supplement your dietary supplement iq

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Supplement Your Dietary Supplement IQ Chris D’Adamo, Ph.D. Assistant Professor Department of Family & Community Medicine Department of Epidemiology & Public Health Director of Research Center for Integrative Medicine

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by: Chris D’Adamo, Ph.D. - Assistant Professor and Director of Research; University of Maryland Center for Integrative Medicine Dietary supplementation is growing in popularity. While most Americans take at least one dietary supplement, many people are confused by the regulation, safety, and efficacy of the supplements that they consume. Dr. D’Adamo will clarify these issues and present the latest research on specific dietary supplements that are effective as well as those that may be best to avoid. Learn about popular dietary supplements that are being taken for a wide variety of health conditions — ranging from arthritis, to immune system enhancement, to depression — and become a more informed consumer when choosing supplements.

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Page 1: Supplement Your Dietary Supplement IQ

Supplement Your Dietary Supplement IQ

Chris D’Adamo, Ph.D.Assistant Professor

Department of Family & Community MedicineDepartment of Epidemiology & Public Health

Director of ResearchCenter for Integrative Medicine

Page 2: Supplement Your Dietary Supplement IQ

Presentation OutlineOverview of Dietary Supplements

DefinitionRegulation

Supplements to Generally ConsiderMultivitaminVitamin DOmega-3 Fatty AcidsProbiotics

Supplements to AvoidPotential for tainting with pharmaceuticals

Page 3: Supplement Your Dietary Supplement IQ

Presentation OutlineSupplement & Drug Interactions

Supplements for Special SituationsPeople taking statins, beta-blockers, acid-blocking drugsVegetariansPregnant women

Evidence-Informed Supplements for Specific ConcernsJoint HealthDigestion

Checklist: Informed Supplement Consumer

Immune SystemHeart Health

Liver HealthDepression

Sleep

Page 4: Supplement Your Dietary Supplement IQ

Dietary Supplements DefinedWhat is a dietary supplement?

1994 Dietary Supplement Health and Education Act (DSHEA)A product (other than tobacco) intended to supplement dietContains one or more dietary ingredients and taken orallyVitamins, minerals, herbs or other botanicals, amino acids

Vitamins Minerals Herbs Amino Acids

Immune System

Page 5: Supplement Your Dietary Supplement IQ

Regulation of Dietary SupplementsFederal Regulation of Dietary Supplements

Food and Drug Administration (FDA)Supplements regulated as food

Pre-DSHEA assumed safe, post-DSHEA provide safety evidenceLabeling and claims requirements

Ingredient names & amounts, directions for use, no health claims, etc.2007 Good Manufacturing Practices (GMP)

Quality standards for manufacturing, preparation, storage, facilityFederal Trade Commission (FTC)

Regulate marketing of supplements

Page 6: Supplement Your Dietary Supplement IQ

Regulation of Dietary SupplementsFederal Regulation of Dietary Supplements

No universal regulation of supplement content“Don’t know what you’re getting”… in many cases, true!

Many dietary supplement companies hire 3rd party laboratories for product purity certificationContains specified ingredientsNo contaminantsDissolves properly GMP compliantSome 3rd party labs better than others

NSF-certified gold standard

Page 7: Supplement Your Dietary Supplement IQ

Supplements to Consider

Page 8: Supplement Your Dietary Supplement IQ

Multivitamin: OverviewMost common dietary supplement

33% of Americans take multivitaminUsually contain at least 13 vitamins &

15 minerals most important to nutrition

How multivitamins are usedGenerally capsule or tablet orally once per day

Powders, liquids, multiple daily doses less commonBest taken with meal

Many of nutrients lipid-soluble, need fat for absorption

Page 9: Supplement Your Dietary Supplement IQ

Multivitamin: TypesRDI-centric

RDI of most important vitamins/mineralsReference Daily Intake – replaced RDA in 1997Prevent micronutrient deficiency in most people "% Daily Value" on food & supplement labels

Widely available

Higher potencyExceeds RDI for many vitamins/minerals

Why? RDI prevent deficiency disease… not to promote optimal health!

Higher in vitamin D, B-vitamins, vitamin C, etc.Health stores, clinical practices, Amazon, etc.

Page 10: Supplement Your Dietary Supplement IQ

Multivitamin: Favorable Research Improves nutritional status

2000 Journal of American College of Nutrition, 2009 European Journal Clinical Nutrition

Reduces risk of birth defects 2001 Epidemiology, 2002 Epidemiology, 2002 Pediatrics, 2003 Pediatrics

Associated with weight loss & decrease in body-fat % 2010 International Journal of Obesity Research

Reduced risk of macular degeneration & cataracts 2007 American Journal of Clinical Nutrition, 2008 Ophthalmology

Reduces risk of heart attack 2010 American Journal of Clinical Nutrition

Reduces risk of colon cancer 2002 Cancer Epidemiology, Biomarkers, & Prevention

Reduces risk of all-cause mortality and cancer mortality 2011 European Journal of Nutrition

Page 11: Supplement Your Dietary Supplement IQ

Multivitamin: Unfavorable ResearchNo benefit in some studies

No reduction in risk of cancer or cardiovascular disease 2009 Archives of Internal Medicine

No reduction in risk of breast cancer 2010 Public Health Nutrition, 2010 American Journal of Clinical Nutrition

Slight increase in non-cancer, non-CVD mortalityLots of media coverage… but study flawed and over-interpreted

2011 Archives of Internal Medicine Direct conflict with 2011 European Journal of Nutrition Study!

Page 12: Supplement Your Dietary Supplement IQ

Multivitamin: RecommendationsDoes brand make a difference? YES!

Cheap brands use cheap vitamin/mineral formsAffects absorption and effectiveness

Natural vitamin forms better absorbed than synthetic Natural vitamin E twice absorption of synthetic

Certain vitamin forms more effective than others Vitamin D3 superior to vitamin D2

Certain mineral binding salts better absorbed than others Magnesium citrate much better absorption than magnesium oxide

Page 13: Supplement Your Dietary Supplement IQ

Multivitamin: RecommendationsHow to choose a good brand?

www.multivitaminguide.org Ranking based on: composition, bioavailability, synergistic effect, potency 101 of most common multivitamins in United States

Comparative Guide to Nutritional Supplements Lyle MacWilliam, biochemist, commissioned by Canadian Minister of Health Scientific analysis of 510 multivitamins available in United States & Canada

Page 14: Supplement Your Dietary Supplement IQ

Multivitamin: Recommendations

Page 15: Supplement Your Dietary Supplement IQ

Multivitamin: RecommendationsQuality is key! Consult rankings

Whole-food based multivitamins also good choice Synergy between hundreds of food components!

Always consume with mealImportant fat-soluble nutrientsPoor absorption in absence of fat

Be an informed consumer! Choose/avoid the following…Vit E: d-alpha tocopherol (natural) NOT dl-alpha tocopherol (synthetic)Vit E: look for "mixed tocopherols" and/or "gamma tocopherol"Vitamin D3 NOT vitamin D2

Methylcobalamin form of B12 NOT cynacobalamin form of B12

Avoid oxide binding salts (magnesium citrate NOT magnesium oxide)Avoid iron for men and postmenopausal women

Page 16: Supplement Your Dietary Supplement IQ

Vitamin D: OverviewA uniquely important vitamin

Hormone-like activity (secosteroid)Controls expression of over 200 genes

Vitamin D active in most biological systemsMusculoskeletal system

Classically emphasized roleEndocrine systemNervous systemCardiovascular systemDigestive systemImmune system

Page 17: Supplement Your Dietary Supplement IQ

Vitamin D: SourcesSun exposure

UVB light converted to vitamin D3 in skinD3 transported to liver, metabolized to 25(OH)D

Also called calcidiol… measured most vitamin D blood tests25(OH)D converted to calcitriol in kidneys

Calcium metabolism… remaining calcitriol & calcidiol → health benefits20,000 international units (IU) from 30 minutes sun exposure

Only spring and summer if north of Atlanta

Limited amount from foodsD3 from oily fish, eggs, butter, cheese, fortified milk/cereals

Vitamin D fat-soluble… needs fat for absorption 10-100 IU: depending upon source

Supplements deliver much higher doses… up to 5,000+ IU per pill

Page 18: Supplement Your Dietary Supplement IQ

Vitamin D: Reference Daily IntakeCurrent RDI varies

Up to age 50: 200 IUAge 51-70: 400 IU70 and older: 600 IU

Amount to prevent vitamin D deficiencyRickets

Softening of bones → deformities, fractures, etc. Most common in children… rare in United States Also occurs in adults… called osteomalacia

Amount to prevent chronic disease… much higher!Call to substantially increase RDI to at least 1,000 IUExplosion in vitamin D research

Page 19: Supplement Your Dietary Supplement IQ

Vitamin D: Favorable ResearchPrevents bone disorders (osteoporosis, fractures, etc.)

2009 Cochrane Systematic Database Review

Reduced risk of cancers (breast, colon, prostate, etc.) 2004 American Journal of Clinical Nutrition, 2009 Cancer Epidemiology

Improved survival among colorectal cancer patients 2012 Cancer Epidemiology, Biomarkers and Prevention

Reduced risk and better control of diabetes 2010 Diabetes, Obesity, & Metabolism, 2010 Diabetes Care

Reduced risk of obesity 2010 Obesity, 2010 Diabetes, 2009 Journal of American Dietetic Association

Help weight loss & improve cardiovascular risk factors 2012 British Journal of Nutrition

Reduced risk of cardiovascular disease 2009 Archives of Internal Medicine, 2010 American Journal of Cardiology

Page 20: Supplement Your Dietary Supplement IQ

Vitamin D: Favorable ResearchImprove depression & Seasonal Affective Disorder

2008 Journal of Internal Medicine, 1999 Journal of Nutrition, Health, & Aging

Reduced risk of Crohn’s disease, rheumatoid arthritis, multiple sclerosis and other auto-immune disorders 2010 Journal of Rheumatology, 2007 American Journal of Clinical Nutrition

Stimulate immune system to prevent infection 2010 American Journal of Clinical Nutrition

Decreased risk of all-cause mortality 2008 Archives of Internal Medicine

Page 21: Supplement Your Dietary Supplement IQ

Vitamin D: Unfavorable ResearchVitamin D supplementation not beneficial in some trials

Breast cancer – 2009 Breast Cancer Research and TreatmentHeart attack – 2007 Circulation

Between 200 – 400 IU vitamin D used… very low dose

No risks of high serum vitamin D in observational studiesUnless extremely high concentrations over 100 ng/mL

Increased risk of atrial fibrillation “excess” 25(OH) D > 100 ng/mL Vitamin D increases calcium absorption… too much calcium in blood?

No evidence of harm from typical vitamin D supplementsFat-soluble, but safe at even at very high intake

Acute D3 toxicity intake ≈ 176,000,000 IU… 440,000 400 IU capsules Only toxic cases manufacturing mistakes (extremely rare)

Page 22: Supplement Your Dietary Supplement IQ

Vitamin D: RecommendationsConvincing evidence: recommend 25(OH)D test to everyone!

Vitamin D inadequacy extremely common Between 36-100% depending on group, 2006 Mayo Clinic Proceedings

Supplementation most important for people who…Live north of Atlanta (in fall & winter)

Cannot synthesize from sunHave darker skin tone

Less efficient synthesis in skinOlder adults

Greater risk of osteoporosis & other chronic diseasesAvoid sun or wear sunscreen

Most vitamin D from sun exposureHave low serum 25(OH)D

Everyone should have vitamin D tested… inexpensive and major risk-factor!

Page 23: Supplement Your Dietary Supplement IQ

Vitamin D: RecommendationsNot much difference by price or brand

Gel capsule preferable to tabletVitamin D fat-soluble… better absorption

Take with foodVitamin D fat-soluble

Vitamin D3 preferable to D2

D3 (cholecalciferol) more effective than D2 (ergocalficerol) 2004 Clinical Endocrinology & Metabolism

Serum 25(OH)D target range ≈ 40 ng/mL (100 nmol/L)More research needed for optimal threshold… most people low!

Page 24: Supplement Your Dietary Supplement IQ

Omega-3 Fats: OverviewClass of polyunsaturated fatty acids (PUFA)

Common structure (C=C in n-3 position)

Three nutritionally important omega-3 fatsAlpha-linolenic acid (ALA)

One of two essential fatty acids “Short-chain”… converts to “long-chain”

Eicosapentaenoic acid (EPA) Long-chain omega-3

Docosahexaenoic acid (DHA) Long-chain omega-3

Health benefits of EPA and DHA most studiedPrecursor to eicosanoids… anti-inflammatory effects

Page 25: Supplement Your Dietary Supplement IQ

Omega-3 Fats: SourcesVary by type of omega-3

ALA Nuts, seeds, vegetables

Flax seed, chia seed, walnuts, leafy greens

EPA/DHAOily fish

Salmon, sardines, mackerel, tuna, etc.Other animal products

Depends on animal's diet… grass-fed beef and pastured eggsSeaweed

Generally DHA onlyFortified foods

Milk, yogurt, cereals, etc.

Page 26: Supplement Your Dietary Supplement IQ

Omega-3 Fats: RationaleStandard American Diet ("SAD") low in Omega-3

Evolved on diet with ≈ even omega-6:omega-3 (1:1)"Paleo-style diet" - Fish, grass-fed meat, vegetables, fruits, etc.Both omega-6 & omega-3 necessary

Linoleic acid (omega-6) an EFA Imbalance affects inflammatory cascade… especially if too much omega-6

Standard American Diet…20:1 omega-6:omega-3!

MUCH higher in many cases Recent changes… industrialization of food supply

Grain-fed beef, soybean oil, corn oil, etc.Thought to play role in auto-immune & inflammatory conditions

Page 27: Supplement Your Dietary Supplement IQ

Omega-3 Fats: Favorable ResearchMore clinical research than any vitamins

All studies below RCT’s or reviews of RCT’s

Improved many auto-immune conditionsRheumatoid arthritis, Irritable Bowel Syndrome, asthma, etc.

2009 Cochrane Systematic Review, 2005 Nutrition, 2000 American Journal of Clinical Nutrition, 2000 European Respiratory Journal

Reduced blood pressure 2002 Journal of Hypertension

Lowers triglycerides 2009 Nutrition and Health

Decreased cardiovascular disease events and mortality 2006 American Journal of Clinical Nutrition, 2008 British Medical Journal,

2009 Clinical Cardiology, 2009 Annals of Internal Medicine

Page 28: Supplement Your Dietary Supplement IQ

Omega-3 Fats: Favorable ResearchHelps treat depression

2009 & 2010 Journal of American College of Nutrition

Helps manage bipolar disorder 2009 European Journal of Clinical Nutrition

Prevention of psychotic disorder among high-risk 2010 Archives of General Psychiatry

Reduction in ADHD symptoms 2009 Journal of Attention Disorders

Decreased cognitive decline in older adults 2011 Journal of Nutrition, Aging, and Health

Page 29: Supplement Your Dietary Supplement IQ

Omega-3 Fats: Unfavorable ResearchSome clinical trials found no benefit

ADHD 2001 Journal of Pediatrics

Cognitive performance2008 Neurology

Schizophrenia 2001 American Journal of Psychiatry

No clinical studies showing harmBut be aware of potential interaction with anticoagulants

Page 30: Supplement Your Dietary Supplement IQ

Omega-3 Fats: RecommendationsConvincing evidence: recommend to most people

Not recommended for people on anticoagulant drugs Coumadin, etc. Omega-3 supplements can thin blood

Most important for people who…Don’t eat fatty, cold-water fish

Vegetarians/vegans… ALA poorly converted to EPA/DHA Flounder, catfish, etc. no omega-3

Have autoimmune or chronic inflammatory conditions Have high triglycerides or are at high risk for heart diseaseEat Standard American Diet

Page 31: Supplement Your Dietary Supplement IQ

Omega-3 Fats: RecommendationsSupplement with ALA or DHA/EPA?

Flaxseed oil (ALA) vs. fish oil (EPA/DHA)

Fish oil superior to flaxseed oilALA conversion to EPA/DHA very poor!

Only 8 to 20% ALA converted to EPA/DHA 2008 Nutrition Reviews

Most omega-3 benefits from EPA/DHAKrill oil another good source of EPA/DHAIf vegetarian/vegan

Consider algae-based omega-3 supplement

Page 32: Supplement Your Dietary Supplement IQ

Probiotics: OverviewProbiotics defined: World Health Organization

“Live micro-organisms… administered in adequate amounts, confer beneficial health effect on the host”

Probiotics can be bacteria or yeastsBacteria much more abundant… bigger role in healthPrimarily colonize or transiently act in gastrointestinal tract

Why are gut bacteria important?Over 100 trillion bacteria in gut

Ten times amount of cells in human body!500 different species of bacteria in gut

Critical role in metabolism and immune system

Page 33: Supplement Your Dietary Supplement IQ

Probiotics: Important VarietiesThree classifications of probiotics

Genus – broadestSpecies – more specificStrain – most specific

Most probiotic supplements classified by genus & species only

LactobacillusOne of most common bacterial genera in gutConvert lactose & other sugars to lactic acid

Can help some with lactose intoleranceAcidic environment inhibits harmful bacteria

Over 100 speciesIndicated by L. _______Some of most important: L. acidophilus, L. casei, L. reuteri, L. brevis

Page 34: Supplement Your Dietary Supplement IQ

Probiotics: Important VarietiesBifidobacterium

Another common bacterial genera in gutInhibit pathogenic bacteria

Competes for resources & produces lactic acid 29 species identified

Indicated by B. _______Some of most important: B. longum, B. breve, B. animalis

SaccharomycesCommon fungal genus in gut

Most yeast damage gut, e.g. Candida AlbicansSome species compete with pathogens

Indicated by S. _______S. Boulardii prevents/treats GI disorders

Page 35: Supplement Your Dietary Supplement IQ

Probiotics: Dietary SourcesFermented foods

Component of most traditional diets

AsianMiso and natto

Fermented beans/grains… often soy L. acidophilus (miso) & B. natto (natto)

Kimchi Fermented cabbage, radishes, etc. L. kimchii

Kombucha Fermented tea S. cerevisiae

Page 36: Supplement Your Dietary Supplement IQ

Probiotics: Dietary SourcesEuropean

Yogurt Fermented dairy

Cow, goat, sheep milk L. bulgaricus & Streptococcus thermophilus

Kefir Also fermented dairy More probiotic species than yogurt L. rhamnosus, B. longum, S. florentinus, etc.

Sauerkraut Fermented cabbage L. plantarum, L. mesenteroides, etc.

Page 37: Supplement Your Dietary Supplement IQ

Probiotics: Dietary SourcesAfrican

Ogi Fermented grains… often corn L. brevis, L. acidophilus, etc.

Currently in United States…Primarily yogurtTraditional products available health food stores

Kefir, kimchi, kombucha, etc.

Page 38: Supplement Your Dietary Supplement IQ

Probiotics: Supplement RationaleAmericans consume few fermented foods!

Commercial yogurt not optimal sourceOften high in sugar… feeds yeast & pathogensRelatively low bacterial count

100 million lactic acid bacteria per serving… 100 trillion bacteria in gut

Page 39: Supplement Your Dietary Supplement IQ

Probiotics: Favorable ResearchMost clinical research of all dietary supplements

All clinical trials or reviews of clinical trialsMajor species listed for each outcome

Regulates bowel functionEffective against diarrhea… especially antibiotic-associated

L. rhamnosus GG, S. Boulardii, L. Bulgaricus and many others 2012 Journal of American Medical Association

Effective against constipation B. lactis, L. casei 2010 World Journal of Gastroenterology

Page 40: Supplement Your Dietary Supplement IQ

Probiotics: Favorable ResearchEffective treatment for some Inflammatory Bowel Disease

Ulcerative Colitis B. Animalis, B. Breve, L. Acidophilus and combinations 2010 Proceedings of the Nutrition Society, 2010 Annals of Pharmacotherapy

Crohn’s Disease Evidence not as convincing… some success with L. Rhamnosus 2009 Current Pharmaceutical Design

Effective treatment for Irritable Bowel Syndrome L. Acidophilus, B. Breve, B. Bifidum, S. Boulardii and combinations 2010 Journal of Nutrition

Page 41: Supplement Your Dietary Supplement IQ

Probiotics: Favorable ResearchEffective treatment for other autoimmune conditions

Eczema and allergic rhinitis L. Acidophilus, B. Lactis, L. Sakei 2010 American Journal of Clinical Dermatology, 2010 Pediatric Pulmonology

Improve immunity in healthy individuals Reduces risk of common cold

L. paracasei, L. plantarum, L. BulgaricusYounger adults

2010 European Journal of Nutrition Older adults

2010 British Journal of Nutrition

Page 42: Supplement Your Dietary Supplement IQ

Probiotics: Unfavorable ResearchIneffective in some trials for certain conditions

Crohn’s Disease2008 Digestive Disease and Sciences

Pancreatitis (feeding tube)2008 Lancet

No evidence of harm from oral probiotic supplementationNot necessarily harmless… more research needed

Page 43: Supplement Your Dietary Supplement IQ

Probiotics: RecommendationsRecommend to people eating Standard American Diet

Usually not necessary if consume variety of fermented foodsDon’t typically need to take on an ongoing basis

Cycle on and off occasionally... few times a year or specific situations

Most important for people who…HAVE BEEN ON ANTIBIOTICS!

Critical to replenish flora & prevent side-effects Have digestive problems and/or food intolerancesWill be travelling out of the country

Prevent diarrheal disordersHave an autoimmune conditionAre at high risk for infections

Especially useful during flu season

Page 44: Supplement Your Dietary Supplement IQ

Probiotics: RecommendationsCore product: contains genus & species variety

Especially Lactobacillus & BifidobacteriumOccasionally rotate products for increased variety

Specific conditions: single-species okay S. boulardii, L. GG, etc. for diarrhea

Choose high potency productsAt least 5 billion colony forming units (CFU)≥ 10 billion preferable… especially after antibiotics

Many products contain over 100 billion CFURemember… 100 trillion bacteria in gut!

Page 45: Supplement Your Dietary Supplement IQ

Probiotics: RecommendationsChoose refrigerated product during summer

Probiotics die if exposed to high temperaturesRefrigerating extends life & assures potency

Choose products that specify strainMost specify genus and species

Best products also specify strain!

Choose products supported by researchProbiotic supplements vary tremendously

Trust those supported by researchCompany can point to studies

Page 46: Supplement Your Dietary Supplement IQ

Supplements to Avoid

Page 47: Supplement Your Dietary Supplement IQ

Supplements to AvoidMost supplements safe… but some may pose risk

Especially products tainted with pharmaceuticalsThree classes of supplements most likely to be tainted

Weight-loss supplementsNot likely to be effective long-term

Cannot replace healthy diet & exercise habitsOften stimulant-based… contraindications?

Especially among overweightSome products tainted with sibutramine

Active ingredient in Reductil (withdrawn by FDA)Increases blood pressure, pulse, potential risk for CVD eventshttp://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsi

ngMedicineSafely/MedicationHealthFraud/ucm234592.htm

Page 48: Supplement Your Dietary Supplement IQ

Supplements to AvoidSexual-enhancement supplements

Some products tainted with tadalafil or sildenafilActive ingredients in Cialis and ViagraCan interact with nitrates to cause low blood pressure http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying

UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm

Bodybuilding supplementsSome products tainted with anabolic steroids

Often marketed as containing “steroid-like” components Have caused liver or kidney problems http://www.fda.gov/Drugs/ResourcesForYou/Consumers/Buying

UsingMedicineSafely/MedicationHealthFraud/ucm234539.htm

Tainted products rare… but can pose health risk!

Page 49: Supplement Your Dietary Supplement IQ

Supplement and Drug Interactions

Page 50: Supplement Your Dietary Supplement IQ

Supplements and Drug InteractionsSt. John’s Wort and Antidepressants

Synergy: increased risk of serotonin syndrome

Red Yeast Rice and StatinsSynergy: increased risk of muscle & liver problems

Calcium/magnesium/zinc and AntibioticsReduced absorption: antibiotic may not work as well

Ginkgo Biloba and AnticoagulantsIncreased bleeding risk

Fish Oil and AnticoagulantsIncreased bleeding risk

Page 51: Supplement Your Dietary Supplement IQ

Supplements for Special Situations

Page 52: Supplement Your Dietary Supplement IQ

Supplements for Special SituationsCoenzyme Q10 for people on statins or beta-blockers

aka “CoQ10”

These medications deplete CoQ10Coenzyme Q10 supplementation recommended

2006 Annals of PharmacotherapyAlso good idea to take with Red Yeast Rice

Why is supplementing with CoQ10 important?Critical in muscle function… particularly heartReduces cardiovascular disease risk and blood pressure

2007 Nutrition Review & 2006 Journal of Cardiac FailureReduces statin-induced muscle myopathy

2007 American Journal of Cardiology

Page 53: Supplement Your Dietary Supplement IQ

Supplements for Special SituationsVitamin B12 for people on stomach acid-blockers

Prilosec, Zantac, antacids, etc.

These medications deplete vitamin B12

Reduced stomach acid to absorb B12

Why is vitamin B12 important?Help metabolize protein, fat, and carbohydratesLow levels → fatigue, depression, neurological damageLow concentrations associated with Alzheimer’s disease

2010 NeurologySupplementation lowers homocysteine

2008 Proceedings of Nutrition SocietySupplementation reduces cognitive decline

2012 American Journal of Clinical Nutrition

Page 54: Supplement Your Dietary Supplement IQ

Supplements for Special SituationsB-vitamins and zinc for vegetarians

Especially B12 for vegansVegetarian diets typically low in these nutrients

2002 American Journal of Clinical Nutrition

Folic acid for pregnant womenDeficiency can cause neural tube defectsSupplementation prevents neural tube defects

2009 Annals of Internal MedicineCan often be obtained in quality multivitamin

Page 55: Supplement Your Dietary Supplement IQ

Evidence-Informed Supplementation for Specific Health Concerns

Page 56: Supplement Your Dietary Supplement IQ

Popular Supplements: Joint HealthGlucosamine & Chondroitin

2006 New England Journal of Medicine

Methylsulfuromethane (MSM)2006 Osteoarthritis and Cartilage

Hyaluronic Acid2008 Nutrition Journal

Turmeric2006 Arthritis and Rheumatism

Ginger2001 Arthritis and Rheumatism

Page 57: Supplement Your Dietary Supplement IQ

Popular Supplements: DigestionGeneral Digestive Support

Digestive EnzymesBroad-spectrum plant-based (preferable)Animal-based

Pancreatin2009 Alimentary Pharmacology & Therapeutics

Acid-reflux… tapering off acid-blocking medications

Deglycyrrhizinated Licorice (DGL)2001 Hospital Practice

Aloe VeraTypically juice

Page 58: Supplement Your Dietary Supplement IQ

Popular Supplements: Immune SystemEchinacea

2006 Cochrane Database Systematic Review

Vitamin C 2010 Journal of International Medical Research

Vitamin D 2010 Nutrition

Zinc 2011 Cochrane Database Systematic Review

Probiotics 2006 Journal of Clinical Gastroenterology

Mushroom extracts 2012 Medicine and Sports Science

Page 59: Supplement Your Dietary Supplement IQ

Popular Supplements: Heart HealthRed Yeast Rice

2010 American Journal of Cardiology

Fish Oil2009 Annals of Internal Medicine

Coenzyme Q102007 European Heart Journal

Vitamin D2009 Archives of Internal Medicine

Page 60: Supplement Your Dietary Supplement IQ

Popular Supplements: Liver HealthMilk Thistle

2008 Annals of Hepatology

N-Acetyl Cysteine (NAC)2005 Clinical Therapeutics

S-Adenosyl Methionine (SAM-e)2007 Hepatology

Turmeric2009 Liver International

Page 61: Supplement Your Dietary Supplement IQ

Popular Supplements: DepressionSt. John’s Wort

2008 Cochrane Database Systematic Review

Fish Oil2010 Journal of Clinical Psychiatry

S-Adenosyl methionine (SAM-e)2002 International Journal of Psychopharmacology

Page 62: Supplement Your Dietary Supplement IQ

Popular Supplements: SleepMelatonin

2004 Journal of Clinical Endocrinology & Metabolism

Valerian Root2006 American Journal of Medicine

5-Hydroxytryptophan (5-HTP)2000 Alternative Medicine Review

Page 63: Supplement Your Dietary Supplement IQ

Checklist: Informed Supplement Consumer□ No interactions with other drugs/supplement - Talk to healthcare professional and consult literature

□ No outrageous label claims - Especially weight loss, sexual, bodybuilding products

□ Carefully read all ingredients on label - Consider content, quality, source of ingredients

- Some forms of vitamins, minerals, etc. better than others - Look for strains on probiotics

Page 64: Supplement Your Dietary Supplement IQ

Checklist: Informed Supplement Consumer□ Seek 3rd party verification certificate - Sign of commitment to product quality - NSF “Gold Standard” of product quality

□ Choose brands supported by peer-reviewed research - Ultimate sign of commitment to product quality! - Companies not required to conduct research…

provides consumers & healthcare professionals with evidence the supplement works

Page 65: Supplement Your Dietary Supplement IQ

Thank You! Questions?

Contact information: [email protected]