Nutritional and Herbal Supplements Flashcards
why do I need to be aware of studies on supplements?
many performed outside US -flaws (not RDBPCT) -limitations (small) -unable to interpret results -different population not regulated by any governing body
St. John’s Wort
-mechanism
inhibits metabolism and reuptake of serotonin, dopamine, and epinephrine
St. John’s Wort
- purpose
- study results
depression
no more effective than placebo for mild to moderate depression (similar to Rx agents) with fewer side effects
not effective for major depression
St. John’s Wort
- recommendations
- side effects
more rigorous studies needed - they always say this
associated with allergic reactions and photosensitization
relatively inexpensive
patient should not self-treat depression
Echinacea
- MOA
- function
enhances phagocytosis, stimulates certain cytokines
anti-inflammatory actions
Echinacea
-study results
may be beneficial for early treatment of URTI (upper resp tract infection), though larger, properly designed trials show no beneefit over placebo
Echinacea recommendations
- may be effective for…
- side effects
- long-term use?
may be effective in reducing a cold’s severity and duration if taken early
probably safe for short term use
allergies and GI pain are commonly reported
long-term use should possibly be avoid due to immunosuppression, though evidence for this is scarce
Ginkgo Biloba
-MOA
free radical scavengers (antioxidant)
inhibits platelet activating factor
increases GABA
Ginkgo Biloba
-study results
potentially increases memory and attention
Ginkgo Biloba
-side effects
drug interactions max exist
may increase risk of bleeding
Saw Palmetto
-MOA
inhibit 5-alpha-reductase
blocks testosterone and dihydrotestosterone uptake by the prostate
anti-inflammatory activity
Saw Palmetto
-study results
improved urologic symptoms and flow when compared to finasteride with fewer side effects
Saw Palmetto
- recommendations
- safety
- drug interactions
may decrease BPH symptoms
probably safe
limited (known) drug interactions
garlic
-MOA
potentially inhibits cholesterol synthesis
also has effects on plasma protein and cell membrane remodeling
garlic
-study results
mixed results on lipid-lowering ability
potentially has modest ability to lower LDL
possible antihypertensive effect
antiplatelet, antithrombotic and fibrinolytic activity seen
garlic
-recommendations
well tolerate with few side effects
drug interactions exist, must use carefully
must use high doses to see any effect
ginger
-function
potentially affects GI motility
some evidence for use as an antiemetic
ginger
-study results
hyperemesis gravidarum (severe morning sickness) results are mixed for treating motion sickness and nausea associated with surgery or chemotherapy
ginger
-drug interactions
drug interactions may exist, must use carefully
ginseng
- MOA
- function
proposed: central cholinergic and dopamingeric effects and stimulation if the HPA axis
claims to increase energy and improve mental abilities
ginseng
-study results
multiple studies have shown no effects on exercise performance, mood, memory or concentration
herbal agents used for pain relief
arnica montana black cohosh chamomile Boswellia Serrata evening primrose oil kava peppermint piscidia-Jamaican Dogwood SAM-e St. Johns Wort Willow Bark Wintergreen Oil
arnica montana
-how is it used
used externally for muscle pain increased by movement
black cohosh
- don’t confuse with…
- used for…
don’t confuse with blue cohosh
generally used to treat Sx of menopause, though high quality trials show no effect
chamomile
- purpose
- evidence
used for stomach and GI pain, cramps, rheumatism, neuralgia, inflammation, ulcers
no robust evidence
boswellia serrata
- aka
- purpose
- evicence
frankincense
believe to disrupt the enzymes which cuase inflammatory pain
robust evidence of efficacy is lacking
evening primrose oil
- evidence
- purpose
no robust evidence
proposed anti-inflammatory actions –> arthritis, joint and back pain
kava
- linked to…
- function
- may be useful for…
linked to liver damage/failure
mild CNS depressant
may be useful in the Tx of anxiety
chondroprotective agents
-how do they work?
increase proteoglycan synthesis
decrease collagenolytic activity
increase in hyaluronic acid production
inhibit lysosomal enzyme release
oral bioavailability of
- glucosamine
- chondroitin
glucosaming -26% -87% absorbed from GI tract (first-pass metabolism accounts for the difference) chondroitin -12%
glucosamine and chondroitin
-MOA
exact machanism not known
glucosamine and chondroitin
-in vitro anti-inflammatory activity
proposed to prevent breakdown of synovial sturctures
glucosamine and chondroitin
- exogenous glucosamine has been shown to…
- -unclear if…
distribute to joints (knees) and increase the synthesis of hyaluronic acid
-unclear if this occurs at synovial concentrations that can be achieved through supplements (5 uM vs. 500 uM)
glucosamine and chondroitin
-trial results
no benefit vs. placebo in short-term studies
long-term (2 years) trials show no benefit over placebo
small sample size in a lot of studies
glucosamine drug interactions
ACE inhibitors
K sparing diuretics
diabetic medications
chondroitin drug interactions
none reported
glucosamine adverse effects and cautions/contras
heartburn moderate constipation diarrhea avoid in/with -pregnancy -shellfish allergy -diabetics/glucose intolerance -CHF/renal impairment
chondroitin adverse effects and cautions/contras
moderate constipation diarrhea nausea/epigastric pain hypersensitivity avoid in pregnancy
supplement concerns
not FDA regulated allergic reactions can still occur -can be serious such as anaphylactic shock toxities -direct -unlisted poisonous ingredients -excessive pharmacologic activity adulteration/contamination misidentification/mislabeling
patients should never…
use herbal products in lieu of seeking medical treatment
-use of herbals may delay Tx
patients should never stop taking their proven conventional therapies to use an unstudied, unproved regimen
use extreme caution around _____ when taking herbal agents
surgery
