Treating Metabolic D Flashcards
Who uses integrated health more?
Gender
Age
Income + education
Females
45-65
Pts with Higher education and income
Highest utilized Integrative health domains
(Biologically based systems)
Herbals + diet
Made from nature: Morphine Digoxin Aspirin Tamoxifen
Morphine: poppies
Digoxin: foxglove
Aspirin: willow bark
Tamoxifen: pacific yew tree
Dietary supplement and health education act DSHEA
- Regulate the evaluation of vitamins, herbals, aa and other botanicals
- Regulates herbal supplements more like food rather than medication
- Products cannot be put on same shelf as OTC or meds
- Prior to 1994 - all products were GRANDFATHERed
Manufacturers
- Do not need to register or get FDA approval
- Responsible to ensure product is safe
- Ensure product label info is truthful and not misleading
Most commonly used natural product by US adults
Fish oil/omega 3/DHA, EPA FA
- safe
- likely effective
- consider recommending
*TG > 500 then you can get Pancreatitis
INcidations for Fish oil/Omega 3
- MOA
Hypertriglyceridemia
MOA:
- Decrease in hepatic secretion of VLDL-C,
- Increase in VLDL-D clearance,
- Reduces TG transport
- Omega 3 FA compete with arachidonic acid in the COX + lipoxygenase pathways
Effects of Fish oil/Omega 3
TG ↓ 20-50%
If TG > 500 = ↓ 45%
Combo with statin in TG lvl 200-499 = ↓ 30%
LDL neutral effects
Recommended tx with fish oil/omega 3
primary prevention: 500 mg qd or 2 fishy meals/week
Secondary prevention (CHD): 1000 mg qd - had an event already, now its to prev another (larger dose)
tx option for pts who cannot take niacin due to gout and flushing rxn (good antiinflammatory)
Fish oil/Omega 3
- adverse rxn
- DDI
- Herb intxn
- adverse rxn:
fishy taste, GI upset, heartburn, belching - DDI
antihypertensive, contraceptives, and orlistat - Herb intxn (G’s)
Garlic, Ginger, Ginkgo, and Ginseng
Effects of Fiber on heart disease
51% of whole grain or more, manufacturers can say that it reduces risk of heart disease
Niacin
Effects
Efficacy
↓ LDL-c 5-25%
↓ TG 20-50%
↑ HDL-c 15-35%
Might have ↓ risk of secondary MI but no sig ↓ in all cause mortality
Niacin side effects
Heart attack
GI
Flushing
Increase blood glucose and uric acid
Monitor: LFT due to HEPATOTOXICITY risk
Plant stERols
MOA
Effects
Adverse rxns
Inhibits ~50% of intestinal absorption of cholesterol
↓ Total cholesterol
↓ LDL-c
NO EFFECT ON HDL
Adverse:
Nausea, indigestion, diarrhea, constipation and gas
Plant stANols
MOA
Effects
Adverse rxns
Inhibits dietary and biliary cholesterol
↓ LDL-c 10-15%
With statin therapy:
↓ Total cholesterol 3-11%
Adverse:
Diarrhea + STEATORRHEA
Plant sterols and stanols Intxns? Time till effectiveness? Discontinue effects? Which is more effective?
Herbs:
- beta carotene and Vit E
Drugs:
- Zetia
Takes 2-3 weeks to be effective
Cholesterol levels will rise back to baseline if discontinued
Both are equally effective
Which drugs/natural products help increase HDL?
Fibrates (↑ 5-15%)
Niacin (↑ 35%)
Statins (↑ 6-14%)
Atkins diet
High fat, Low carb
Max of 40 g/day
First 10 days ketosis = Rapid weight loss
Macrobiotic
Low fat
Emphasizes whole grains, vegies
Restrict fluid intake
Ornish
Only 10% of their calories from fat
Allows fruits and vegies
South beach
Low carb
Focus on glycemic index
“Good” carbs and fats (no saturated/trans fat)
Zone
40% carbs
30% protein
30% fat
Ephedra (no longer on market)
MOA
Efficacy
adverse rxns
ephedrine and pseudoephedrine are non selective α + β receptor agonist which stimulate the nervous system
Efficacy
- Weight loss of 0.9kg/month. Up to 6 mo. With
Bitter orange
MOA
Adverse effects
Caution in
contains 1-6% of synephrine (related to ephedrine)
Adverse: same problems
- Dizziness, anxiety, insomnia, HA, dry mouth, n/v, heartburn, tachycardia, palpitations, ↑ BP
- SEIZURES, CARDIOMYOPATHY, MI, ARRYTHMIAS, SUDDEN DEATH
Caution in HTN, and CV pts
generally recognized as safe
Calcium
- efficacy
- adverse rxn
- clinical pearl
Pts with low Ca intake will often gain more weight and have higher BMI
Efficacy
- 800-1200 mg/qd shows ↑ weight reduction and body fat loss
Adverse:
- belching, flatulence
Pearl:
Supplement calcium alone ≠ low fat dietary intake
Orlistat (OTC weight loss agent)
- MOA
- Efficacy
- Adverse RXN
(Safest - OTC weight loss agent)
Reversible inhibitor of pancreatic and gastric lipase
Efficacy:
- pts with BMI > 27 saw weight loss ~ 3%
- FDA approved for long term use
Adverse:
Headache, oily spotting, abdominal discomfort, gas, fecal urgency, steatorrhea, LIVER RELATED EVENTS
- adverse with psyllium!
orlistat
- DDI
Anticoagulant, amiodarone, levothryoxine & vitamins
Take a MVI 2 hours before or after dose
Due to risk of liver injury, inform pts sx - monitor LFTs
Chromium III (food)
Use + effects
MOA
Adverse effects
Commonly taken to supplement diabetes tx
- ↓ FBG from 190 to 150
- ↓ HBa1c 8.2% to 7.6%
- ↓ Tc 235 to 213
might reduce oxidative stress
low levels are associated with impaired glucose & insulin
adverse:
HA, insomnia, irritability, mood changes & sleep disturbances
Vomiting, diarrhea, & hemorrhage
Chromium intxns
Herbs:
- bilberry, brewer yeast, iron, Vit CC, Zn
Drugs:
- Insulin, levothyroxine, NSAIDS, corticosteroids
Vanadium
MOA
Efficacy
Adverse rxn
Activates insulin rcptr proteins
Stimulates glucose oxidation & transport
Liver: stimulates glycogen synthesis
Adipose: inhibits lipolysis
Skeletal muscle: promotes glucose uptake
- overall: improve insulin sensitivity, reduce blood glucose levels
EFFECTIVE IN T2D ONLY, NOT T1D
Adverse:
- GI upset, kidney toxicity, fatigue, lethargy, tongue discoloration (green?)
Vanadium intxns
Herbs “G’s”
- garlic, ginger, ginkgo, ginseng
Drugs:
Anticoagulants and antiplateletes
Disease:
diabetes and renal dysfxn
Garlic Indications MOA Adverse rxn DDI Herb Intxn
Indications
HTN
Hyperlipidemia
MOA
Inhibits hepatic cholesterol synthesis
activates production of endothelium derived relaxation factor to relax sm and vasodilation
Adverse:
Halitosis, body odor, heartburn, GI upset
Drug intxn: Anticoagulants Antiplatelets CYP3A4 CYP2E1
Herb intxn:
Ginger, ginkgo, Vit E
Discontinue 2-3 weeks prior to surgery (bleeding)
Coenzyme Q10
Indications
MOA
Efficacy
Indications
- CHF if taken with prescription tx
- Preventing statin induced myopathy
MOA
- Has antioxidant properties to stop damage and give E to cells
- Cofactor in metabolic pathways
Coenzyme Q10
Use
Drug intxn
cigarette smoking may deplete body stores, so use supplements
Drug intxn:
anticoagulants
