supplements in metabolic disease Flashcards
- Define complementary and alternative medicine (CAM).
- Complementary Medicine = Medicine is used together with conventional western medicine.
- Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
- Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
- Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
- Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.• Complementary Medicine = Medicine is used together with conventional western medicine.
- Alternative Medicine = Medicine is used in place of conventional western medicine. • CAM = Using therapies that are proven safe and effective and adopting them into conventional health care.
- Explain the purpose of Dietary Supplement and Health Education Act (DSHEA) 1994.
Evaluates vitamins, herbals, aa and other botanicals and regulates supplements more like food rather than meds. Products cannot be put on the same shelf as OTC or meds. Prior to 1994 all products were grandfathered in
responsibilities of manufacturers of supplements
Ensure product is safe and product label is truthful and not misleading. Do NOT need to register or get FDA approval
responsibilities of FDA in supplements
Take action in product is unsafe once on the market. Monitor safety (adverse event reporting system), product labeling, claims, package inserts and accompanying literature.
- Distinguish a higher quality supplement due to product labeling.
• Required Disclaimer – “This statement has not been evaluated by the FDA. This products is not intended to diagnosed, treat, cure, or prevent disease” • Structure-function claim – What the product can be used for • Follow Good Manufacture Practices • Supplement seal of Approval (GMP’s, CL, USP, NSF)
List CAMs used for dyslipidemia
fish oil/omega 3 fatty acid (very safe and effective) , plant sterols and stanols (very safe and effective), fiber (very safe and effective),
fish oil indications and MOA
Indicated for hypertriglyceridemia. Decreases hepatic secretion of of VLDL-C, increase VLDL-C clearance, reduces TG transport. Omega 3 fatty acids compete with arachidonic acid in the cycloxygenase and lipoxygenase pathways
Fish oil efficacy
Decreases TG by 20-50%. If TG >500mg/dl, decreases by 45%. If TG is 200-499mg/dl and fish oil is combined with statin, TG decreases by 30%. Neutral effects on LDL-C
Fish oil doses
Primary prevention: 500 mg qd or 2 fishy meals a week. Secondary prevention (CHD): 1000 mg qd
Fish oil adverse effects and DDIs
Adverse rxns: fish taste, GI upset, heartburn, belching. DDI: Antihypertensives, contraceptives, Orlistat, Anticoagulants/Antiplatelets.
Fish oil herb interactions
garlic, ginger, ginkgo and ginseng
fish oil safety
generally recognized as safe (GRAS)
Which fish should be avoided in pregnancy
shark, swordfish and tilefish
Fiber benefits
FDA permits health claims: 51% whole grain reduce risk of heart disease.
Blond Psyllium benefits
decreases total cholesterol 3-14% and LDL-C 5-10%
Niacin benefits
Decreases LDL 5-25% and TG 20-50%. Increases HDL 15-35%. May lower risk of scondary MI but no significant decrease in all cause mortality.
Niacin side effects
HA, GI, flushing, increase blood glucose and uric acid. Monitor LFT due to hepatotoxicity risk
Efficacy of niacin
IM > LA > ER
MOA of plant sterols vs stanols
sterols: Inhibits about 50% intestinal absorption of cholesterol. Stanols: Inhibits dietary and biliary cholesterol
Plant sterols efficacy
Decreases total cholesterol, and LDL. NO effect on HDL. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.
Plant stanols efficacy
Decreases LDL 10-15%. When combined with statin therapy, decreases total cholesterol 3-11% and LDL 7-16%. Takes 2-3 weeks to be effective, and cholesterol levels rise back to baseline 2-3 weeks after stopping.
Plant sterols adverse rxns
•Nausea, indigestion, diarrhea, constipation & gas
Plant stanols adverse rxns
diarrhea and steatorrhea
Plant sterols and stanols interactions
Herbs: Beta carotene and Vit. E. Drugs: Zetia®
Plant sterols vs stanols efficacy
equally effective
Atkins diet
high fat, low carb (max 40 g per day). First 10 days of ketosis result in rapid weight loss
macrobiotic diet
•Low fat, emphasizing whole grains, vegetables & restricting fluid intake
Ornish diet
Only 10% calories from fat. Allow fruits and veggies
south beach diet
low carb, glycemic index, allow good carbs and fats, limit bad saturated and trans fats
zone diet
•40 % carbohydrates, 30 % protein, and 30 % fat
Mediterranean diet
whole grains,fruits and veggies, olive oil, fish and seafood, lean meats, herbs and spices, fresh unprocessed foods, portion control, healthy lifestyle, glass of wine with meal
ephedra MOA
•Ephedrine and pseudoephedrine are non-selective alpha and beta receptor agonists which stimulate nervous system
ephedra efficacy
•Weight loss of 0.9 kg/month up to 6 months with ≤ 30 % of dietary fat intake with moderate exercise
ephedra adverse reactions
Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death
ephedra uses
risk outweighs benefits-
Bitter orange MOA
•Contains 1-6% of synephrine which is related to ephedrine
Bitter orange adverse effects
Dizziness, anxiety, insomnia, HA, dry mouth, N/V, heartburn, tachycardia, palpitations, & elevated BP. Seizures, cardiomyopathy, MI, arrhythmias & sudden death
Bitter orange uses
There is no evidence that this supplement is safer than ephedra, yet it is generally recognized as safe (GRAS). Manufactures use it instead of ephedra
Benefits of calcium
Patients will low calcium intake often gain more weight and have a higher BMI.
Calcium adverse rxns
belching and flatulence
Alli (orlistat) MOA
•Reversible inhibitor of pancreatic & gastric lipase
Alli adverse reactions
•HA, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea & liver related events. Risk of liver injury
Alli DDI
•Anticoagulants, amiodarone, levothyroxine, & vitamins
Alli uses
FDA approved for long term weight loss. Patients with BMI of 27 or more have seen benefits.
Hoodia gordonii efficacy
Side effects (nausea and skin sensation, elevated BP, pulse, HR, bilirubin, alk phosph) and does not change body weight, body fat or energy intake
Chromium MOA
Might reduce oxidative stress. Low levels are associated with impaired glucose and insulin so may be used for diabetes. Decreases fasting blood glucose, A1C and total cholesterol
compare types of chromium
Chromium 0 has no activity. Chromium III found in food and supplements. Chromium VI used in welding industries & carcinogenic
Chromium adverse rxns
•HA, insomnia, irritability, mood changes & sleep disturbance. Vomiting, diarrhea, hemorrhage. Caution in renal dysfunction
chromium DDI
Herbs: bilberry, brewer yeast, iron, Vit. C & zinc. Drugs: insulin, levothyroxine, NSAIDs & corticosteroid. Disease: diabetes, renal dysfunction
forms of chromium
•Picolinate, nicotinate, polynicotinate and chloride
Vanadium MOA
Activates insulin receptor proteins, stimulates glucose oxidation & transport. Liver: stimulates glycogen synthesis. Adipose: inhibits lipolysis. Skeletal muscle: promotes glucose uptake
Vanadium efficacy
High does of 100 mg qd may improve insulin sensitivity and possibly reduce blood glucose levels. Effective in Type 2 but not Type I diabetes
Vanadium adverse rxns
•GI upset, kidney toxicity, fatigue, lethargy & tongue discoloration. Risk of bleing when used in combo with RX, OTC or supplments
vanadium interactions with herbs, drugs, labs and diseases
Herbs: garlic, ginger, ginkgo & ginseng. Drugs: anticoagulants & antiplatelets. Labs: blood glucose & serum creatinine. Disease: diabetes & renal dysfunction
List dietary herbs used for diabetes
bitter melon, cassia cinnamon (caution in liver dz), magnesium (decreases risk for T2DM), prickly pear cactus, stevia, chia, fruit
Garlic indications and MOA
HTN and hyperlipidemia. Allicin is th active ingredient and it inhibits hepatic cholersterol synthesis and activates production of endothelium derived relaxation factor to relax smooth muscle and vasodilation
garlic adverse rxns
•Halitosis, body odor, heartburn, and GI upset
garlic interactions- drugs, herbs, diseases
drugs: Anticoagulant, antiplatelet, CYP3A4 and 2E1. Herbs: ginger, ginkgo and Vit E. Diseases: diabetes, HIV or AIDs
garlic clinical pearls
Fresh garlic needs to sit for 10 mins after being chopped up. Discontinue 2-3 weeks prior to surgery. Products marketed as odorless may not contain allicin
CoQ 10 indications
CHF (possibly effective), Preventing statin-induced myopathy (Insufficient Reliable evidence)
CoQ10 MOA
Has antioxidant properties to stop damage and give energy to cells. Cofactor in metabolic pathways
CoQ10 efficacy
No evidence when taken as monotherapy, possibly useful with prescription treatment for HF. No significant benefit for myopathy or statin tolerability
CoQ10 adverse rxns
GI upset, heartburn, appetite loss
CoQ10 interactions- drugs, labs, diseases
drugs: anticoagulants. Labs: Increases T4/T8 ratio. Diseases: may lower BP, cigarette smoking may deplete body stores
Meds that can lower CoQ10 levels
statins, beta blockers, diuretics
list CAMs that are proved effective
EPA, fish oils, fiber, niacin, plant sterols and stanols,
