dr. stephen holt-dietary supplement dispensation
TRANSCRIPT
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DIETARY SUPPLEMENT DISPENSATIONIN CLINICAL PRACTICE
PRODUCT SELECTION, PROFITS, PITFALLS AND
LEGALITIES
Stephen Holt MD, LLD (Hon.) ChB., PhD, DNM,
FRCP (C) , MRCP (UK), FACP, FACG, FACN,FACAM, OSJ
Distinguished Professor of Medicine, NYCPM,Scientific Advisor, Natural Clinician LLC
NATURAL CLINICIAN LLC.
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DIETARY SUPPLEMENTS AS A
PROFIT CENTER
Declining revenue for cognitive activity inclinical practice
Dietary supplement dispensaries are a
major profit center Supplement sales promote return visits
and precipitate spontaneous demandsfrom patients for disease prevention
Margins on sales are high Supporting literature saves consultation
time
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ETHICS
Physicians must not engage in selfreferral
Private labels with physician identity
are problematic
State licensing authorities have mixed
beliefs about supplement sales
At law, dietary supplements are not to
be used to prevent or treat any disease Medical practice should not be
legislated
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HISTORIC PERSPECTIVES
Pharmacognosy: the study of
natural products used in medicine
Ancient discipline of medicalscience
Pharmakon = drug, Gnosis =
knowledge
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CONCEPTS
Natural medicine cannot integrate intogeneral medical practice without ascientific base.
Botanicals or herbs are drugs and
many drugs are botanicals or herbs, orsynthetic copies.
Dietary supplement manufacturersexhibit widespread ignorance about
pharmaceutical science. Hiding behind mythical and magical
thinking is no longer acceptable inintegrative medicine.
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CONCEPTS
Some natural clinicians baulk at attemptsto explain the bioactivity of naturaltherapies within the framework of currentscientific knowledge.
While sympathy exists for this position,our understanding of pharmacodynamiceffects of herbs, botanicals or nutrientsmust be based on scientific principle.
Conversations about clinicalpharmacology among dietary supplementmanufacturers are rare and practicallynon-existent with their customer base.
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DRUG OR NUTRACEUTICAL
DISPOSITION If dietary supplements are to be used astherapeutic agents, there must be somerespect for basic pharmacologic concepts.
The concepts are A, D, M and E. One may look critically at some dietary
supplements by simply consideringfactors that influence absorption,
distribution, metabolism and excretion ofchemical compounds [drugs ornutraceuticals].
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ABSORPTION
Absorption is a complex function of routeof delivery, chemical characteristics,processes of movement across
absorption barriers and physiologicalevents such as gastric emptying, ormodified by presence of disease, age etc.
Some nutraceuticals claim that they haveabsorption and bioavailability that cannotbe present, based on simple scientificprinciples.
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ABSORPTION [examples]
FISH OIL: Unstable in regularformulations, denatured by gastric acid,power is with EPA. Dosage requirements
high, compliance issues, triplebioavailability with enteric coat.Standard fish oil products passe.
SHARK CARTILAGE: solid or extract,enzymatic degradation of antiangiogenicproteins, buccal absorption a fairy tale,interesting facilitated absorption by aleaky gut.
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DISTRIBUTION
Drug distribution is often uneven:different tissue binding, different PH orpermeability of tissues.
Example: Antioxidant Therapy: Idealantioxidant has lipophilic and hydrophilicprofiles and acts in a wide REDOX range.
Single high dosage antioxidants have
dangerous pro-oxidant effects. Most antioxidant supplements do not use
the correct principles of formulation.
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METABOLISM
The process of chemical alteration ofdrugs in the body.
A primary but not exclusive function of
the liver. Inactive and active metabolites are
produced, by synthetic or non-syntheticreactions.
Example: Isoflavones: genistein/genistin,conjugation eg daidzein sulfate. Acomplicated story.
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EXCRETION
Elimination from the body, primarily bythe kidneys.
A real concern exists with age related
reduction in renal function andnutraceutical dosage adjustment.
Some complex mechanisms exist egreabsorption transport mechanisms,
tubular secretion and biliary excretionwith enterohepatic cycling.
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DSHEA 1994
Grassroots consumer lobby
Defining a dietary supplement
Section 3 : vitamins, minerals, herbs etc
Safety : risk of illness or injury
Section 5 : publications, balanced, not
labels
Labeling protocols : honest label ( section3)
The enigma: not to be used
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DSHEA- BASED MODEL
WEAK SUPPORTINGDATA
DIETARY SUPPLEMENT
?
CREATE PLATFORM
SELL WITH CLAIM
PEER ACCEPTANCE
SUCCESS FAILURE
STRONG R & D
PRODUCT AS A DIETARYSUPPLEMENT
BODY STRUCTURE FUNCTIONCLAIM
PEER ACCEPTANCE
SELL (PHASE IV AND V)
SUSTAINED
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A PEEK INTO THE INDUSTRY
The product of the month
The evidence based formula
Condition specific formulations CEO survey reveals scientific-
based, new formulations are of
major importance Who formulated the supplements
you use in your practice?
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KEY PUBLIC HEALTH
INITIATIVES
Lifestyle medicine combined with
nutritional interventions have
overshadowed allopathic approaches
for many public health problems
First line options for disease
prevention are not rooted generally in
drugs or surgery. Many factors have moved consumers
of health care to the new paradigm of
simple, gentle and more natural
interventions
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KEY PUBLIC HEALTH
INITIATIVES
Adult obesity
Childhood obesity (A Dead-Loss
Disorder) Cardiovascular health
Cancer
Arthritis Osteoporosis
Etc
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THE KEY PUBLIC HEALTH
INITIATIVE
The metabolic syndrome(SYNDROME X)
A complex disorder rooted ingenetics, adverse lifestyle withprimary nutritional precipitation
Defining Syndrome X
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THE UNKNOWN EPIDEMIC
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REDEFINING SYNDROME X
Classic Definition: Obesity,Hypercholesterolemia, High Bloo
Pressure, Linked by Insulin
Resistance.
Syndrome X, Y and Z.., an
expanded definition incorporatinga novel unifying concept of
common diseases
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SUPER-SIZING AMERICA
Americans exude
complacency about
their overweight
status
Obesity is part of a
metabolic syndrome
Syndrome X is
under diagnosedand often mistreated
by conventional
medicine
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UnrealisticUnrealistic
weight lossweight lossexpectationexpectation
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THE SAN BUSHMENTHE SAN BUSHMEN
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Folklore useFolklore use Ethnobotanical factsEthnobotanical facts
Whole plant/ plantWhole plant/ plantextractsextracts
Steroidal glycosidesSteroidal glycosides
Animal studiesAnimal studies
Human studiesHuman studies
PROPERTIES OFHOODIAPROPERTIES OFHOODIA
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