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What You Need to Know
About Dietary Supplements
Lyndsey N. Hogg, PharmD, BCACP
Clinical Pharmacy Specialist, Ambulatory Ca...
2
Introductions and Disclosures
 About the Speaker
 Clinical Pharmacist at Via Christi Clinic
 Doctor of Pharmacy (Phar...
3
Today’s Goals
1) Provide you with knowledge to safely
utilize dietary supplements
2) Guide you to reliable resources
3) ...
4
Interesting Facts
 More than 50% of Americans use dietary
supplements on a regular basis
 Regulated as foods, not drugs
5
Key Points
 Do not self-diagnose any health condition
 Check with your health care providers
before starting any suppl...
What are Dietary
Supplements?
6
Dietary Supplements
 Dietary supplements
include:
 Vitamins
 Minerals
 Herbals & botanicals
 Amino acids
 Enzymes
 ...
8
Who Regulates Supplements?
 U.S. Food & Drug Administration (FDA)
 Different set of regulations compared to
“conventio...
9
Supplements: How are they
different from drugs?
 Research studies to prove safety are
not required
 FDA cannot take ac...
10
Which Products Do I Buy?
 “Seals of Approval”
 U.S. Pharmacopeia
 NSF International
 Consumerlab.com
 Seal of appr...
Determining What’s
in a Supplement
11
12
RDA vs. DV
 RDA: Recommended Daily Allowance
 Food & Nutrition Board at the Institute of Medicine of
the National Aca...
13
Reading a Supplement Label
Serving Size
varies among
products
% DV
Not the RDA
Supplement
Components
Fillers,
binders,
...
Dietary Supplements
 Don’t replace variety of foods important to a
healthy diet
 Dietary Guidelines for Americans
 Choo...
15
Brief Overview of
Select Supplements
16
Calcium
 Use
 Osteoporosis (prevention & treatment)
 Evidence
 Well-documented: adequate intake is important for
ke...
17
How Much Calcium Should I Take?
Age RDA for Men1 RDA for Women1
19-50 1,000 1,000 mg
51-70 1,000 mg 1,200 mg
71+ 1,200 ...
18
Forms of Calcium
 Carbonate
 Most common (inexpensive & convenient)
 Take with food for best absorption
 Tends to c...
19
Tips on Taking Calcium
 Optimizing your calcium intake
 No more than 500 mg per dose (your body can’t
absorb more tha...
20
Vitamin D
 Use
 Bone health
 Helps with calcium absorption
 Daily requirements
 National Osteoporosis Foundation
•...
21
Folate (Folic Acid)
 Critical for women of child-bearing potential
 prevention of certain birth defects (spina bifida...
22
Black Cohosh
 Reported Uses:
 Menopausal symptoms
 Evidence
 Preliminary evidence encouraging but not sufficient
(u...
23
Cranberry
 Reported Uses:
 urinary track infections
 Evidence
 Prevention- preliminary evidence not definitive
 Tr...
24
Vitamin C
 Reported Uses:
 Common cold
 Evidence
 Prevention: data does not support
 Duration/severity: no effect ...
25
Fish Oil & Omega-3 Fatty Acids
 Side effects
 Bad breath, belching, heartburn, nausea, loose stools
 Who should not ...
26
Glucosamine/Chondroitin
 Reported Uses
 Osteoarthritis
 Evidence
 Does not slow joint destruction or relieve pain†
...
27
Coenzyme Q-10
 Reported Uses:
 Heart disease
 Drug-induced muscle weakness (e.g. statins)
 Reproductive disorders
...
28
Interactions
29
Interactions with
Dietary Supplements
 Warfarin (Coumadin®) +
many herbal products
 Co Q-10
 Ginkgo Biloba
 Ginseng...
30
Examples of Interactions
Rx Medications Dietary Supplement Possible Effect
Propranolol (blood pressure) Vitamin C Incre...
31
Examples of Interactions with Food
 Warfarin & vitamin K
 Calcium-rich dairy products,
antacids, & multivitamins
+ an...
32
Helpful Resources
33
Resources
 Your local pharmacist

 free mobile app “MyDS”
34
Resources
 Dietary Supplement Label Database (NIH)
 Searchable database for products, ingredients,
health-related cla...
35
Other Reliable Sources
 NIH fact sheets
 Nutrient recommendations (NIH)
 PubMed Dietary Supplement Subset
 MedlineP...
36
Tips on Searching the Web for
Information on Supplements
 Questions to think about:
 Who operates the website?
 What...
37
More Tips
 Ask yourself: Does it sound too good to be true?
 Think twice about chasing the latest headline
 Contact ...
Video Quiz
Federal Trade Commission’s
7 Point ‘Gut Check’
38
39
Questions
to Ask
40
Questions?
 Who Should I Ask?
 Your doctor or other provider
 Your pharmacist
 When should I ask?
 New medication ...
41
General Questions to Ask
 What is the name of my medicine?
 Why am I taking this medicine?
 How much do I take and h...
42
Questions About Interactions
 Is the interaction something my doctor can
monitor for or should the medication/food
be ...
A few highlights from today
43
44
Key Points
 Dietary supplements do not replace necessary
medications
 Do your research- utilize reliable resources
 ...
45
Tips from a
Pharmacist
46
Know Your
Medicines
47
Electronic Medication Record
http://www.fda.gov/downloads/AboutFDA/Rep
ortsManualsForms/Forms/UCM095018.pdf
48
Utilizing Technology
 MyMedSchedule.com
 Mobile phone
applications
 Email and text
reminders
49
Tips from a Pharmacist
 Keep a list of ALL your medications
This includes vitamins & supplements!
 Keep copies in you...
50
Tips from a Pharmacist
 Use ONE pharmacy
 Check medications before leaving the pharmacy
 All necessary refills prese...
51
Summary
Know Your
PHARMACIST
Know Your
MEDICINE
(and supplements)
Thank You!
52
What You Need to Know
About Dietary Supplements
Lyndsey N. Hogg, PharmD, BCACP
Clinical Pharmacy Specialist, Ambulatory Ca...
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What you need to know about dietary supplements

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Via Christi Women's Connection lecture on vitamins and supplements presented by Via Christi pharmacist Lyndsey Hogg, PharmD.

Publicada em: Saúde e medicina, Negócios
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What you need to know about dietary supplements

  1. 1. What You Need to Know About Dietary Supplements Lyndsey N. Hogg, PharmD, BCACP Clinical Pharmacy Specialist, Ambulatory Care Via Christi Clinic, P.A.1 July 8th, 2014
  2. 2. 2 Introductions and Disclosures  About the Speaker  Clinical Pharmacist at Via Christi Clinic  Doctor of Pharmacy (PharmD)  Board Certified Ambulatory Care Specialist (BCACP)  Disclosures  Dr. Hogg has nothing to disclose concerning possible financial or personal relationships with pharmaceutical manufacturers that may have a direct or indirect interest in the subject matter of this presentation  Via Christi Health and Dr. Hogg do not endorse any specific medications or indications which may be discussed during today’s presentation.  Always discuss with your health care provider(s) before starting, stopping, or changing any medications or dietary supplements.
  3. 3. 3 Today’s Goals 1) Provide you with knowledge to safely utilize dietary supplements 2) Guide you to reliable resources 3) Inform you on questions to ask about dietary supplements & medications
  4. 4. 4 Interesting Facts  More than 50% of Americans use dietary supplements on a regular basis  Regulated as foods, not drugs
  5. 5. 5 Key Points  Do not self-diagnose any health condition  Check with your health care providers before starting any supplements  Supplements should not replace prescribed medications or a healthy diet  Do your research- use reliable sources
  6. 6. What are Dietary Supplements? 6
  7. 7. Dietary Supplements  Dietary supplements include:  Vitamins  Minerals  Herbals & botanicals  Amino acids  Enzymes  Many other products  Variety of forms:  Tablets  Capsules  Powders  Drinks  Energy bars 7
  8. 8. 8 Who Regulates Supplements?  U.S. Food & Drug Administration (FDA)  Different set of regulations compared to “conventional” foods & drug products
  9. 9. 9 Supplements: How are they different from drugs?  Research studies to prove safety are not required  FDA cannot take action against manufacturer until after product is marketed  Proven efficacy is not required  All claims must be followed by statement: This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease
  10. 10. 10 Which Products Do I Buy?  “Seals of Approval”  U.S. Pharmacopeia  NSF International  Consumerlab.com  Seal of approval does NOT mean “safe & effective”. Rather provides assurance the product:  Was properly manufactured  Contains listed ingredients  Does not contain harmful levels of contaminants
  11. 11. Determining What’s in a Supplement 11
  12. 12. 12 RDA vs. DV  RDA: Recommended Daily Allowance  Food & Nutrition Board at the Institute of Medicine of the National Academies  Vary by age, gender and pregnancy status  Recommended intake amount of nutrient per day  DV: Daily Value  Food & Drug Administration  Do NOT vary by age or gender (one DV for anyone >4 years old)  Suggest how much nutrient per serving  Often match or exceed RDA for most people
  13. 13. 13 Reading a Supplement Label Serving Size varies among products % DV Not the RDA Supplement Components Fillers, binders, flavors, etc. Adapted from FDA’s “Dietary Supplement Labeling Guide”
  14. 14. Dietary Supplements  Don’t replace variety of foods important to a healthy diet  Dietary Guidelines for Americans  Choose MyPlate  Natural does NOT mean safe 14
  15. 15. 15 Brief Overview of Select Supplements
  16. 16. 16 Calcium  Use  Osteoporosis (prevention & treatment)  Evidence  Well-documented: adequate intake is important for keeping bones strong & reducing bone loss  Regular weight-bearing & muscle-strengthening exercises are also important
  17. 17. 17 How Much Calcium Should I Take? Age RDA for Men1 RDA for Women1 19-50 1,000 1,000 mg 51-70 1,000 mg 1,200 mg 71+ 1,200 mg 1,200 mg 1 1 300 200 750 Estimating your daily calcium intake: Table & Recommended Daily Allowances (RDA) obtained from National Osteoporosis Foundation: Clinician’s Guide to Prevention and Treatment of Osteoporosis (2014 Issue, Version 1)
  18. 18. 18 Forms of Calcium  Carbonate  Most common (inexpensive & convenient)  Take with food for best absorption  Tends to cause more side effects (bloating, constipation)  Citrate  Take with or without food  Other forms: gluconate, lactate, phosphate
  19. 19. 19 Tips on Taking Calcium  Optimizing your calcium intake  No more than 500 mg per dose (your body can’t absorb more than this at one meal)  Take at separate time from multivitamin  Calcium can decrease absorption of:  Certain antibiotics (Levaquin, tetracycline)  Bisphosphonates (Fosamax, Boniva, etc)  Levothyroxine (Synthroid)  Phenytoin (Dilantin)
  20. 20. 20 Vitamin D  Use  Bone health  Helps with calcium absorption  Daily requirements  National Osteoporosis Foundation • <50 years: 400-800 IU/day • 50 years & older: 800-1000 IU/day  Institutes of Medicine Dietary Reference Intake • <70 years: 600 IU/day • 71 & older: 800 IU/day  Most people with osteoporosis need >1000 IU/day
  21. 21. 21 Folate (Folic Acid)  Critical for women of child-bearing potential  prevention of certain birth defects (spina bifida and anecephaly)  Recommended intake  Childbearing potential: 400 mcg/day  Pregnant: 600 mcg/day  Most women will not obtain sufficient amounts through their diet alone
  22. 22. 22 Black Cohosh  Reported Uses:  Menopausal symptoms  Evidence  Preliminary evidence encouraging but not sufficient (use < 6 months)  Side Effects  Few reported (stomach upset, headaches)  Long-term safety data unavailable  Who should not take it:  Pregnant women  Breast cancer  Liver disorders
  23. 23. 23 Cranberry  Reported Uses:  urinary track infections  Evidence  Prevention- preliminary evidence not definitive  Treatment- not effective  Side effects  Stomach upset or diarrhea (when used in excess)  Who should not take it:  Those taking warfarin (Coumadin)  Possibly those on medications which affect the liver
  24. 24. 24 Vitamin C  Reported Uses:  Common cold  Evidence  Prevention: data does not support  Duration/severity: no effect to mild effect Foods Containing Vit C† Amount of Vit C† Citrus fruits Medium orange = 70 mg Red & green peppers ½ cup red pepper = 96 mg Other fruits & veggies (broccoli, strawberries, cantaloupe, tomatoes, etc) ½ cup broccoli = 39 mg ½ cup strawberries = 40mg Medium tomato = 17 mg Fortified foods & beverages Recommended Amount† Adult women 75 mg Pregnant women 85 mg Breastfeeding women 120 mg Smokers add 35 mg † National Institutes of Health Office of Dietary Supplements- “Vitamin C Quick Facts”
  25. 25. 25 Fish Oil & Omega-3 Fatty Acids  Side effects  Bad breath, belching, heartburn, nausea, loose stools  Who should not take it:  Fish or seafood allergy  Liver disease  Possibly those at high bleeding risk Reported Uses† Evidence† Heart disease Reduces all-cause mortality High cholesterol May lower triglycerides (dose-dependent) Cognitive function (memory) Inadequate evidence Asthma No conclusions possible † National Institutes of Health Office of Dietary Supplements- “Summary of AHRQ Report on Omega-3”
  26. 26. 26 Glucosamine/Chondroitin  Reported Uses  Osteoarthritis  Evidence  Does not slow joint destruction or relieve pain†  Pregnancy  Use caution  Who should not take it:  Allergy to shellfish (glucosamine) † National Institutes of Health Office of Dietary Supplements- “Summary of GAIT Study”
  27. 27. 27 Coenzyme Q-10  Reported Uses:  Heart disease  Drug-induced muscle weakness (e.g. statins)  Reproductive disorders  Cancer  Evidence varies among uses  Side effects  No serious effects reported  Insomnia, rash, nausea, dizziness, headache  Use during pregnancy or breastfeeding- NO
  28. 28. 28 Interactions
  29. 29. 29 Interactions with Dietary Supplements  Warfarin (Coumadin®) + many herbal products  Co Q-10  Ginkgo Biloba  Ginseng  Green Tea  St. John’s Wort
  30. 30. 30 Examples of Interactions Rx Medications Dietary Supplement Possible Effect Propranolol (blood pressure) Vitamin C Increased blood pressure (avoid >500mg/day vit C) Coumadin- aka warfarin (blood thinner) Cranberry Ginkgo biloba Increased risk of severe bleeding (avoid combo) Prilosec- aka omeprazole (reflux or heart burn) Ginkgo biloba Decreased ability to reduce reflux (avoid combo) Aspirin, ibuprofen (pain relievers) Ginkgo biloba Increased risk of bleeding (avoid combo) Levaquin- aka levofloxacin (antibiotic) Calcium-containing products Decreased antibiotic effect (avoid calcium during antibiotic course) Coumadin, Prograf. Simvastatin, Zoloft, Paxil, Allegra, Digoxin, oral contraceptives & many others St. John’s Wort Various effects
  31. 31. 31 Examples of Interactions with Food  Warfarin & vitamin K  Calcium-rich dairy products, antacids, & multivitamins + antibiotics  Grapefruit  Cholesterol medicines  Some heart medicines
  32. 32. 32 Helpful Resources
  33. 33. 33 Resources  Your local pharmacist   free mobile app “MyDS”
  34. 34. 34 Resources  Dietary Supplement Label Database (NIH)  Searchable database for products, ingredients, health-related claims, label statements
  35. 35. 35 Other Reliable Sources  NIH fact sheets  Nutrient recommendations (NIH)  PubMed Dietary Supplement Subset  MedlinePlus (National Library of Medicine)  Food & Drug Administration  Federal Trade Commission
  36. 36. 36 Tips on Searching the Web for Information on Supplements  Questions to think about:  Who operates the website?  What is the purpose of the website? • Educate the public vs sell a product  What is the source of the information & is it referenced? • Reputable peer-reviewed journals  Is the information current?  How reliable is the internet or e-mail solicitations? • UPPERCASE LETTERS & LOTS OF !!!!!!!!!!!! Questions adapted from FDA.gov
  37. 37. 37 More Tips  Ask yourself: Does it sound too good to be true?  Think twice about chasing the latest headline  Contact manufacturer for more information  Check your assumptions:  “Even if a product may not help me, it at least won’t hurt me.”  “When I see the term ‘natural’, it means that a product is healthful and safe.”  “A product is safe when there is no cautionary information on the product label.” Questions adapted from FDA.gov
  38. 38. Video Quiz Federal Trade Commission’s 7 Point ‘Gut Check’ 38
  39. 39. 39 Questions to Ask
  40. 40. 40 Questions?  Who Should I Ask?  Your doctor or other provider  Your pharmacist  When should I ask?  New medication started  Medication stopped  Medication dose change  Significant change in diet
  41. 41. 41 General Questions to Ask  What is the name of my medicine?  Why am I taking this medicine?  How much do I take and how often?  What side effects are possible? What should I do if they occur?  What should I do if I miss a dose or double the dose?  Is there anything I should avoid while taking this medicine?
  42. 42. 42 Questions About Interactions  Is the interaction something my doctor can monitor for or should the medication/food be stopped?  If I take them at different times, will this prevent the interaction?  What side effects should I watch for? What should I do if they occur?
  43. 43. A few highlights from today 43
  44. 44. 44 Key Points  Dietary supplements do not replace necessary medications  Do your research- utilize reliable resources  Natural ≠ safe  Some dietary supplements can interact with prescription medications  Notify all providers of your current medications  ALWAYS ask your pharmacist or provider before starting (or stopping) dietary supplements
  45. 45. 45 Tips from a Pharmacist
  46. 46. 46 Know Your Medicines
  47. 47. 47 Electronic Medication Record http://www.fda.gov/downloads/AboutFDA/Rep ortsManualsForms/Forms/UCM095018.pdf
  48. 48. 48 Utilizing Technology  MyMedSchedule.com  Mobile phone applications  Email and text reminders
  49. 49. 49 Tips from a Pharmacist  Keep a list of ALL your medications This includes vitamins & supplements!  Keep copies in your wallet & at your house  Take to all provider appointments  Track any changes  Update after each provider appointment  Take medications exactly as prescribed
  50. 50. 50 Tips from a Pharmacist  Use ONE pharmacy  Check medications before leaving the pharmacy  All necessary refills present?  Any medications that were stopped?  When a medication is stopped:  Cancel automatic refills  Update medication list
  51. 51. 51 Summary Know Your PHARMACIST Know Your MEDICINE (and supplements)
  52. 52. Thank You! 52
  53. 53. What You Need to Know About Dietary Supplements Lyndsey N. Hogg, PharmD, BCACP Clinical Pharmacy Specialist, Ambulatory Care Via Christi Clinic, P.A.53 July 8th, 2014

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