Supplements in Metabolic Disease

Question 1

Define Integrative Health

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

What population uses CAM the most and what percentage report CAM use to their physician?

Answer 2

Most often used by Elderly Women American population with higher education and income.
72 % patient didn’t report CAM use to health care provider!

Question 3

Why do people use CAM?

Answer 3

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

Question 4

What do patients believe about CAM therapy?

Answer 4

Natural is better than synthetic
Patients don’t consider herbs as “drugs”
Herbs don’t have side effects 
Herbs are regulated, standardized, and safe
Used for thousands of years

Question 5

What are the Dietary Supplement and Health Education Act regulations?

Answer 5

Evaluates 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 6

Who are the two key players in the DSHEA act and what are their roles?

Answer 6

1. 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
2. US Food and Drug Administration (FDA)
   • Takes action if product is unsafe once on the market
   • Monitors safety (ADR MedWatch reporting) www.fda.gov/medwatch/report/hcp.htm
   • Monitors product information - Labeling , Claims, Package inserts & Accompanying literature

Question 7

What are the four requirements for labeling and manufacturing supplements?

Answer 7

• Label contains the required disclaimer – “This statement has not been evaluated by the FDA. This products is not intended to diagnosed, treat, cure, or prevent disease”
• Label may include a structure-function claim (claim for its use) this statement is not required
• Manufacture follows Good Manufacture Practices
• Label contains a Supplement Seal of Approval (GMP’s, CL, USP, NSF) if applicable

Question 8

What are two CAM treatment options for dyslipidemia?

Answer 8

Fish oil/Omega 3 Fatty acid

Plant Sterols and Stanols

Question 9

What are guidelines and suggestions for using fish oil/Omega 3 fatty acid supplements?

Answer 9

• 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
• 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 TC or LDL-c
• Omega Quant HS–Omeg-3 Index test
• Krill Oil – Dr. Oz
• 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 10

What are the guidelines and suggestions for using plant sterols and stanols?

Answer 10

• 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 11

What are three CAM treatment options for weight loss?

Answer 11

Ephedra (illegal but still common)
Bitter Orange (replacement for ephedra in many supplements)
Alli (OTC Orlistat)

Question 12

What are the guidelines and suggestions for using Ephedra?

Answer 12

• Moderate weight loss benefits
• FDA has received many serious or fatal case reports
• Product has been band from market
• Potential risk outweighs the benefit

Question 13

What are the guidelines and suggestions for using Bitter Orange?

Answer 13

• 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 14

What are the guidelines and suggestions for using Alli?

Answer 14

• 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 15

What are two CAM treatment options for diabetes?

Answer 15

Chromium

Vanadium

Question 16

What are the guidelines and suggestions for using Chromium?

Answer 16

• 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 17

What are the guidelines and suggestions for using Vanadium?

Answer 17

• Average diet contains 6-18 mcq qd
• Only 5% is absorbed
• Kidney toxicity
• Effective in Type 2 DM
• Increase risk of bleeding when used in combination with RX, OTC or Supplements

Question 18

What are two CAM treatment options for hypertension?

Answer 18

Garlic

Coenzyme-Q

Question 19

What are the guidelines and suggestions for using Garlic?

Answer 19

• 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)
Allicin is the active ingredient

Question 20

What are the guidelines and suggestions for using Coenzyme-Q?

Answer 20

• 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