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Dietary Supplements

 herbals.  minerals.  amino  acids.Dietar y Supplements •  Majority  of  adults  in  US  take  1+  dietary   supplement  either  every  day  or  occasionally   •  May  include  vitamins.  powder.  capsule.   botanicals.  drink.  others   •  Can  be  in  tablet.  enzymes.  Office  of  Dietary  Supplements.   energy  bar  forms   Na#onal  Ins#tutes  of  Health.  2011   .  Dietary  Supplements:  What  You  Need  to  Know.

 2009.   Image:  Jose  Paolo  S.Supplement Sales  Dietary  supplement   sales  in  the  US  are   $22.  Borromeo   .5  billion  per   year  (2006)     Source:  Natural  Products  Founda#on’s  Dietary  Supplement  Informa#on  Bureau.

European Union •  •  •  •  EU  Food  Supplement’s  DirecMve  of  2002   Establishes  purity  criteria   Must  be  proven  safe  before  sale   Must  be  labeled  “this  is  not  a  medicinal   product”  if  similar  to  medicinal  product   .

 amino  acid  or  combinaMon  of  any  of  these   used  to  supplement  the  diet   Regulated  as  a  category  of  foods.  industry  largely  unregulated   .  botanicals  (except   tobacco).  minerals.  herbs.  not  drugs   Don’t  have  to  prove  efficacy  or  safety  before  sale  –   FDA  regulates  aYerwards  if  safety  issues  arise   Enforcement  is  spoZy.United States •  •  •  •  •  Dietary  Supplement  Health  and  EducaMon  Act  of  1994   (DSHEA)   Includes  vitamins.

Dietar y Supplement Facts Panel .

Quality •  Quality  standards  exist  –  although  may  be   quesMonably  reinforced   •  IdenMty.  composiMon   •  Independent.  purity.S.  strength.  extra-­‐governmental   organizaMons  may  add  addiMonal  quality   tesMng:  U.  ConsumerLab.  Pharmacopeia.   NSF  InternaMonal   .

Concer ns •  May  contain  trace  amounts  of  lead  and  other   contaminants   •  May  displace  income  that  could  otherwise  be   used  for  Rx  drugs  and  healthy  foods   •  Users  do  not  always  disclose  to  pracMMoners.   pracMMoners  do  not  always  ask  about  supps   •  Herbals  can  contain  dozens  of  compounds  and   acMve  ingredients  may  not  be  known   .

  “prescripMon-­‐strength”   •  Self-­‐diagnosing  is  harmful   •  More  expensive  supplements  ≠  beZer  quality   •  Some  may  interact  with  prescripMon  and   over-­‐the-­‐counter  medicaMons   .  “pharmacy-­‐grade”.Supplement Savvy •  “Natural”  means  nothing   •  “High-­‐potency”.

 Office  of  Dietary  Supplements.  Dietary  Supplements:  What  You  Need  to  Know.Contraindications •  Vitamin  K  can  reduce  ability  of  blood  thinner   Coumadin  to  prevent  blood  from  clofng   •  St.  2011   .  John’s  wort  can  expedite  breakdown  of  many   drugs  –  including  oral  contracepMves  and   anMdepressants  –  and  reduce  effecMveness   •  AnMoxidants  such  as  vitamins  C  and  E  may   reduce  effecMveness  of  certain  chemo  therapies   Na#onal  Ins#tutes  of  Health.

000 mg 100 mcg 100 mg 1. vitamin K. vitamin B12.IOM Tolerable Upper Intake Levels Nutrient Vitamin A Vitamin C Vitamin D Vitamin B6 Vitamin E Calcium Choline Copper Folate (Vitamin B9) UL 3. riboflavin.000 mg 3.000 mcg Nutrient Iron Magnesium Manganese Molybdenum Niacin (Vitamin B3) Phosphorus Selenium Zinc UL 45 mg 350 mg 11 mg 2. pantothenic acid. biotin.000 mg 400 mg 40 mg No UL for: thiamin. chromium or carotenoids .000 mcg 2.000 mg 2.500 mg 10.000 mcg 1.000 mcg 35 mg 4.

 JAMA  2010  Jul  7.  no  significant   difference  between  glucosamine  &  placebo   NEJM  2006  Feb  23.  Norwegian  researchers  tested  glucosamine  for   chronic  LBP  &  degeneraMve  lumbar  OA.  RTC  found  glucosamine  +  chondroiMn  no  more   effecMve  than  placebo  to  slow  carMlage  damage  from  OA   2010.Claim: “Promotes joint health” •  •  •  •  •  “Joint  health”  =  $800  mil/annual  sales   Glucosamine  &  chondroiton  –  mostly  negaMve  results   2006.  Glucosamine/ChondroiMn  ArthriMs  IntervenMon  Trial   (GAIT)  found  no  clear  benefit  for  most  paMents   2009.304(1):45-­‐52   .354(8):795-­‐808.

 JAMA  2008  Nov  19. focus” Ginkgo  EvaluaMon  of  Memory  (GEM)     •  Randomized.302(24):2663-­‐70.Claim: “Improves memor y.300(19)2253-­‐62.  placebo-­‐controlled  trial  of   3.069  people  age  72-­‐96  at  6  academic  medical  centers   •  Twice-­‐daily  doses  of  120  mg  ginkgo  extract  did  no  beZer   than  placebo  to  slow  cogniMve  decline  over  6  years   •  Earlier  GEM  findings:  debunked  benefit  against   Alzheimer’s  &  demenMa   •  DeKosky.  double-­‐blind.  “I’ve  got  no  good  reason  to  suggest   you  conMnue  to  take  it  beyond  your  own  blind  faith”   JAMA  2009  Dec  23.  UVA  author.   .

8(2):157-­‐68.     .  Improves  health  &  longevity  of  overweight.  aged  mice     2008.Claim: “Prevents aging” •  •  •  •  •  •  •  Resveratrol:  anMoxidant  found  in  red  wine   Appears  to  inhibit  enzymes  that  regulate  cell  energy   2006.  May  slow  age-­‐related  deterioraMon  and  funcMonal  decline  of   mice  on  a  standard  diet  –  doesn’t  increase  longevity  when  started   at  middle  age   Clinical  studies  of  resveratrol  in  humans  use  1  g/day  =  667  boZles   of  red  wine   Long-­‐term  effects  &  safety  are  unknown   Great  example  of  exploiMng  preliminary  animal  study  data  for   profit  before  science  unquesMonably  can  prove  benefits   Cell  Metab  2008  Aug.

 children   Why?   <1600  kcal  per  day  may  benefit  from  vitamin/mineral  supplement   Vitamin  B12.  vitamin  D.  decreased  IF  producMon).  iron   Pregnant  women   400  mcg  folic  acid  from  forMfied  foods  or  supplements.  prenatal  vitamins   Older  adults   Darker  skin   CigareZe   smokers   Alcohol  abusers   MedicaMon   Vitamin  B12  (gastriMs.  calcium  and  vitamin  D   Fluoride.  calcium  and  vitamin  D   Vitamin  D   Vitamin  C  –  helps  prevent  cigareZe  smoke-­‐induced  oxidaMve  damage   B  vitamins  –  alcohol  inhibits  B  vitamin  absorpMon  and  metabolism   Many  medicaMons  may  interfere  with  normal  vitamin/mineral  metabolism   .Who May Need a Supplement? Group   Dieters   Vegans.  no  dairy   Infants.

In Summar y •  •  •  •  •  Just  because  you  don’t  need  a  prescripMon  doesn’t  mean  a   supplement  is  harmless   Don’t  waste  Mme  and  money  on  supplements  if  you  don’t   need  to   Changing  diet  and  exercise  paZerns  IS  harder  than   popping  a  supplement  pill   Most  individuals  can  obtain  all  nutrients  from  foods  alone   When  supplements  are  indicated.  they  should  be  taken   with  cauMon  and  under  the  supervision  of  a  qualified   medical  professional     .

For More Infor mation •  •  Office  of  Dietary  Supplements.nih.wellnessleZer.  Dietary  Supplement  Fact  Sheets:   hZp://ods.html  Berkeley  Wellness  LeZer  Dietary  Supplements   Guide:   hZp://­‐all/     UC  Berkeley.nlm.  Herbal  Medicine:   hZp://www.od.  Using  Dietary  Supplements  Wisely:   hZp://­‐of-­‐wellness/ dietary-­‐supplements-­‐guide/     MedlinePlus.htm     •  •  .nccam.