Herb Update Final09 B

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Update on the use of herbs and supplements.

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Herb Update Final09 B

  1. 1. What You Need to Know About Herbs & Supplements Jonathan Klemens, B.S. Bio, BS Pharm, MSLBE
  2. 2. <ul><li>“ The Herbs and Supplements that your Patients are Talking about” </li></ul>
  3. 3. PHARMACIST OBJECTIVES <ul><li>Review Herb & Supplement Market </li></ul><ul><li>Discuss Herb & Supplement Safety & Regulations </li></ul><ul><li>Identify Herbs & Supplements of Choice </li></ul><ul><li>Discuss Indications, Major Side Effects </li></ul><ul><li>& Interactions </li></ul><ul><li>Identify Herbs & Supplements Under Study </li></ul><ul><li>Identify Resources for Information </li></ul>
  4. 4. TECHNICIAN OBJECTIVES <ul><li>Define Scope of Herbal / Supplement Market </li></ul><ul><li>Discuss Importance of Herb & Supplement Safety & Regulations </li></ul><ul><li>Identify Herbs & Supplements of Choice </li></ul><ul><li>Define Technician’s Role in Use of Herbs & Supplements </li></ul><ul><li>Identify Herbs & Supplements Under Study </li></ul>
  5. 5. <ul><li>A fellow traveler </li></ul><ul><li>on a voyage to </li></ul><ul><li>explore the many </li></ul><ul><li>possibilities and </li></ul><ul><li>opportunities of </li></ul><ul><li>Integrative </li></ul><ul><li>Medicine. </li></ul>
  6. 6. Small Print Legal Stuff <ul><li>■ This presentation may discuss therapeutic products that have not been approved by the US FDA & off-label uses of approved products. </li></ul><ul><li>■ This information is not all-inclusive and is not meant to replace the diagnosis, advice, treatment, & judgment of medical professionals. </li></ul><ul><li>■ Please v erify all information and data and review updates before treating patients, employing any therapies, or recommending any herbs or supplements. </li></ul><ul><li>■ These views do not reflect the views of the Jefferson Regional Medical Center. </li></ul>
  7. 7. <ul><li>“ I really didn’t say everything I said” </li></ul><ul><li>- Yoga Berra </li></ul>
  8. 8. <ul><li>I have an earache: </li></ul><ul><li>2000 B.C. - Here, eat this root. 1000 A.D. - That root is heathen, say this prayer. 1850 A.D. - That prayer is superstition, drink this potion. 1940 A.D. - That potion is snake oil, swallow this pill. 1985 A.D. - That pill is ineffective, take this antibiotic. 2000 A.D. - That antibiotic is artificial. Here, eat this root. </li></ul><ul><li>&quot;A Brief History Of Medicine&quot; Posted by Thunderbird </li></ul>
  9. 9. November - 1998
  10. 10. HERBS <ul><li>Aromatic ● Savory ● Medicinal </li></ul><ul><li>Between 1991 – 1997, the use of herbals in USA rose by 380% (JAMA, 1998). </li></ul><ul><li>Annual sales of herbals in USA approx. $2.7 billion - $23.2 billion world market, $5 trillion by 2050. </li></ul>
  11. 11. <ul><li>1994 – Passage of Dietary Supplement Health and Education Act (DSHEA). </li></ul><ul><li>“ Phytomedicinals” are classified as “dietary supplements.” </li></ul><ul><li>Claims are limited to product’s role in “affecting structure or function” or to maintain health. </li></ul><ul><li>Allows a product to remain on market as long as NOT proven to be unsafe. </li></ul>
  12. 12. <ul><li>There are NO safety controls for herbs and supplements like those for prescription or OTC drugs </li></ul><ul><li>Vioxx (9/04) </li></ul>
  13. 13. AARP / NCCAM SURVEY <ul><li>1,559 individuals age 50 and older surveyed in the spring of 2006 </li></ul><ul><li>63 % reported having used one or more CAM therapies </li></ul><ul><li>42 percent used herbal/dietary supplements </li></ul>
  14. 14. <ul><li>1998 JAMA STUDY– ONLY 4% </li></ul><ul><li>USED CAM ALONE </li></ul><ul><li>↓ </li></ul><ul><li>INTEGRATIVE MEDICINE </li></ul><ul><li>INTEGRATIVE HEALTH </li></ul>
  15. 15. More than 95 of nation’s 125 medical schools (76%) require Some CAM coursework.
  16. 16. <ul><li>Why do people use products that have not been proven safe and effective? </li></ul>
  17. 17. <ul><li>Perceived lower healthcare costs </li></ul><ul><li>Control over own health </li></ul><ul><li>Prevention of disease / condition </li></ul><ul><li>Diseases without cure </li></ul><ul><li>Fear of surgery </li></ul><ul><li>Decreased side effects? </li></ul><ul><li>Popular and expert advocates </li></ul>
  18. 19. <ul><li>▪ Dr. Andrew Weil, founder - Program in Integrative Medicine, & Weil Lifestyle, at University of Arizona </li></ul><ul><li>▪ Degrees in biology and medicine (Harvard) </li></ul><ul><li>▪ Author of numerous articles and 7 books </li></ul>
  19. 20. <ul><li>Holistic – Natural Approach – Drugless? Perception that NATURAL = SAFE (Arsenic & Cyanide) </li></ul><ul><li>Recommendations - family & friends </li></ul><ul><li>Will not affect insurability </li></ul><ul><li>Dissatisfaction with provider / therapy -> internet search -> sales pitch -> perceptions from misinformation </li></ul>
  20. 21. Precarious Situation
  21. 22. <ul><li>THESE ARE DEFINITELY DRUGS! </li></ul><ul><li>Drug usage is a Balancing of Risks and Benefits </li></ul><ul><li>Not FDA approved, Claims and NOT Indications (Evidence Based?) </li></ul><ul><li>Lack of standardization, spice v. med – optimal dose ? </li></ul><ul><li>They do not work for everyone to same extent </li></ul><ul><li>OTC, Unregulated Distribution, Good Profit Margin, Online Sales </li></ul>
  22. 23. <ul><li>Contaminated (Chinese, Ayurvedic – lead, mercury, arsenic etc.) </li></ul><ul><li>Contraindications, Consumer Confusion, Drug/Food Interactions, SE, Allergies / Sensitivities, Perioperative Cautions </li></ul><ul><li>Synergy – Beneficial or Harmful </li></ul><ul><li>Share Decision with Provider(s) and Pharmacist(s) </li></ul><ul><li>Cultural Transformation & Patient’s Rights </li></ul>
  23. 25. Side Effects & Interactions <ul><li>Allergic reactions & Sensitivities </li></ul><ul><li>Increase/decrease bleeding tendency </li></ul><ul><li>Increase/decrease blood sugar </li></ul><ul><li>Aggravate hypertension </li></ul><ul><li>May effect organ systems or disease states </li></ul>
  24. 26. <ul><li>New England Journal of Medicine suggests that repeated topical use of products containing lavender oil and/or tea tree oil may cause prepubertal gynecomastia, a rare condition resulting in enlarged breast tissue in boys prior to puberty … (01/31/07) </li></ul>
  25. 27. <ul><li>Inhibit key metabolic enzymes (CYP isoenzymes): Additive/inhibitory effect on medication and supplements </li></ul><ul><li>Negative perioperative effects </li></ul><ul><li>Discontinue 3 weeks </li></ul><ul><li>prior to surgery </li></ul>
  26. 28. <ul><li>Interactions between drugs and supplements: pharmacokinetic and pharmacodynamic. </li></ul><ul><li>The CYP system is involved in the oxidative metabolism of drugs. The human body has over 30 CYP enzymes, but only six of them are known to be relevant for interactions. </li></ul><ul><li>Over 90% of oxidative drug metabolism occurs via 6 CYP enzymes: </li></ul><ul><li>1A2, 2C19, 2E1, 2C9, 2D6, 3A4 </li></ul>
  27. 29. CYP 3A4 <ul><li>The CYP 3A4 enzyme is involved in the metabolism of over 50% of all drugs. Supplements such as St. John's Wort, garlic, DHEA and others that alter this enzyme can interact with a very long list of medications. </li></ul><ul><li>St. John's Wort INDUCES CYP3A4 and therefore usually REDUCES activity of drugs metabolized by this enzyme. </li></ul><ul><li>EXCEPTION: Clopidogrel (Plavix) is a pro-drug. It needs to be metabolized by CYP3A4 to become active. Taking clopidogrel with St. John's wort actually INCREASES the activity of clopidogrel.13038 </li></ul>
  28. 30. Most Popular Herbs <ul><li>1. Ginkgo Biloba (oldest?) </li></ul><ul><li>2. St. John’s Wort (6/24) </li></ul><ul><li>3. Ginseng </li></ul><ul><li>4. Garlic </li></ul><ul><li>5. Echinacea </li></ul><ul><li>6. Saw Palmetto </li></ul><ul><li>7. Kava </li></ul><ul><li>Survey – Drug Store News </li></ul>
  29. 31. <ul><li>8. Soy </li></ul><ul><li>9. Valerian </li></ul><ul><li>10. Evening Primrose </li></ul><ul><li>11. Grape Seed </li></ul><ul><li>12. Milk Thistle </li></ul><ul><li>13. Bilberry </li></ul><ul><li>14. Black Cohosh </li></ul><ul><li>15. Pycnogenol </li></ul>
  30. 32. <ul><li>Ginkgo - Antioxidant, > blood flow, memory. SE: > bleeding tendency, monitor Type I induces P450 2C19 but inhibits other P450 enzymes </li></ul><ul><li>St. John’s Wort (6/24) – Antidepressant. SE: > effects of many drugs (P450), warfarin, HIV meds, OC. May > activity of clopidogrel, > photosensitivity, mania, withdrawal </li></ul>
  31. 33. <ul><li>Ginseng (Wild: $400) {Asian, American, Siberian} - Fatigue, weakness, ED. SE: May > bleeding (check INR with 2 weeks), insomnia, mania, may prolong QT interval, may < blood sugar. Vitamin C can interfere with absorption </li></ul><ul><li>Garlic - < BP, < cholesterol. SE: > bleeding with warfarin, ASA, NSAIDS, < OC, may induce or inhibit CYP450 enzymes </li></ul>
  32. 34. <ul><li>Echinacea - Colds and respiratory infections. SE: may augment hepatotoxicity/nephrotoxicity with other hepatotoxic drugs, Contra in progressive systemic diseases and immune disorders, Inhibits CYP3A4 isoenzymes </li></ul><ul><li>Saw Palmetto - Enlarged prostate. SE: < OC and hormone therapy, > bleeding </li></ul>
  33. 35. <ul><li>Kava - Sedative, sleep aid. SE: Very hepatotoxic, exacerbates hepatitis and may cause a progressive form of Parkinsonism, may cause severe liver damage resulting in transplant, yellowing of skin, inhibits a variety of P450 enzymes, has caused coma with alprazolam </li></ul>
  34. 36. <ul><li>Soy (Phytoestrogens) - Menopausal symptoms. SE: Cross allergy to peanuts, may interact with warfarin causing sub-therapeutic INR, may worsen hypothyroidism, may > certain cancers </li></ul><ul><li>Valerian (5%) - Anxiety, sleep aid. SE: May > effects of anti-seizure meds and sedatives, long term may be hepatotoxic, may inhibit CYP3A4 enzymes, withdrawal symptoms </li></ul>
  35. 37. <ul><li>Evening Primrose (GLA) - Inflammation, PMS, menopause, immune disorders, MS, rosacea/ eczema / acne. SE: < bleeding tendency, may exacerbate temporal lobe epilepsy. Contra schizophrenia </li></ul><ul><li>Grape Seed Extract (OPC - oligomeric proanthocyanidins ) - Antioxidant, allergies. SE: May < plasma levels of certain drugs, > effect of warfarin </li></ul>
  36. 38. OPC’s <ul><li>Unique flavonoids </li></ul><ul><li>50X more powerful than vitamin E & 20X more powerful than vitamin C in terms of antioxidant activity </li></ul><ul><li>Strengthen/repair connective tissue, moderate allergies and inflammation </li></ul>
  37. 39. <ul><li>Milk Thistle - Liver disease, liver protection, hangovers? SE: > drug levels by inhibiting CYP3A4/CYP2C9 enzymes, Contra in progressive systemic diseases and immune disorders </li></ul><ul><li>Bilberry (Huckleberry) - Eye disorders. SE: may < blood sugar, and inhibit platelet aggregation, interferes with iron absorption </li></ul>
  38. 40. <ul><li>Black Cohosh - PMS, menopause, menstrual disorders. SE: May be hepatotoxic, may > metastasis of breast cancer, may > toxicity of certain chemo agents but < cytotoxic effects of cisplatin </li></ul><ul><li>Pycnogenol (OPC) - Antioxidant, poor circulation, immunity. SE: May interfere with immunosuppressant therapy, avoid in autoimmune patients </li></ul>
  39. 41. <ul><li>Tea Tree oil - antifungal, antibacterial, antiviral </li></ul><ul><li>Green Tea - antioxidant, < cholesterol, ant-cancer activity? </li></ul><ul><li>Goji Juice (Lycium) - Wolfberry </li></ul><ul><li>Guarana - guaranine ?, caffeine </li></ul><ul><li>Goldenseal - wounds, mucus membrane infections, cold/flu, mask drugs </li></ul>
  40. 42. <ul><li>Medical Mushrooms (200/700) - adaptogens, Reishi – Maitake – Shitake </li></ul><ul><li>Yerba Mate - 196 active compounds! (cancers?) </li></ul><ul><li>Salvia divinorum - (“Diviner’s Sage” </li></ul><ul><li>hallucinogen, the “new marijuana”?) </li></ul>
  41. 43. ACAI BERRIES <ul><li>The açaí berry comes from the Brazilian Açaí palm. </li></ul><ul><li>Referred to as “The Tree of Life,” by the Yanomami Indians. </li></ul>
  42. 44. <ul><li>Flavor that faintly resembles raspberries and chocolate </li></ul><ul><li>10 times more antioxidants than red grapes and 10 to 30 times more than the artery-protective flavonoids of red wine. </li></ul><ul><li>Seems to inhibit key enzymes that may reduce inflammation. </li></ul><ul><li>Helps in loosing weight </li></ul><ul><li>One 60-capsule supply runs about $19.95 for a two-week dose. </li></ul>
  43. 45. SPECIFIC CONDITIONS
  44. 46. DIABETES <ul><li>Cinnamon </li></ul><ul><li>● Journal of Diabetes Care (01/09/2008) </li></ul><ul><li>● Hartford Hospital – “Meta-analysis” of 5 studies, 282 type 1 or type 2 diabetics cinnamon (cassia) or placebo for up to 16 weeks, 1-6 g daily </li></ul><ul><li>● No significant change in HgbA1c, FBS, or lipid parameters </li></ul>
  45. 47. Supplements with Claims to Lower Blood Sugar <ul><li>Cinnamon Bark, Ginseng, Neem, Banaba, Jambolan,, Kudzu,, Milk Thistle, Aloe Vera, Soy, Bilberry, Stevia, Pterocarpus marsupium (Indian Kino Tree), Holy Basil, Devil’s Claw, Jackfruit, Gulvel, Pycnogenol, Vanadyl Sulfate, Black/GreenTea </li></ul><ul><li>Gymnema Slyvestre, Bitter Melon (Balsam Pear), Agaricus Mushroom, Alpha Lipoic Acid, GTF, Ginger </li></ul><ul><li>Xanthan Gum, Blond Psyllium, Guar Gum, Glucomannan (Konjac), Beta-glucan, Fenugreek, Oats, Prickly Pear Cactus (Nopal), </li></ul><ul><li>Vitamin D-3, Niacinamide, Salsalate </li></ul>
  46. 48. Glucobetic ® (Atrium) Normalize Elevated Blood Sugar Levels <ul><ul><li>Zinc Gluconate 15 mg </li></ul></ul><ul><ul><li>Chromium GTF 240 mg </li></ul></ul><ul><ul><li>Vanadyl Sulfate 10 mg </li></ul></ul><ul><ul><li>Gymnema Sylvestre Extr. 200 mg </li></ul></ul><ul><ul><li>Bitter Melon Extract 200 mg </li></ul></ul><ul><ul><li>Fenugreek Extract 100 mg </li></ul></ul><ul><ul><li>Bilberry Extract 40 mg </li></ul></ul><ul><ul><li>Cinnamon Extract 30 mg </li></ul></ul><ul><ul><li>Jambolan 75 mg </li></ul></ul><ul><ul><li>Pterocarpus Marsupium 200 mg </li></ul></ul><ul><ul><li>Gulvel 50 mg </li></ul></ul>
  47. 49. WEIGHT CONTROL <ul><li>Hoodia Gordonii (Trim-Fast ™) </li></ul><ul><li>Glucomannan (2 hrs) </li></ul><ul><li>Chitosan </li></ul><ul><li>Fish Oil </li></ul><ul><li>Ephedra </li></ul><ul><li>Ginger ? </li></ul><ul><li>Acai Berries </li></ul><ul><li>Misc: Lipozene ™ (Latin American Yam, Green Tea), Banatol™ </li></ul>
  48. 50. ENERGY <ul><li>Caffeine </li></ul><ul><li>Guarana (Fiber-Bound Caffeine) </li></ul><ul><li>Yerba Mate </li></ul><ul><li>Ginseng </li></ul><ul><li>Ginkgo Biloba </li></ul>
  49. 51. CHOL / TRIG <ul><li>Red Yeast Rice </li></ul><ul><li>Fish Oil, Krill Oil (48X) </li></ul><ul><li>Flax Seed </li></ul><ul><li>Glucomannan (2 hrs) </li></ul><ul><li>Sitostanol </li></ul><ul><li>Guar Gum </li></ul><ul><li>Alfalfa </li></ul><ul><li>Turmeric </li></ul><ul><li>Avocado </li></ul><ul><li>Chitosan </li></ul><ul><li>Oats </li></ul><ul><li>Olive Oil / Safflower Oil </li></ul><ul><li>Nuts (Walnuts/Almonds/Pecans/ </li></ul><ul><li>Pistachios/Macadamia) </li></ul><ul><li>Nopal (Prickly Pear) </li></ul><ul><li>Aloe Vera ? </li></ul>
  50. 52. Red Yeast Rice <ul><li>Red yeast rice is rice that has been fermented by the red yeast, Monascus purpureus. </li></ul><ul><li>Used in China for over 1,000 years for medicinal purposes. Claims: useful for improving blood circulation, indigestion and diarrhea. </li></ul><ul><li>Claimed to lower cholesterol and triglycerides. Monacolin K/Lovastatin (low levels). </li></ul><ul><li>Caution: Citrinic acid concentrations. </li></ul>
  51. 53. <ul><li>Monacolin, most important ingredient in red yeast rice extract, varies considerably. </li></ul><ul><li>One study of different brands of red yeast rice supplements: monacolin ranged from 0% to 0.58%. </li></ul><ul><li>In 2000, the 10th U.S. Circuit Court of Appeals ruled that red yeast rice IS subject to FDA regulation. FDA has aggressively gone after companies selling red rice yeast containing lovastatin. </li></ul><ul><li>Essentially, supplements containing appreciable amounts of monacolin have disappeared from retail stores. </li></ul>
  52. 55. ED <ul><li>L-Arginine – Increase Nitric oxide concentration </li></ul><ul><li>Cnidium Monnier (fruit) Also called “Snake Bed” – induces nitric oxide, inhibits PDE-5 </li></ul><ul><li>Epimedium Extract, “Horny Goat Weed”- inhibits acetylcholinesterase </li></ul><ul><li>(Yohimbe) </li></ul><ul><li>Panax Ginseng </li></ul><ul><li>Ashwaganda </li></ul><ul><li>Ginkgo </li></ul>
  53. 56. SIGRA ® (Alpha Pharmaceuticals - Holland) <ul><li>Cnidium Monnier (fruit) – induces nitric oxide, inhibits PDE-5 </li></ul><ul><li>Xanthoparmelia Scabrosa (lichen) – smooth muscle relaxation, increases blood flow </li></ul><ul><li>Epimedium Extract, “Horny Goat Weed” (leaves, stems) – inhibits acetylcholinesterase </li></ul><ul><li>Cistanches (root) – ↑ blood circulation </li></ul><ul><li>L-arginine, Gamma Amino Butyric Acid </li></ul>
  54. 57. HYPERTENSION (one class of flavonoids, the flavanols, is receiving increasing attention) <ul><li>Garlic </li></ul><ul><li>Co-Q 10 </li></ul><ul><li>Fish Oil </li></ul><ul><li>Pycnogenol </li></ul><ul><li>Cacao </li></ul><ul><li>Green Tea </li></ul><ul><li>Pomegranate </li></ul><ul><li>Arginine </li></ul><ul><li>Magnesium </li></ul><ul><li>Grape seed </li></ul><ul><li>Blond Psyllium </li></ul>
  55. 58. ALLERGIES <ul><li>Quercetin </li></ul><ul><li>Butterbur </li></ul><ul><li>Stinging Nettle </li></ul>
  56. 59. MEMORY <ul><li>Phosphatidyl Choline </li></ul><ul><li>Phosphatidyl Serine (PS) </li></ul><ul><li>Huperzine – (Chinese club moss) Alzheimer's, Memory loss </li></ul><ul><li>Ginkgo ? </li></ul><ul><li>Turmeric? </li></ul><ul><li>Vitamin D3? (Obtain level first) </li></ul>
  57. 60. MIGRAINES <ul><li>Butterbur </li></ul><ul><li>Feverfew </li></ul><ul><li>Burdock </li></ul><ul><li>Chicory </li></ul><ul><li>Devil’s Claw </li></ul><ul><li>Elder </li></ul><ul><li>Ginkgo </li></ul><ul><li>Ginseng </li></ul><ul><li>Ginger </li></ul><ul><li>C0-Q10 </li></ul><ul><li>Arginine </li></ul><ul><li>SAMe </li></ul>
  58. 61. INSOMNIA <ul><li>Melatonin </li></ul><ul><li>Lemon Balm </li></ul><ul><li>Hops </li></ul><ul><li>L-tryptophan </li></ul><ul><li>Valerian </li></ul>
  59. 62. ARTHRITIS / JOINT PAIN / INFLAMMATION <ul><li>Glucosamine – Chrondrotin </li></ul><ul><li>Turmeric </li></ul><ul><li>Ginger </li></ul><ul><li>SAMe </li></ul><ul><li>Beta-Carotene </li></ul><ul><li>Avocado </li></ul><ul><li>Bromelain </li></ul><ul><li>Boswillia </li></ul><ul><li>Devil’s Claw </li></ul><ul><li>Fish Oil </li></ul><ul><li>Hyaluronic Acid /Hyaluronan (Baxyl ®) </li></ul><ul><li>MSM (Methylsulfonylmethane) </li></ul><ul><li>Rutin </li></ul><ul><li>Vitamin E </li></ul><ul><li>Evening Primrose Oil </li></ul>
  60. 63. UTI <ul><li>Cranberries </li></ul><ul><li>Vitamin C </li></ul>
  61. 64. Herbs with Negative Perioperative Effect Discontinue at least 3 weeks prior to surgery: Evening Primrose Oil, Saw Palmetto; Echinacea, Ephedra, Feverfew, Garlic, Ginkgo Biloba, Ginseng, Kava Kava, St. John’s Wort, Valerian (JAMA 2001;286:208-216) Chamomile, Licorice, Ginger, Turmeric, Willow Bar, Policosanol, Bitter Orange, Guarana, L-Tryptophan
  62. 65. The Dirty Dozen <ul><li>Bitter Orange </li></ul><ul><li>Chaparral </li></ul><ul><li>Comfry </li></ul><ul><li>Germander </li></ul><ul><li>Groundsel </li></ul><ul><li>Kava </li></ul><ul><li>Lobelia </li></ul><ul><li>Margosa Oil </li></ul><ul><li>Pennyroyal Oil </li></ul><ul><li>Sassafras </li></ul><ul><li>Skullcap </li></ul><ul><li>Yohimbe </li></ul>
  63. 66. SPECIAL SUPPLEMENTS
  64. 67. <ul><li>Annual sales of supplements in USA ~ $8.8 billion </li></ul><ul><li>Surveys indicate that over 50% of adults use supplements </li></ul><ul><li>- Improve health and well-being </li></ul><ul><li>- Increase muscle mass, maintain </li></ul><ul><li>desired weight </li></ul><ul><li>- Antioxidant effects </li></ul><ul><li>- Feel better </li></ul><ul><li>SAFE OR EFFECTIVE??? </li></ul>
  65. 68. Most Popular Supplements <ul><li>Glucosamine / Chrondrotin </li></ul><ul><li>(Joint Juice - 1500mg) </li></ul><ul><li>Co-Enzyme Q10 </li></ul><ul><li>Melatonin </li></ul><ul><li>Amino Acids </li></ul><ul><li>Fish Oil ( Omega 3 FA) </li></ul><ul><li>- Drug Store News Survey, 2000 </li></ul>
  66. 69. <ul><li>▪ Alpha Lipoic Acid (Thiotic Acid, 1951) Universal Antioxidant </li></ul><ul><li>▪ Bee Hive Products: </li></ul><ul><li>“ Apitherapy” - Pollen / Propylis / Royal Jelly / Bee Venom </li></ul><ul><li>▪ Creatine Monohydrate </li></ul>
  67. 70. <ul><li>Emu Oil </li></ul><ul><li>SAME-e (S-adenosyl-methionine) </li></ul><ul><li>Shark Oil, Cartilage </li></ul><ul><li>Vanadyl Sulfate (V2G) </li></ul><ul><li>GTF (chromium) </li></ul>
  68. 71. Nutraceuticals <ul><li>Coined in 1989: Foundation for Innovation in Medicine </li></ul><ul><li>Foods with therapeutic claims – </li></ul><ul><li>“ Functional </li></ul><ul><li>Foods” </li></ul><ul><li>Special benefits </li></ul>
  69. 72. <ul><li>► “ Functional” dark chocolate bar, 50-60% (CocoaVia ™) </li></ul><ul><li>► 3 oz/day/ 500 cal </li></ul><ul><li>► 60-61% Cacao – “Semisweet” </li></ul><ul><li>► 70-72% - “Bittersweet” </li></ul><ul><li>► Unsweetened baking chocolate – </li></ul><ul><li>100% Cacao </li></ul>
  70. 73. Probiotics (1965) <ul><li>GI tract: 400 strains of bacteria – Probiotics – beneficial strains that help maintain microflora balance, homeostasis, promote overall immunity. </li></ul><ul><li>Bifidobacterium longum, B. bifdum, Lactobacillus bulgaricus, L. acidophilus, Saccharomyces boulardii </li></ul>
  71. 74. <ul><li>Low levels of </li></ul><ul><li>probiotics can cause: </li></ul><ul><li>● Constipation, diarrhea, Crohn’s </li></ul><ul><li>Disease, ulcerative colitis, IBS (10- </li></ul><ul><li>20% of adults in U.S.). </li></ul><ul><li>● Also implicated in jock itch, vaginitis, and yeast infections (Candida albicans), gingivitis, psoriasis, eczema, migraines, </li></ul><ul><li>UTIs, chronic fatigue syndrome. </li></ul>
  72. 75. <ul><li>The independent lab. ConsumerLab.com, tested 26 probiotic supplements and found that only 8 of the products contained less than 1% of the claimed number of live bacteria or the expected minimum of 1 billion organisms </li></ul>
  73. 76. Class Action Litigation <ul><li>Activia® </li></ul><ul><li>Activa Lite® </li></ul><ul><li>and </li></ul><ul><li>DanActive® </li></ul>
  74. 77. Get Some Culture! <ul><li>Yogurt </li></ul><ul><li>Kefir (ke-fir ′ ) </li></ul><ul><li>Cottage cheese </li></ul><ul><li>Buttermilk </li></ul><ul><li>Sauerkraut / Kimchi (Korea) </li></ul><ul><li>Acidophilus fortified milk </li></ul>
  75. 79. Influenza Prevention/Treatment <ul><li>Seasonal Flu (44%), Avian Flu (H5N1) </li></ul><ul><li>TAMIFLU – Chinese Star Anise (+ other sources) </li></ul><ul><li>RESVERATROL – Grapes, raisins, peanuts </li></ul><ul><li>SAMBUCOL – Black elderberries </li></ul><ul><li>IMMUNE BOOSTING MUSHROOMS </li></ul><ul><li>(e.g.Maitake, Shiitake, Reishi, Agaricus) </li></ul><ul><li>ASTRAGALUS </li></ul>
  76. 80. <ul><li>ECHINACEA, GARLIC, GINSENG </li></ul><ul><li>KIMCHI, SAUERKRAUT, KEFIR, YOGURT </li></ul><ul><li>CARROTS – LETTUCE – CELERY (Alkaline) </li></ul><ul><li>OSCILLOCOCCINUM – Homeopathic Remedy </li></ul><ul><li>Beware of potential “Cytokine Storm” </li></ul>
  77. 81. The Search for Clinical Evidence http://nccam.nih.gov/clinicaltrials/alltrials.htm
  78. 82. NATIONAL CENTER FOR CAM <ul><li>Acupuncture Arthritis Black Cohosh Cancer Chelation Chiropractic Chondroitin Depression Dietary Supplements </li></ul><ul><li>Echinacea Ephedra Ginkgo Ginseng Glucosamine Herbs at a Glance Homeopathy Menopause St. John's Wort </li></ul>
  79. 83. NCCAM ( NIH ) Clinical Trials <ul><li>Screening Herbs for Drug Interactions </li></ul><ul><li>Herb-Opioid Interactions </li></ul><ul><li>Extract of Ginkgo and Vascular Function </li></ul><ul><li>Effects of Selected Vegetable/Herb Mix on Advanced Non-Small Cell Ling Cancer </li></ul>
  80. 84. <ul><li>Hawthorn Extract Randomized Blinded Chronic Heart Failure Trial </li></ul><ul><li>Evaluation of Interaction between Herbal Products and Anticoagulants </li></ul><ul><li>Treatment of Major Depression with St. John’s Wort (Hypericum) </li></ul><ul><li>Effects of Dark Chocolate on Insulin Sensitivity in Hypertensive Patients </li></ul>
  81. 85. <ul><li>Ginkgo Biloba: Antidepressant-Induced Sexual Dysfunction </li></ul><ul><li>Herbal Alternatives for Menopause Symptoms </li></ul><ul><li>Ginger Control of Chemotherapy Induced Nausea and Vomiting </li></ul><ul><li>Therapeutic Effect of Chinese Herbal Medicine on Food Allergy </li></ul><ul><li>Salsalate: NSAID in treating diabetes </li></ul>
  82. 86. Favorite Picks <ul><li>Alpha Lipoic Acid </li></ul><ul><li>Coenzyme Q10 </li></ul><ul><li>Grape Seed Extract </li></ul><ul><li>Green Tea </li></ul><ul><li>Omega 3 (Fish Oil, Flax Seed) </li></ul><ul><li>Phosphatidyl Serine (PS) </li></ul><ul><li>Probiotics </li></ul><ul><li>Pycnogenol </li></ul><ul><li>Resveratrol </li></ul><ul><li>Turmeric </li></ul><ul><li>Vitamin D3 (get level first) </li></ul>
  83. 87. <ul><li>I heartily encourage all of you to </li></ul><ul><li>further study the integration of herbs </li></ul><ul><li>and supplements into our healthcare </li></ul><ul><li>to better understand, and perhaps </li></ul><ul><li>improve, the health of our patients </li></ul><ul><li>in body, mind, and spirit. </li></ul>
  84. 88. <ul><li>NATIONAL CENTER FOR CAM (NIH) </li></ul><ul><li>http://nccam.nih.gov/ </li></ul><ul><li>NATURAL MEDICINES COMPREHENSIVE DATABASE (Compiled : Editors of Pharmacist’s Letter & Prescriber’s Letter) http://www.naturaldatabase.com/(S(ufdxlkr1tbjogim02tqapj3k))/home.aspx?cs=&s=ND </li></ul><ul><li>NATURAL STANDARD – THE AUTHORITY ON INTEGRATIVE MEDICINE </li></ul><ul><li>(Compiled: International Board of Editors) http://www.naturalstandard.com/index.asp </li></ul>
  85. 89. QUESTIONS?
  86. 90. <ul><li>http://jksamurai.googlepages.com/ </li></ul><ul><li>[email_address] </li></ul><ul><li>Dedicated to your Health in Body, Mind, and Spirit </li></ul><ul><li>Copyright © J Klemens 2008, 2009 </li></ul>

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