Supplements

Question 1

Fish Oil/Omega-3 FA

Answer 1

Decreases hepatic secretion of VLDL and increases VLDL clearance, lowers TGs by 30% w/statins (does NOT affect LDL)
Treatment option for patients who can’t take niacin due to gout or flushing reaction

Question 2

Fish Oil SE

Answer 2

Fishy taste (decrease by freezing)
 GI side effects
 Increase risk of bleeding with anticoagulants
 Interactions with “G” herbs: ginger, garlic, ginkgo, ginseng
Pregnancy limit to 12 oz/wk

Question 3

Fiber

Answer 3

If 51% whole graincan say that reduces risk of heart disease
 Blond Psyllium (10-12 grams)
 Oat Bran

Question 4

Niacin

Answer 4

1200-3000 mg/day may lower LDL and TG, and increase HDL, but no significant decrease in all cause mortality
 Can give aspirin before to avoid flushing

Question 5

Niacin SE

Answer 5

Side effects: flushing, increase uric acid (gout), increase blood sugar, headache, hepatoxicity

Question 6

Plant Sterols and Stanols

Answer 6

Inhibits about 50% of intestinal cholesterol absorption (decrease TG and LDL, no effect on HDL)
 Can be found in butters and juices

Question 7

Plant Sterols SE

Answer 7

Diarrhea and steatorrhea
 Takes 2-3 wks
Interactions with beta carotene and Vit. E and Zetia

Question 8

Flaxseed

Answer 8

Good source of linolenic acid

 40-50 g/d to decrease LDL

Question 9

Flaxseed SE

Answer 9

Diarrhea
 Increased risk of bleeding with anticoagulants
Interactions with “G” herbs: ginger, garlic, ginkgo, ginseng

Question 10

Red Yeast Rice

Answer 10

Active ingredient resembles a statin (inhibits HMG CoA reductase)
 May contain Citrinin (renal toxicity)

Question 11

Red Yeast Rice SE

Answer 11

GI upset, heartburn, flatulence

Many DDIs

Question 12

Calcium

Answer 12

800-1200 mg/d increases weight loss

Question 13

Ca SE

Answer 13

Belching, flatulence

Question 14

Hoodia Gordonii

Answer 14

Raspberry flavored yogurt drink that causes weight loss

Question 15

Hoodia Gordonii SE

Answer 15

Nausea and skin issues

Question 16

Ephedra

Answer 16

Significant weight loss

Question 17

Ephedra SE

Answer 17

Dizziness, N/V, palpitations, HTN, MI, arrhythmias, sudden death  DO NOT RECOMMEND! Risk outweighs benefit

Question 18

Bitter Orange

Answer 18

Was created in response to ephedra ban: contains 1-6% of synephrine (related to ephedrine) and often also contains caffeine

Question 19

Bitter Orange SE

Answer 19

Dizziness, N/V, palpitations, HTN, MI, arrhythmias, sudden death  DO NOT RECOMMEND! Risk outweighs benefit

Question 20

Chromium

Answer 20

May reduce oxidative stress

 May reduce blood glucose, HbA1c, FFA

Question 21

Chromium SE

Answer 21

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

Question 22

Vanadium

Answer 22

Stimulates glycogengenesis, inhibits lipolysis

Question 23

Vanadium SE

Answer 23

GI upset, tongue discoloration (green tongue)

 Interactions with “G” herbs and anticoags

Question 24

Garlic

Answer 24

Allicin is the active ingredient; inhibits hepatic cholesterol synthesis; relaxes smooth muscle (vasodilation=decrease BP); also used for dyslipidemia

Question 25

Garlic SE

Answer 25

Halitosis, body odor, heartburn, GI upset

 DDIs: anticoagulant /antiplatelet; CYP3A4 and CYP2E1

Question 26

Coenzyme Q-10

Answer 26

Used for CHF

preventing myopathy

Question 27

Coenzyme Q-10 SE

Answer 27

GI upset, heartburn, appetite loss

 DDIs with anticoagulants

Question 28

Dietary Supplement and Health Education Act (DSHEA) of 1994

Answer 28

Evaluate vitamins, herbals, etc more like food rather than medicationproducts can’t be on same shelf as OTC drugs
o Two key players: Manufacturers (need to ensure product is safe and that label is not misleading) and FDA (pull products if bad