Supplements

Question 1

clinical pearls about fish oil

Answer 1

• Decrease the fishy taste – freeze, take with food, or an enteric coated product
• Generally recognized as safe (GRAS)
• Pregnancy limit consumption of 12 oz. per week of fish. Avoid shark, swordfish, and tilefish due to the levels of mercury
• Treatment option for patients who cannot take niacin due to gout and flushing reaction
• Not effective in lowering Total Cholesterol or LDL-c
• Omega Quant HS–Omeg-3 Index test to quantify DHA/EPA
• Increase risk of bleeding in combination with Rx, OTC’s or other supplements
• DHA/EPA (measures potency) – amount vary in commercial products
• Use both in primary and secondary prevention per the AHA recommendations

Question 2

Clinical pearls about plant sterols and stanols

Answer 2

• Takes 2-3 weeks to be effective
• When discontinued, cholesterol levels rise back to baseline in 2-3 weeks
• Sterols and Stanols appear to be equally effective
• GI side effects
• Drug interaction with Zetia®

Question 3

T/F most people don’t report CAM (Complementary Alternative Medicine) use to their doctor.

Answer 3

True. 72% don’t report.

Question 4

The FDA takes action if ____.

Answer 4

A product already on the market appears to be unsafe. No pre-testing/regulation steps exist. This is the responsibility of the manufacturer. This is the result of the

Dietary Supplement and Health Education Act (DSHEA) 1994

Question 5

What are 4 weight loss treatment options discussed in this lecture?

Answer 5

Calcium
Bitter orange
Ephedra
Alli

Question 6

Ephedra. Still on the market?

Answer 6

NO. FDA pulled it due to serious and fatal case reports.

Question 7

Bitter orange. Still on the market?

Answer 7

YES. However, No evidence that this supplement is safer than Ephedra!

• Due to FDA ban on ephedra, manufactures switch to bitter orange
• Often products contain caffeine
• Generally recognized as safe (GRAS)

Question 8

Alli. Still on the market? Evidence?

Answer 8

Alli
• Take a MVI qd 2 hours before or after dose
• Due to risk of liver injury inform patient signs and symptoms
• FDA approved for long term weight loss
• Patients with BMI of 27 or more have seen benefits

Question 9

Diabetes treatment options discussed in this lecture? Dangerous contraindication for both of these?

Answer 9

Chromium
Vanadium

CAUTION in renal patients.

Question 10

Clinical pearls on Chromium?

Answer 10

Chromium
• Several salt forms (Picolinate, nicotinate, polynicotinate and chloride)
• Chromium picolinate most often used in studies
• No reliable method to diagnoses deficiency
• Caution in renal dysfunction
• Mix data on effectiveness

Question 11

Clinical pearls Vanadium?

Answer 11

Vanadium
• Average diet contains 6-18 mcq qd
• Only 5% is absorbed
• Kidney toxicity
• EFFECTIVE in Type 2 DM…if we believe her.
• Increase risk of bleeding when used in combination with RX, OTC or Supplements

Question 12

Hypertension treatments discussed in this lecture?

Answer 12

Garlic, CoenzymeQ

Question 13

Clinical pearls on garlic?

Answer 13

1. Garlic
   • 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
   • 0.65-1% allicin for standardization (measure potency)

Question 14

Clinical pearls on Coenzyme Q?

Answer 14

Coenzyme Q-10
• Some medications can lower Co Q 10 levels (Statins, beta blockers, and diuretics)
• Increase risk of bleeding
• Increase T4/T8 labs in normalized patients
• Take with a fatty meal for best absorption