boulardii, L. GG, etc. for diarrhea
Choose high potency products At least 5 billion colony forming units (CFU) ≥ 10 billion preferable… especially after antibiotics Many products contain over 100 billion CFU Remember… 100 trillion bacteria in gut!
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Probiotics: Recommendations Choose refrigerated product during summer Probiotics die if exposed to high temperatures Refrigerating extends life
Generally choose enteric-coated capsules Many species die in acidic stomach conditions
Choose products that specify strain Most specify genus and species Best products also specify strain!
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Supplements to Avoid
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Supplements to Avoid Most supplements safe… but some may pose risk Especially products tainted with pharmaceuticals Three classes of supplements most likely to be tainted
Weight-loss supplements Not likely to be effective long-term Cannot replace healthy diet & exercise habits
Often stimulant-based… contraindications? Especially among overweight
Some products tainted with sibutramine Active ingredient in Reductil (withdrawn by FDA) Increases blood pressure, pulse, potential risk for CVD events http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsin
gMedicineSafely/MedicationHealthFraud/ucm234592.htm
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Supplements to Avoid Sexual-enhancement supplements Some products tainted with tadalafil or sildenafil Active ingredients in Cialis and Viagra Can interact with nitrates to cause low blood pressure http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying
UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm
Bodybuilding supplements Some products tainted with anabolic steroids Often marketed as containing “steroid-like” components Have caused liver or kidney problems http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying
UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm
Tainted products rare… but can pose health risk!
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Supplement and Drug Interactions
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Supplements and Drug Interactions St. John’s Wort and Antidepressants
Synergy: increased risk of serotonin syndrome
Red Yeast Rice and Statins Synergy: increased risk of muscle & liver problems
Calcium/magnesium/zinc and Antibiotics Reduced absorption: antibiotic may not work as well
Ginkgo Biloba and Anticoagulants Increased bleeding risk
Fish Oil and Anticoagulants Increased bleeding risk
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Supplements for Special Situations
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Supplements for Special Situations Coenzyme Q10 for people on statins or beta-blockers aka “CoQ10”
These medications deplete CoQ10 Coenzyme Q10 supplementation recommended
2006 Annals of Pharmacotherapy Also good idea to take with Red Yeast Rice
Why is supplementing with CoQ10 important? Critical in making ATP & strong antioxidant Reduces cardiovascular disease risk and blood pressure
2007 Nutrition Review & 2006 Journal of Cardiac Failure Reduces statin-induced muscle myopathy
2007 American Journal of Cardiology
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Supplements for Special Situations Vitamin B12 for people on stomach acid-blockers Prilosec, Zantac, antacids, etc.
These medications deplete vitamin B12 Reduced stomach acid to absorb B12
Why is vitamin B12 important? Help metabolize protein, fat, and carbohydrates Low levels → fatigue, depression, neurological damage Low concentrations associated with Alzheimer’s disease
2010 Neurology Supplementation lowers homocysteine
2008 Proceedings of Nutrition Society Supplementation reduces cognitive decline
2012 American Journal of Clinical Nutrition
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Supplements for Special Situations B-vitamins, iron and zinc for vegetarians Especially B12 for vegans Vegetarian diets low in these nutrients 2002 American Journal of Clinical Nutrition
Iron not recommended for men Or most post-menopausal women… not lost through menstruation Accumulates and can cause oxidative stress
Folic acid for pregnant women Deficiency can cause neural tube defects Supplementation prevents neural tube defects 2009 Annals of Internal Medicine
Can often be obtained in quality multivitamin
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Popular Supplements by Health Condition
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Popular Supplements: Immune System Echinacea
2006 Cochrane Database Systematic Review
Vitamin C 2010 Journal of International Medical Research
Vitamin D 2010 Nutrition
Zinc 2011 Cochrane Database Systematic Review
Probiotics 2006 Journal of Clinical Gastroenterology
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Popular Supplements: Joint Health Glucosamine & Chondroitin
2006 New England Journal of Medicine
Methylsulfuromethane (MSM) 2006 Osteoarthritis and Cartilage
Hyaluronic Acid 2008 Nutrition Journal
Turmeric 2006 Arthritis and Rheumatism
Ginger 2001 Arthritis and Rheumatism
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Popular Supplements: Liver Health Milk Thistle
2008 Annals of Hepatology
N-Acetyl Cysteine (NAC)
2005 Clinical Therapeutics
S-Adenosyl Methionine (SAM-e)
2007 Hepatology
Turmeric
2009 Liver International
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Popular Supplements: Heart Health Red Yeast Rice
2010 American Journal of Cardiology
Fish Oil
2009 Annals of Internal Medicine
Coenzyme Q10
2007 European Heart Journal
Vitamin D
2009 Archives of Internal Medicine
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Popular Supplements: Digestion Digestive Enzymes
Plant-based Bromelain Papain Broad-spectrum
Animal-based Pancreatin
2009 Alimentary Pharmacology & Therapeutics
Betaine HCL/Pepsin/Conjugated Bile Acids 2007 Gastroenterology
Deglycyrrhizinated Licorice (DGL) 2001 Hospital Practice
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Popular Supplements: Depression St. John’s Wort
2008 Cochrane Database Systematic Review
Fish Oil
2010 Journal of Clinical Psychiatry
S-Adenosyl methionine (SAM-e)
2002 International Journal of Psychopharmacology
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Popular Supplements: Sleep Melatonin
2004 Journal of Clinical Endocrinology & Metabolism
Valerian Root 2006 American Journal of Medicine
5-Hydroxytryptophan (5-HTP)
2000 Alternative Medicine Review
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Checklist: Informed Supplement Consumer No interactions with other drugs/supplement
- Talk to healthcare professional and consult literature
No outrageous label claims
- Especially weight loss, sexual, bodybuilding products
Only buy from reputable sources
- Vitamin Shoppe, health food stores, Amazon, etc. - Avoid “too good to be true” websites, unlabeled products, products not labeled in English, multi-level marketing
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Checklist: Informed Supplement Consumer Carefully consider all ingredients on label
- Consider potential for interactions - Also content and quality of ingredients - Some forms of vitamins, minerals, etc. better than others
Seek 3rd party verification certificate
- Sign of commitment to product quality - NSF “Gold Standard” of product quality