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DEMS Unit IV - Endocrine > Supplements in Metabolic Disease > Flashcards

Supplements in Metabolic Disease Flashcards

1
Q

Integrative Health

A

Healing or

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2
Q

Do a lot of people utilize integrative health?

A

No

33% of adult american population
11% of children in ‘merica

72% of patients did not report CAM use to health care provider (Complementary and Alternative Medicine)

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3
Q

Who are the highest utilizers of CAM?

A

44-65 years old

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4
Q

What are the IH Domains? Which are highest utilized?

A
  1. Biologically Based Systems - Most used (Herbals, Diet)
  2. Manipulative & Body - Based
  3. Mind-Body Medicine
  4. Alternative Medical Systems
  5. Energy Therapies
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5
Q

Why are people using IH?

A
  • Dissatisfied with the results of conventional therapy
  • Lack of disease curing
  • Dramatic reports from media
  • Patient empowerment
  • Focused on spiritual and emotional wellbeing
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6
Q

What patients believe regarding supplements

A
  • Natural is better than synthetic
  • Patients don’t consider herbs as “drugs”
  • Herbs don’t have side effects
  • Herbs are regulated, standardized, and safe
  • They’ve been used for thousands of years
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7
Q

Evidence of IH

A

Efficacy

  • Folklore
  • Anecdotes
  • Small studies

Safety

  • Inherent toxicity
  • Interaction with other conventional drugs ***

Mainstream medicine

  • Poppies = morphine
  • Foxglove = Digoxin
  • Willow bark = aspirin
  • Pacific yew tree = tamoxifen
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8
Q

What is the role of DSHEA?

A
  • Regulate the evaluation of vitamins, herbals, AA
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9
Q

Role of manufacturers vs. FDA

A

Manufacturers

  • Do not need to register or get FDA approval
  • Responsible to ensure product is safe
  • Ensure product label information is truthful and not misleading

FDA

  • Take action if product is unsafe once on the market *** (prescription drugs are done before)
  • Monitors safety (ADR MedWatch reporting)
  • Monitors product information (labeling, claims, package inserts, accompanying literature
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10
Q

What can be reported via MedWatch?

A
  • Regulated drug
  • Biologic
  • Medical device
  • Dietary supplement
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11
Q

What came of the White House Commision on CAM policy?

A
  • Coordination of research to increase CAM knowledge
  • Educate and train the health care practitioners in CAM
  • Provide reliable and useful info about CAM practices to products and professionals
  • Guidance regarding appropriate access to delivery of CAM
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12
Q

What are the labeling requirements for supplements?

A
  • Disclaimer (that it isn’t meant to treat something and hasn’‘t been evaluated by the FDA)
  • Structure-function claim (what to use it for)
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13
Q

What are Good Manufacturing Practices (GMPs)?

A
  • Record keeping
  • Quality control
  • Testing
  • Production
  • Verify quality of raw materials
  • Increase inspecting of facilities by FDA inspectors
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14
Q

How to determine which supplement is better?

A
  • Good labeling
  • 3rd party company studies product and receive a seal from GMP, CL, USP, NSF (the 3rd party surveyor)
  • Note that United States Pharmacopoeia (USP) is the most commonly seen
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15
Q

How should you use supplements?

A
  • Start low and go slow
  • D/c if ineffective or unsafe
  • DDIs
  • Best to use single active ingredients vs. combinations (helps you figure out which ingredient is the problem)
  • Purchase product from a reliable source

Use extra caution in:

  • Pregnancy
  • Nursing
  • Elderly
  • Children
  • Patients with serious health problems
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16
Q

Most used Natural Products by US Adults

A
  • Fish oil/omega 3/ DHA
  • COQ10
  • Garlic
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17
Q

What is the national medicine comprehensive database?

A
  • Provides information regarding naturals/botanicals

- Treats them as prescriptions

18
Q

Fish oil / Omega 3

A

Indication: hypertriglyceridemia

Mechanism of action:

  • Decrease hepatic secretion of VLDL-C, increase VLDL-C clearance, reduces TG transport
  • Omega 3 FA compete with AA in the cycloxygenase & lipoxygenase pathways

Effects:

  • TG 20-50%
  • If TG > 500 mg/dl = 45%
  • Combo with statin in TG levels of 200-499 mg/dl = 30%
  • LDL-C neutral effects

Recommended amount:
Primary prevention - 500 mg qd or 2 fishy meals a week
Secondary prevention - 1000 mg qd

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

DDI:
- Antihypertensive, contraceptives, and orlistat

Herb interaction:
- Garlic, Ginger, Ginkgo, Ginseng

19
Q

What does DHA and EPA correlate to?

A

Potency.

The higher it is, the better.

Most are 120 mg DHA and 180 mg EPA

20
Q

Clinical Pearls of Fish oil / Omega 3

A
  • Pt hate the fishy taste; most effective way to reduce fishy taste is to freeze it
  • Generally recognized as safe
  • Pregnancy limit consumption of 12 oz per week (avoid shark, swordfish, and tilefish bc of mercury)
  • Use caution in patients allergic to shellfish
  • Tx option for patients who cannot take niacin due to gout and flushing
  • Omega Quant HS - Omeg-3 Index test
  • Krill oil = Dr. Oz… try to stay on fish oil because we don’t know enough about this
  • Avoid cod-liver oils
21
Q

Fibers FYI

A
  • FDA permits health claims (51% whole grain reduce risk of heart disease)

Blond Psyllium (10-12 grams daily to lower cholesterol and LDL)

  • Take a multivitamin as a separate dose
  • Works better with food

-Oat bran (delay food absorption)

22
Q

Niacin

A

Dose: 1200-1500 mg TG & 2-3g LDL daily
- Great lowering effects

Efficacy

  • AIM HIGH study shows that it may not be effective
  • Not significant decrease in all cause mortality

Side effects:

  • Flushing**
  • HA, GI, Increase blood glucose and uric acid

Monitor: LFT due to hepatotoxicity risk

Products: IM Niacin (most effective, but most flushing)  > LA Niacin  (least effective, least flushing, most hepatotoxicity> ER Niacin (somewhere between the two)
inositol nicotinate ("no flush" niacin)
23
Q

Plant Sterols

A

MOA:
- Inhibit about 50% intestinal absorption of cholesterol

Efficacy:
- TC, LDL-C, no effect on HDL

Dosage:
- 800 mg - 6 g qd, prior to low fat meals (lots of calories added via butter if you get it that way)

24
Q

Plant Stanols

A

MOA:
- Inhibit dietary and biliary cholesterol

Efficacy:
- LDL-C, TC, no effect on HDL

Adverse reactions:
- diarrhea & steatorrhea

Dosage:800 mg - 4 g qd

25
Q

Clinical pearls of sterols and stanols

A
  • 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
26
Q

Recall the different types of diets

A

Atkins - high fat, low carb
Macrobiotic - low fat, emphasizing whole grains, veggies and restricting fluid intake
Ornish - only 10% of calories from fat
South beach - Low carb diet, focus on glycemic index
Zone - 40% carb, 30% protein, 30% fat
Vegetarian - No red or white meat

All fad diets

27
Q

Ephedra

A

Pulled off of the market

Efficacy: lose up to 1 kg/mo for up to 6 months with Potential risk outweighs the benefit!

28
Q

Bitter Orange

A

Because of the ban of ephedra, it was substituted with bitter orange

Adverse effects = same as ephedra
Caution: in HTN and CV patients

Clinical pearl:

  • Often contain caffeine
  • GRAS
  • No evidence that this supplement is safer than ephedra **
29
Q

Calcium

A
  • Low dietary calcium gain more weight and have higher BMI

Efficacy:

  • 800-1200 mg/qd dietary calcium has weight reduction and body fat loss
  • 900-1000 mg/qd shows weight loss of 8-9 kg

Adverse rxn: belching and flatulence

Clinical pearls: supplement calcium alone does not = low fat dietary intake. Need the dietary calcium

30
Q

Orlistat

A

1 of 5 long term weight loss drugs

MOA: reversible inhibitor of pancreatic & gastric lipase (anabuse for food lovers)

Efficacy:
- BMI > 27 saw a significant reduction of weight loss ~3% than diet alone

Adverse reactions:

  • HA, oily spotting, abdominal discomfort, gas, fecal urgency & liver related events ** (need LFTs)
  • Psyllium/Fibers 6g with dose or 12 qhs

Dosage: 60 mg tid with each meal that contains fat

DDIs: - anticoagulants, amiodarone, levothyroxine, and vitamins

Need to take multivitamin

31
Q

Clinical pearls of Orlistat

A
  • Take a MVI qd 2 hours before or after dose

- Due to risk of liver injury inform patient signs and symptoms

32
Q

Chromium

A

For diabetes

MOA: Chromium III is in food and supplements; VI is carcinogenic

Adverse rxns:
- GI, HA, insomnia, irritabiity, mood changes & sleep disturbances

Dosage:

  • poor absorption
  • Renally excreted

Interactions:
- lots of them… with herbs, drugs, and can cause renal dysfunction

33
Q

Clinical pearls of chromium

A
  • Several salt forms
  • Chromium picolinate is most often used
  • No reliable method to diagnose deficiency but is helpful to reduce blood glucose if deficient (let patient try for a few months, if no effect d/c)
34
Q

Vanadium

A

Efficacy:
Only effective for T2DM

Adverse reactions:
- GI upset, kidney toxicity, fatigue, lethargy & green tongue discoloration

Dosage: 50 mg bid of sulfate form

DDIs: lots, especially the G’s for blood thinning

35
Q

Clinical pearls of vanadium

A
  • Average diet contains 6-18 mcq qd

- Very little (5%) is absorbed

36
Q

Dietary/Culinary Herbs

A
  • Bitter melon
  • Cassia Cinnamon
  • Magnesium
  • Prickly pear cactus
  • Stevia
  • Chia
  • Fruit
37
Q

Garlic

A

Indications:
- HTN & Hyperlipidemia

MOA:

  • Allicin is the active ingredient
  • Inhibits hepatic cholesterol synthesis
  • Activates production of endothelium-derived relaxation factor to relax smooth muscle and vasodilation

Adverse reactions:
- Halitosis, body odor, heartburn, and GI upset

DDI:

  • Anticoag
  • Antiplatelet
  • CYP3A4
  • CYP2E1

Dose:
600-1200 mg/day in TID doses for hyperlipidemia

38
Q

Clinical pearls for garlic

A
  • When using fresh product, needs to sit for 10 minutes for best results
  • GRAS
  • Discontinue 2-3 weeks prior to surgery
  • Products marketed as odorless may not contain allicin
39
Q

CoQ-10

A

Ubiquitous

Indications: CHF and statin-induced myopathy

MOA:

  • Antioxidant properties to stop damage
  • Cofactor in metabolic pathways

Efficacy:

  • No evidence when taken as monotherapy, possibly useful with tx for CHF
  • No significant benefit for myopathy or statin tolerability

Adverse rxns:
- GI and appetite loss

DDI:

  • anticoagulants
  • Increased T4/T8 ratio in normal patients
  • May lower blood pressure and cigarettes may deplete body stores

Dose:
- Do not exceed 300 mg daily because of liver issues

40
Q

Clinical pearls of CoQ-10

A
  • Some meds may lower CoQ-10 levels (statins, beta-blockers, diuretics)
  • Take it with a fatty meal

DEMS Unit IV - Endocrine (3 decks)

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