Supplements

Question 1

1. Define Integrative Health (IH).

Answer 1

Healing-oriented practice that incorporates the relationship between the provider and whole person (mind, body, and spirit).

It emphasizes the evidence and makes use of all appropriate therapeutic approaches to achieve optimal health and healing.

Question 2

2. Explain the purpose of Dietary Supplement and Health Education Act (DSHEA) 1994.

Answer 2

Regulate the evaluation of vitamins, herbals, amino acids and other botanicals

Regulates herbal supplements more like food rather than medication

Products cannot be put on the same shelf as OTC or meds

Prior to 1994 – all products were grandfathered

Question 3

3. Distinguish a higher quality supplement due to product labeling. (4)

Answer 3

Good Manufacturer Practices (GMPs)
Examples: Nature’s Way, Country Life, Twin

Consumer Labs (CL)
Examples: Good Neighbor Pharmacy, Sundown

United States Pharmacopoeia (USP)
Example: Nature Made

National Sanitation Foundation (NSF)
Example: GNC Nutritional Supplements

Question 4

dyslipidemia supplement treatments

Answer 4

EPA, fish oil

Fibers

Niacin

Plant Sterols and Stanols

Question 5

fish oil

adverse reactions
DDI, herb interactions

other info

Answer 5

Adverse reactions:
Fish taste, GI upset, heartburn, and belching

Drug interactions:
Antihypertensive, contraceptives, and orlistat (moderate)

Herb interactions:
Garlic, Ginger, Ginkgo, and Ginseng

Decrease the fishy taste

Generally recognized as safe (GRAS)

Pregnancy limit consumption of 12 oz per week
Avoid shark, swordfish, and tilefish

Use caution in patients allergic to shellfish

Treatment option for patients who can not take niacin due to gout and flushing reaction

Omega Quant HS–Omeg-3 Index test

Krill Oil – Dr. Oz

Question 6

Niacin

Answer 6

Monitor: LFT due to Hepatotoxicy risk
Products: IM Niacin >LA Niacin >ER Niacin
Inositol Nicotinate (“no-flush” niacin)

Question 7

plant sterols and stanols s/e

Answer 7

sterols
Nausea, indigestion, diarrhea, constipation & gas

Stanols-Diarrhea & steatorrhea

Question 8

Obesity

Answer 8

nothing recommended

ephedra-

Bitter Orange

Calcium-

Alli™ (Orlistat)-

Question 9

ephedra-

Answer 9

Mechanism of action:
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
Adverse reactions:
Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & BP
Seizures, cardiomyopathy, MI, arrhythmias & sudden death

Question 10

Bitter Orange

Answer 10

Clinical pearl:
Due to FDA ban on ephedra, manufactures switch to bitter orange
Often products contain caffeine
Generally recognized as safe (GRAS)
No evidence that this supplement is safer than Ephedra!!

Question 11

Calcium-

Answer 11

supplement calcium alone ≠ low fat dietary intake

Question 12

Alli™ (Orlistat)-

DDI
clinical pearls

Answer 12

Drug Interactions:
Anticoagulants, amiodarone, levothyroxine, & vitamins

Clinical pearls:
Take a MVI qd 2 hours before or after dose
Due to risk of liver injury inform patient signs and symptoms

Question 13

Diabetes

Answer 13

nothing recommended
Chromium-
Vanadium

Question 14

Chromium

Answer 14

Adverse reactions:
HA, insomnia, irritability, mood changes & sleep disturbance
Vomiting, diarrhea, & hemorrhage

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

Clinical pearls:
Several salt forms
Picolinate, nicotinate, polynicotinate and chloride
Chromium picolinate most often used in studies
No reliable method to diagnoses deficiency

Question 15

Vanadium

Answer 15

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

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

Question 16

Hypertension

Answer 16

nothing recommended

Question 17

Garlic

Answer 17

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

Drug interactions: 
Anticoagulant
Antiplatelet
CYP3A4
CYP2E1

Question 18

Coenzyme Q-10

Answer 18

Adverse reactions: GI upset, heartburn, and appetite loss

Drug interactions: anticoagulants

Lab interactions: increase T4/T8 ratio in normal patients

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

clinical pearls
Some medications can lower Co Q 10 levels
Statins, beta blockers, and diuretics
Take it with a fatty meal