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Overuse of Herbal and Dietary Supplements

Overuse of Herbal and Dietary Supplements | Heart and Vascular Health | Scoop.it

Herbal and dietary supplement use is prevalent. Medication reconciliation should include a careful review of herbal and dietary supplements, including medical and nonmedical harms and benefits. The use of shared decision-making is recommended to integrate these findings into a patient-centered treatment plan. A case of an 80 year old man taking 50 supplements (over $35,000 annually) is reviewed and a teaching point about herbal and dietary supplements is discussed.

Seth Bilazarian, MD's insight:

This case study presents an example of the excessive and inappropriate use of dietary supplements, which can present challenges akin to those recognized in polypharmacy. The strategy highlighted for the physician to review the literature and then present the case regarding risk & benefits and costs to the patient regarding supplements is certainly reasonable but frequently ineffective since patients often are committed to "natural" therapies and believe they are safe and effective.  Furthermore, patients often think physicians are inclined to discredit these therapies.  In my practice, the use of fish oil supplements is the best example of a therapy with no demonstrated cardiovascular benefit and possible harm, There is $12 billion spent annually on fish oil alone.

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How Can We Know if Supplements Are Safe if We Do Not Know What Is in Them?

How Can We Know if Supplements Are Safe if We Do Not Know What Is in Them? | Heart and Vascular Health | Scoop.it

Americans spend over $20 billion annually on dietary supplements.1 Although supplements are regulated by the US Food and Drug Administration (FDA) under the Dietary Supplement Health and Education Act, there is no requirement for supplement manufacturers to demonstrate efficacy or safety of their products prior to marketing them. However, companies may not include unapproved ingredients. It turns out that even this minimal requirement is not fulfilled. Harel et al identified 237 dietary supplements that were recalled by the FDA owing to inclusion of unapproved drug ingredients. Given the limited regulation of these products, it is likely that the number of recalls grossly underestimates the number of products on sale with unapproved ingredients. Dietary supplements should be treated with the same rigor as pharmaceutical drugs and with the same goal: to protect consumer health.

Seth Bilazarian, MD's insight:

Over 50% of Americans use supplements.  The purity and potency of these supplements is nto closely regulate so the safety of this common practice amongst Americans is questionable at best.  The full NIH report is here http://goo.gl/bUwpy  ;

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Steve S Ryan, PhD's curator insight, June 15, 2013 11:01 PM

Steve S Ryan, PhD's insight:        

This is the author's summary from a medical journal article by Mitchell H. Katz, MD.JAMA Intern Med. 2013;173(10):928. doi:10.1001/jamainternmed.2013.415.

The full article is not yet available from Pub/Med.gov. Check this page: http://www.ncbi.nlm.nih.gov/pubmed/23588233

 

Want to know about about mineral deficiencies in A-Fib patients? Read by article: ‘Natural’ Supplements for a Healthy Heart, at http://a-fib.com/treatments-for-atrial-fibrillation/mineral-deficiencies/supplements-for-healthy-heart/

 

For my recommended products by brand, see

http://a-fib.com/a-fib-minerals-supplements-astore/

Dorothy Hale's curator insight, June 16, 2013 8:52 PM

Could supplement makers be unethical by not demonstrating efficacy or saftey prior to hitting retail stores?

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High intake of supplemental calcium associated with excess CVD death in men but not women

High intake of supplemental calcium associated with excess CVD death in men but not women | Heart and Vascular Health | Scoop.it

Importance Calcium intake has been promoted because of its proposed benefit on bone health, particularly among the older population. However, concerns have been raised about the potential adverse effect of high calcium intake on cardiovascular health.

 

Objective To investigate whether intake of dietary and supplemental calcium is associated with mortality from total cardiovascular disease (CVD), heart disease, and cerebrovascular diseases.

 

Results During a mean of 12 years of follow-up, 7904 and 3874 CVD deaths in men and women, respectively, were identified. Supplements containing calcium were used by 51% of men and 70% of women. In men, supplemental calcium intake was associated with an elevated risk of CVD death (RR>1000 vs 0 mg/d, 1.20; 95% CI, 1.05-1.36), more specifically with heart disease death (RR, 1.19; 95% CI, 1.03-1.37) but not significantly with cerebrovascular disease death (RR, 1.14; 95% CI, 0.81-1.61). In women, supplemental calcium intake was not associated with CVD death (RR, 1.06; 95% CI, 0.96-1.18), heart disease death (1.05; 0.93-1.18), or cerebrovascular disease death (1.08; 0.87-1.33). Dietary calcium intake was unrelated to CVD death in either men or women.

 

Conclusions and Relevance Our findings suggest that high intake of supplemental calcium is associated with an excess risk of CVD death in men but not in women. Additional studies are needed to investigate the effect of supplemental calcium use beyond bone health.

Seth Bilazarian, MD's insight:

Thre has been concern that the risks of taking calcium supplements may exceed the benefits in some patients. The "hardening of the arteries" that causes vascular problems such as heart attack, stroke and gangrene, is caused by calcium deposits (vascular calcification).  Taking high doses of calcium raises the available calcium in the blood vessles for deposit in the artery wall and the calcium may not be incorporated in the bones which is the goal of treatment.  The recommendation that men consider avoiding calciu supplemetns is reasonable.

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Vitamins Herbal & Natural - A Cardiologists Perspective

Pentucket Medical cardiologists Seth Bilazarian and Sunny Srivastava discuss vitamins and dietary supplements as alternative, complimentary and natural therapies.

Patients often think doctors are "against" the use of vitamin or herbal therapies.  I try to explain on our community program "Matters of the Heart"  the doctors viewpoint on Vitamin supplements - cautions and recommendations.  I speak about Vitamin D deficiency and its treatment.

Because its a VItamin or because it says its natural doesn't mean its good.

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Mortality in Randomized Trials of Antioxidant Supplements

Mortality in Randomized Trials of Antioxidant Supplements | Heart and Vascular Health | Scoop.it

 All randomized trials involving adults published by October 2005 comparing beta carotene, vitamin A, vitamin C (ascorbic acid), vitamin E, and selenium either singly or combined vs placebo or vs no intervention were included. The effect of antioxidant supplements on all-cause mortality was analyzed We included 68 randomized trials with 232 606 participants (385 publications).

Conclusions Treatment with beta carotene, vitamin A, and vitamin E may increase mortality. The potential roles of vitamin C and selenium on mortality need further study.

Seth Bilazarian, MD's insight:

Oxidative stress is implicated in most human diseases so antioxicants mae theoretical sense. . Many primary or secondary prevention trials of antioxidant supplements have been conducted to prevent several diseases.   This trial review found that antioxidant supplements, with the potential exception of selenium, were without significant effects on gastrointestinal cancers and increased all-cause mortality. This review of antioxidant trials not only found that taking them is not beneficial but may be harmful.

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Dangers of Too Much Calcium

Dangers of Too Much Calcium | Heart and Vascular Health | Scoop.it

New research suggests that older women who take large calcium supplements may be at increased risk of heart disease and death. After controlling for physical activity, education, smoking, alcohol and other dietary factors, they found that women who consumed 1,400 milligrams or more of calcium a day had more than double the risk of death from heart disease, compared with those with intakes between 600 and 1,000 milligrams. These women also had a 49 percent higher rate of death from cardiovascular disease, and a 40 percent higher risk of death from any cause.

Seth Bilazarian, MD's insight:

Seeing is believing.  Calcified coronary arteries on the coronary angiograms performed during cardiac catheterization raise the risk for patients.  The "hardening of the arteries" was described more than a century ago.  The arteries become "bony canals".  I agree with: “If you have a normal diet, you don’t need to take calcium supplements,” said the lead author, Dr. Karl Michaëlsson.

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Eating Fish, but Not Supplements, Cuts Stroke Risk

Eating Fish, but Not Supplements, Cuts Stroke Risk | Heart and Vascular Health | Scoop.it

Eating fish -- and the more the better -- appears to be associated with a small but significant decrease in the risk of cerebrovascular events, a meta-analysis showed.

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Vitamin D — Baseline Status and Effective Dose

Vitamin D — Baseline Status and Effective Dose | Heart and Vascular Health | Scoop.it

Take Home Message: Vitamin Supplements are useful for individuals who are deficient.  For now treatment with Vitamin D supplements to a bood level of Vitamin D-25 greater than 30 is reasonable and recommended. More is not better. It's easy to have the blood level checked.

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An editorial that accompanies a meta anlaysis in NEJM which shows a modest benefit of Vitamin D on fracture risk.  Robert Heaney does an excellent job explaining why we see diiferent results in many vitamin or nutrient trials.

 

Evaluating a certain dose of a Vitamin will not assess the benefit if the patients tested are not deficient.  In the meta analysis the baselinie Vitamin D level in the placebo and different doses of Vitamin D all had a baseline level > 40 (< 30 is deficient)

 

"giving additional amounts of a nutrient to persons who already have enough, or not giving enough to push a person with a deficiency up onto the ascending limb of the response curve, is likely to produce a null response"

 

See the article here http://goo.gl/XG59l (requires subscription)

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