Dietary supplements, consider

When obtaining the drug history, the nurse must always question the patient about the use of herbs, teas, vitamins, or other nutritional or dietary supplements. Many patients consider herbs as natural and therefore safe It is also difficult for some to report the use of an herbal tea as a part of the health care regimen. Display 1-4 identifies teaching points to consider when discussing the use of herbs and nutritional supplements with patients. Although a complete discussion about the use of herbs is beyond the scope of this book, it is important to remember that the use of herbs and nutritional supplements is commonplace in many areas of the country. To help the student become more aware of herbal therapy and nutritional supplements, Appendix B gives... 

Although rice bran is still a wasted product all over the world, recent scientific studies have recognized its potential health benefits. This is a unique, nutrient-dense natural product which offers health benefits for a series of ailments. It is a food pharmacy worth considering not only for general health maintenance but also as a dietary supplement for serious health conditions. With the advent of unique stabilization technology rice bran, an under-utilized waste product, has now been made available as a highly nutritious, health-promoting food for humans. 

Dietary intake data from a number of studies in North America and the United Kingdom indicate that intake of lutein from natural sources is in the range of 1 to 2 mg/day (approximately 0.01 to 0.03 mg/kg body weight per day). Simulations considering proposed levels of use as a food ingredient resulted in an estimated mean and 90th percentile of intake of lutein plus zeaxanthin of approximately 7 and 13 mg/day, respectively. Formulations containing lutein and zeaxanthin are also available as dietary supplements, but no reliable estimates of intakes from these sources were available. 

Complementary and alternative medicines A group of practices and products that are not presently considered to be part of conventional medicine, including alternative medical systems (e.g., homeopathic medicine and naturopathic medicine), mind-body interventions (e.g., meditation and mental healing), biologically-based therapies (e.g., dietary supplements, vitamins, herbs, and other natural products), manipulative body-based methods (e.g., acupuncture and massage), and energy therapies (e.g., therapeutic touch and bioelectromagnetic-based therapies). 

In addition to food- or nutrient-based interactions in the metabolism of drugs, it has become quite clear in recent years that so-called dietary supplements including botanicals have the potential to participate in such interactions. The latter observation has special relevance because of the extensive use of such products worldwide ( 12 billion per year in the United States alone), their easy commercial availability (no prescription required), and their common use with prescribed drugs. Furthermore, many people consider such natural products to be safe and free of any bad effects (it should be pretty easy to recall many poisons... 

Many dietary supplements should be avoided in pregnancy because they may have emmenagogue activity, promoting menstruation. Some herbs that are considered emmenagogues are feverfew, garlic, and hawthorn [4]. St. John s wort should be avoided in pregnancy due to its emmenagogue and abortifacient properties. 

If a pharmacist posted a sign in a pharmacy claiming a dietary supplement is effective in treating or preventing a certain disease, the pharmacist would be violating the FDCA. The product would be considered a drug but not properly labeled as a drug and therefore would be misbranded. 

The Federal Trade Commission (FTC) regulates dietary supplement advertising. The FTC prohibits unfair or deceptive acts or practices with the advertisement of dietary supplements from retailers and manufacturers. A pharmacy would be held liable if the pharmacy published a manufacturer s ad that was considered deceptive [26]. 

Natural and herbal diet pills available in the United States today are considered dietary supplements and are not subject to FDA review prior to being sold. Although these agents may have drug-like activity in the body, they do not need to be proven safe or effective like conventional drugs do. Unlike conventional drugs, natural and herbal diet pills can only be withdrawn from the market when they are proven to be dangerous. As a result, many herbal products reach the market without any scientific evidence that they are safe or effective. These products are discussed in more detail in Chapter 6. 

Figure 11.17 Supplementation of diet with y-linolenic acid to overcome a deficiency of A desaturase Supplementation of a diet with DOPA to overcome a deficiency of monooxygenase in Parkinson s disease. A desaturase is a rate-limiting enzyme in the synthesis of arachidonic acid. Supplementation of diet with y-linolenic acid bypasses this enzyme. Damage to neurones in the brain that use dopamine as a neurotransmitter causes a deficiency of rate-limiting a supplement - enzyme, tyrosine monooxygenase, which is bypassed by a supplement, DOPA (dihydroxyphenylalanine). DOPA (usually, described as L-DOPA) is considered by the medical profession as a drug but, in reality, it is a dietary supplement.

Calcium/Vitamin D supplementation Patients should receive supplemental calcium if dietary intake is inadequate. Patients at increased risk for vitamin D insufficiency (eg, those in nursing homes, chronically ill, older than 70 years of age), should receive vitamin D supplementation in addition to that provided in alendronate/cholecalciferol. Patients with Gl malabsorption syndromes may require higher doses of vitamin D supplementation consider measurement of 25-hydroxyvitamin D. 

Complementary and alternative medicine CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH]... 

All of the vitamins are used as specific treatments for their respective deficiency diseases. The dosages required will vary depending on the severity of the disease and the vitamin. Vitamins have also been used like drugs to treat diseases. However, unlike drug products, vitamins are not reviewed by the U. S. Food and Drug Administration before formulations appear on the market. Vitamins are considered to be dietary supplements under the Dietary Supplement Health and Education Act (DSHEA). Vitamins and other dietary supplements are not permitted to be marketed as a treatment or cure for a specific disease or condition unless the vitamin is approved as a drug for that purpose. However, under DSHEA, supplement manufacturers may make health claims, such as the link between a food substance and a disease or health-related condition. This may make it difficult for patients to assess the need for vitamin supplementation. 

TABLE 29.1 Issues to Consider and Discuss with Patients or Parents in Relation to Herbal Treatments and Dietary Supplements... 

Dietary supplements are products taken by mouth that contain an ingredient intended to supplement the diet, such as vitamins, minerals, herbs or other botanicals, amino acids, and substances such as enzymes, organ tissues, and metabolites. Dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps, liquids, and powders. They have special requirements for labeling. In the U.S., the Dietary Supplement Health and Education Act of 1994 states that dietary supplements are considered foods, not drugs. (Note that some dietary supplements are used in conventional medicine for example, folic acid... 

Herbal remedies currently are considered dietary supplements and, hence, are regulated under the same provisions as foods. Thus, to be marketed, these products do not have to meet the same stringent manufacturing or testing requirements as do patented drugs. The net result is twofold ... 

Management of chronic arsenic poisoning consists primarily of termination of exposure and nonspecific supportive care. Although empiric short-term oral chelation with unithiol or succimer for symptomatic individuals with elevated urine arsenic concentrations may be considered, it has no proven benefit beyond removal from exposure alone. Preliminary studies suggest that dietary supplementation of folate—thought to be a cofactor in arsenic methylation—might be of value in arsenic-exposed individuals, particularly men, who are also deficient in folate. 

Under the DSHEA, dietary supplements are not considered over-the-counter drugs in the USA but rather food supplements. Although dietary supplements are regulated as food, consumers may use them in the same fashion as drugs and even use them in place of drugs or in combination with drugs. 

The [FDA] Task Force considered various issues in its deliberations, including. .. what steps are necessary to ensure that the existence of dietary supplements on the market does not act as a disincentive for drug development."... 

Table 2.1 presents examples of the main classes of low-molecular-weight bioactive molecules which are currently considered to be helpful for human well-being and which can be therefore used as food supplements as well as active components in skin-care applications (Ratnam et al., 2006 McClements et al., 2009). The required physicochemical properties of effective bioactive compounds, which should be considered in the formulation of the prophylactic and therapeutic dietary supplements at their desired oral dosages, are described in the scientific literature. These properties are (i) solubility in aqueous media (ii) permeability through the gastrointestinal tract and cell membranes (iii) physical stability and (iv) bioavailability. 

In addition to traditional medications, consumers have access to many substances that are not considered a part of conventional or mainstream pharmacothera-peutics. These substances often consist of natural products such as herbal preparations, vitamins, minerals, and other nutritional substances that are taken to promote optimal health or to treat various conditions. These products are usually classified as dietary supplements by the Food and Drug Administration (FDA), and are therefore not subjected to the rigorous testing and scrutiny required for prescription drugs and many over-the-counter medications. 

Vitamins and minerals are not considered medications, but these substances are essential for maintaining physiologic function and homeostasis throughout the body. Many individuals consume these substances to compliment other medications and to help promote optimal health. It is beyond the scope of this chapter to address all the pertinent issues related to vitamin and mineral metabolism. Nonetheless, a brief overview of these substances and their use as dietary supplements is provided here and summarized in Tables 38-2 and 38-3. Readers are also referred to other sources for a more detailed discussion of vitamins and minerals.4,55 76... 

According to the Physician s Desk Reference (PDR) for Nutritional Supplements, there are no known adverse interactions between creatine monohydrate supplements and prescription drugs, herbs, and/or other dietary supplements. However, the effects of creatine may be decreased or altered by the use of other drugs or supplements, so anyone considering taking the supplement should consult a physician first. 

Because melatonin is found in certain foods, the Food and Drug Administration considers it to be a dietary supplement instead of a drug. However, since melatonin has not been studied very extensively, it is still unknown if it causes long-term side effects. 

Dietary) Supplement A product containing one or more ingredients meant to have an effect on health. Dietary supplements are considered neither foods nor medications. 

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