❗ Supplements in Metabolic Disease

Question 1

What percent of people didn’t report supplement use to providers?

Answer 1

72%

Question 2

What age group has the highest rate of supplement use?

Answer 2

45 - 64 years

Question 3

What are the most commonly used integrative medicines?

Answer 3

Diet and herbals

Question 4

What drug is made (originally) from the Pacific yew tree?

Answer 4

Tamoxifen

Question 5

Adverse reactions to dietary supplements can be reported to _____________.

Answer 5

the FDA

Question 6

What must be on the label of supplements?

Answer 6

“This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”

Question 7

What are the three most commonly used supplements?

Answer 7

• Fish oil/omega-3
• Glucosamine/chondroitan
• Probiotics/prebiotics

Question 8

What physiologic effect does fish oil have?

Answer 8

It decreases VLDL secretion and increases VLDL absorption by the liver.

Question 9

People should only be taking omega ______.

Answer 9

3

Question 10

Triglycerides can decrease as much as _________ with use of fish oil.

Answer 10

20% - 50%

Question 11

Fish oil can increase risk of bleeding if taken with ________________.

Answer 11

garlic, gingko, ginseng, or ginger

Question 12

How can you decrease the fishy taste of taking fish oil?

Answer 12

Freeze it.

Question 13

Fish oil is a good alternative for those who can’t take ____________.

Answer 13

niacin due to flushing or gout

Question 14

In terms of regulation, how is fiber unique?

Answer 14

The FDA permits health claims.

Question 15

Inositol nicotinate is also called ___________.

Answer 15

“no-flush niacin”

Question 16

What supplement was famously banned for MI and arrhythmogenic effects?

Answer 16

Metabolife 356 (a formula containing ephedra)

Question 17

_____________ is chemcially related to ephedra.

Answer 17

Bitter orange

Question 18

______________ is like the antabuse for dieters.

Answer 18

Orlistat (because if they eat fat they get steatorrhea, flatulence, and GI upset)

Question 19

What is the mechanism of orlistat?

Answer 19

It inhibits pancreatic lipase. (“It ORders a stop to LIpase, STAT!”)

Question 20

Many people think coenzyme Q10 prevents ____________.

Answer 20

statin-induced myopathy

Question 21

What are two aspects of integrative medicine that Dr. Nuffer wants you to know for the exam?

Answer 21

• It “emphasizes the evidence.”

- It incorporates “the whole person (mind, body, spirit).”

Question 22

In what ways does the FDA regulate supplements?

Answer 22

It (1) enforces that they cannot make specific health claims without evidence and (2) can remove products if deemed to be unsafe once on the market

Question 23

___________ may cause liver injury.

Answer 23

Alli (orlistat)

Question 24

Which mineral supplement may increase the risk of bleeding?

Answer 24

Vanadium

Question 25

Which demographic is the highest user of IHM?

Answer 25

Older, educated women with higher income

Question 26

What was the goal of WHCCAMP?

Answer 26

To give the President info on how to maximize the benefits of CAM to all

Question 27

_______________ compete with arachidonic acid at COX1/2.

Answer 27

Omega-3 fatty acids

Question 28

Some people think it’s good to get up to ______ grams of fish oil per day.

Answer 28

16

Question 29

Consider monitoring LFTs in those taking ________.

Answer 29

niacin

Question 30

What is the mechanistic difference between sterols and stanols?

Answer 30

Stanols inhibit the absorption of both biliary and dietary cholesterol, while sterols only inhibit the absorption of dietary cholesterol.