4/24/15  

1  

DIETARY SUPPLEMENTS & ESSENTIAL NUTRIENTS: EFFECTIVENESS, SAFETY & COST ACCORDING TO THE 2010 DIETARY GUIDELINES FOR AMERICANS, "NUTRIENTS SHOULD COME PRIMARILY FROM FOODS. FOODS IN NUTRIENT-DENSE, MOSTLY INTACT FORMS CONTAIN NOT ONLY THE ESSENTIAL VITAMINS AND MINERALS THAT ARE OFTEN CONTAINED IN NUTRIENT SUPPLEMENTS, BUT ALSO DIETARY FIBER AND OTHER NATURALLY OCCURRING SUBSTANCES THAT MAY HAVE POSITIVE HEALTH EFFECTS. ...DIETARY SUPPLEMENTS...MAY BE ADVANTAGEOUS IN SPECIFIC SITUATIONS TO INCREASE INTAKE OF A SPECIFIC VITAMIN OR MINERAL."

OBJECTIVES !  Define and understand the history of dietary

supplements and essential nutrients !  Identify 9 essential nutrients that can be safely

recommended to patients

" Composition " Dosing (RDA) " Sources " EBR " Safety " Drug Interactions " Cost

!  Resources online that can facilitate your

understanding of the appropriate and recommended use of supplementation

4/24/15  

2  

DEFINITIONS Dietary Supplements: According to the FDA a dietary supplement is, “ a product intended for ingestion that contains a “dietary ingredient” intended to add further nutritional value to (supplement) the diet. It may be: a vitamin, a mineral, an herb or botanical, an amino acid, a dietary substance, or a concentrate, metabolite, constituent, or extract.” Supplements can help to ensure that a person obtains an adequate supply and intake of essential nutrients, and many can help to reduce the overall risk of disease. Essential Nutrients: A nutrient which is required for normal body function, it is a nutrient that cannot be synthesized by the body. They include: dietary minerals, essential fatty and amino acids, and vitamins. Some essential nutrients like Vitamin C are considered phytonutrients as they are occur in plants.

HISTORY In 1994 the Congress passed the Dietary Supplement Health and Education Act which gave a definition to supplementation and turned regulation over to the FDA. While dietary supplements are regulated by the FDA they are regulated differently from foods and other drugs. A dietary supplement can contain three types of claims: a health claim, nutrient content claim, or structure/function claim. There are currently no provisions for the FDA to “approve” supplements for safety or effectiveness. Herbal supplements Without Herbs: http://www.nytimes.com/2015/02/07/opinion/herbal-supplements-without-herbs.html?_r=0

SELECTION OF 8 ESSENTIALS

! Magnesium (mineral) ! Calcium (mineral) ! Vitamin C/Zinc (water-soluble, mineral) ! Vitamin D (fat-soluble) ! B12 (water-soluble) ! Fish Oil, Omega 3 (essential fatty acid) ! Probiotics ! CoQ10 (fat-soluble)

4/24/15  

3  

HOW DO VITAMINS WORK? TED-ED EXPLAINS

http://ed.ted.com/lessons/what-s-the-value-of-vitamins-ginnie-trinh-nguyen

FAT-SOLUBLE Fat-soluble vitamins are ingested via food Food is then digested by the stomach, then travels to the small

intestines. Bile then breaks down the fats, and nutrients are absorbed through the walls of the small intestine

Once absorbed fat-soluble vitamins enter the lymph and move into the blood stream, in most cases they must first be coupled with a protein to travel through the body

While most are used by the body excess is stored in the liver and fatty tissues, making it possible for toxic levels to build up in the body. Rare if ingested via food, more likely if using supplementation

Fat-soluble include: A, D, E, and K

WATER-SOLUBLE Absorbed directly into the bloodstream after consumption Hydrolyzed in the stomach from the protein complexes found in

food Most are then absorbed in the upper intestine (vitamin B12 is

absorbed in the ileum) Then through the portal vein to the liver where they are stored

(B12 is sent out to circulation) Kidneys regulate the consumption and shunt excess via urine Require replenishment every few days Water-soluble include: B vitamins and C

4/24/15  

4  

MINERAL Function differently, some with similar properties to fat-

soluble vitamins like calcium, and others like potassium which are similar to water-soluble vitamins.

Essential for overall mental and physical well-being

MAGNESIUM

Composition: Has the atomic number of 12, with 12 protons and approximately 12 neutrons inside its shell 12 electrons orbit in 3 shells, with 2 valence electrons. On the periodic table magnesium is known as the alkaline earth metal. It cannot be found in nature independently as it is highly reactive.

In the human body: " Fourth most abundant mineral " 4-6 tablespoons are found in the body composition " 1% is found in blood, the rest is found in the cells of the

muscles, heart, and liver. " Absorption occurs in the small intestine, this begins

approximately 1 hour after it is ingested in the jejunum

Magnesium in Man: Implications for Health and Disease, Jeroen H. F. de Baaij , Joost G. J. Hoenderop , René J. M. Bindels, Physiological Reviews Published 1 January 2015 Vol. 95 no. 1, 1-46 DOI: 10.1152/physrev.00012.2014

4/24/15  

5  

RECOMMENDED DAILY ALLOWANCE: MAGNESIUM

Recommended Dietary Allowance (RDA) for Magnesium Life Stage  Age  Males (mg/day)  Females (mg/day)  Infants  0-6 months 30 (AI)  30 (AI)  Infants  7-12 months  75 (AI)  75 (AI)  Children  1-3 years   80  80  Children 4-8 years 130  130  Children  9-13 years  240  240  Adolescents  14-18 years  410  360  Adults  19-30 years  400  310  Adults  31 years and older  420 320  Pregnancy  18 years and younger  - 400  Pregnancy  19-30 years - 350  Pregnancy  31 years and older - 360  Breast-feeding  18 years and younger - 360  Breast-feeding  19-30 years - 310  Breast-feeding  31 years and older - 320

Sources: current daily value (DV) for magnesium is 400 mg, main sources are from food ingestion and supplementation Top 10 Foods Highest in Magnesium: ! Dark Leafy Greens, 79 mg (20% DV) ! Nuts and Seeds, 534 mg (134% DV) ! Fish, 97 mg (24% DV) ! Beans & Lentils, 86 mg (22% DV) ! Whole Grains, 44 mg (11% DV) ! Avocados, 29 mg (7% DV) ! Low-fat dairy, 19 mg (5% DV) ! Bananas, 27 mg (7% DV) ! Dried Figs, 68 mg (17% DV) ! Dark Chocolate, 327 mg 82% DV)

POSITIVE EFFECTS OF MAGNESIUM IN THE BODY, WHAT DOES THE EVIDENCE SHOW?

Hypertension & Cardiovascular Health; studies have shown that magnesium supplementation works to lower blood pressure to only a small extent, while the DASH diet has shown to have a moderate effect on blood pressure, it is difficult to attribute independently to magnesium as the diet increases intake of other nutrients as well. A systemic review and meta-analysis in 2013 demonstrated that higher levels of magnesium intake (250 mg) were associated with lower risks of ischemic heart disease.

Type 2 Diabetes; It is known that magnesium plays an important role in glucose metabolism and this may be way there is an associated link between higher amounts of magnesium and lower risks of diabetes. A 2011 study found that a 100 mg/day increase decreased the risk of diabetes by 15%. Although studies have demonstrated the potential link the American Diabetes Association (ADA) states that there is insufficient evidence to support the link between magnesium and risk of diabetes.

Osteoporosis; studies have shown magnesium deficiency is a risk factor in the development of osteoporosis, although further studies are needed to strengthen this finding.

Migraine Headaches; while the research is limited the American Academy of Neurology and the American Headache Society have released statements that, “magnesium therapy is probably effective for migraine prevention.”

4/24/15  

6  

SAFETY/DRUG INTERACTIONS # While there is no danger associated with dietary intake of

magnesium to toxic levels, supplementation excess can lead to diarrhea, nausea, and abdominal cramping.

#  Risk of toxicity increases with renal impairment or kidney failure given that the kidneys are responsible for the removal of excess magnesium in the body

$  Bisphosphonates: can decrease absorption, should be separated

by at least 2 hours. $  Antibiotics: Tetracyclines and Quinolones should be taken 2

hours before or 4-6 hours after supplementation $  Loop Diuretics: may lead to the loss of magnesium

concentrations in the body (depletion) $  PPI: FDA has recommended that healthcare providers assess

magnesium levels of any patient who is started on a PPI prior to initiation for long-term use. Continue to assess magnesium levels while taking any long-term PPI

COST Supplementation: $15-35/month

Dark Leafy Greens: $1.38/poundBananas: $ 0.77/poundDark Chocolate: $2.50/barLentils: $ 1.20/poundNuts & Seeds: $10-20/pound

CALCIUM Composition:

•  Major structural element in teeth and bones •  Hydroxyapatite is the main mineral component in bones, which

contains calcium, phosphorus, and oxygen •  There is tight control in the body on calcium concentrations

given their importance in preserving normal physiological functioning.

•  The relationship between Vitamin D and Calcium is critical (see next slide)

•  Calcium is also used in the mediation of vasoconstriction and vasodilation, nerve impulse transmission, muscle contraction, and secretion of hormones (insulin).

•  Calcium is also important in the regulation of protein function and works with Vitamin K in a series of events which lead to clot formation.

•  Calcium interacts with a number of other nutrients including: vitamin D, sodium, protein, and phosphorus.

4/24/15  

7  

RECOMMENDED DAILY ALLOWANCE: CALCIUM

Recommended Dietary Allowance (RDA) for Calcium: Life  Stage    Age      Males  (mg/day)    Females  (mg/day)  

   Infants      0-­‐6  months  200  (AI)    200  (AI)      Infants      6-­‐12  months    260  (AI)    260  (AI)      Children    1-­‐3  years    700      700      Children    4-­‐8  years    1,000      1,000      Children    9-­‐13  years    1,300      1,300      Adolescents    14-­‐18  years    1,300      1,300      Adults      19-­‐50  years    1,000      1,000      Adults      51-­‐70  years    1,000      1,200      Adults      71  years  and  older  1,200      1,200      Pregnancy    14-­‐18  years  -­‐      1,300      Pregnancy    19-­‐50  years  -­‐      1,000      Breast-­‐feeding    14-­‐18  years  -­‐      1,300      Breast-­‐feeding    19-­‐50  years  -­‐      1,000

Top 10 Foods Highest in Calcium: ! Dark Leafy Greens, 120 mg (12% DV) ! Low Fat Cheese, 961 mg (95% DV) ! Milk & Yogurt, 125 mg (11% DV) ! Tofu, 350 mg (35% DV) ! Chinese Cabbage, 105 mg (11% DV) ! Okra, 77 mg (8% DV) ! Broccoli, 47 mg (5% DV) ! Green Snap Peas, 37 mg (4% DV) ! Almonds, 264 mg (26% DV) ! Canned Sardines, 383 mg (38% DV)

Supplementation: •  Two main forms: carbonate and citrate •  Carbonate: inexpensive, needs to be taken with food to

properly absorb, increased GI side effects •  Citrate: with or without food, beneficial for anyone with

absorption issues

4/24/15  

8  

POSITIVE EFFECTS OF CALCIUM IN THE BODY, WHAT DOES THE EVIDENCE SHOW?

Supplementation with calcium and vitamin d have demonstrated a decreased risk of fractures and falls and an overall decrease in osteoporosis. In January 2010 the US Food and Drug Administration released the following statement: "Adequate calcium throughout life, as part of a well-balanced diet, may reduce the risk of osteoporosis" and "Adequate calcium and vitamin D as part of a healthful diet, along with physical activity, may reduce the risk of osteoporosis in later life.” Studies show promise that calcium supplementation may decrease overall risk of colon cancer, although long-term studies are needed for additional support ***Previously it was believed that calcium supplementation may decrease CVD risk, however more recent studies have brought up the possibility that calcium may be detrimental to cardiovascular health. This is a hot topic in the scientific community and research is pending.

SAFETY/DRUG INTERACTIONS

***Hypercalcemia can lead to: renal insufficiency, kidney stones, constipation, and potentially increased risk of cardiovascular disease.*** Numerous potential interactions with medications. Calcium can decrease absorption of the following: bisphosphonates, levothyroxine, fluoroquinolones, tetracyclines Thiazide diuretics may lead to hypercalcemia Glucocorticoids can cause calcium depletion which may lead to osteoporosis

4/24/15  

9  

COST

Supplementation: $10-20/month***best absorbed if taken in small amounts throughout the day, divide if larger than 500 mg dose***

Dark Leafy Greens: $1.38/poundOkra: $ 1.00/poundBroccoli: $1.30/barSnap Peas: $ 1.99/poundCanned Sardines: $0.88/4 oz

VITAMIN D

Composition: ! Produced endogenously when the sun strikes the skin and

triggers vitamin D synthesis ! Must undergo two hydroxylations in the body: 1) in the liver

which converts D to 25-hydroxyvitamin D [1,25(OH)D] or calcidiol, 2) in the kidneys which forms 1,25-dihydroxyvitamin D [1,25(OH2D] or calcitriol

In the human body: Promotes calcium absorption to enable mineralization of bone Vitamin D is essential in the reduction of inflammation Deficiency can lead to the development of rickets **There is much debate about the measurement of 25(OH)D in the body and what level is adequate for overall health. Current serum concentrations of >50 are considered adequate.

VITAMIN D

Fig. 2: The endocrine, paracrine and intracrine functions of vitamin D. Vitamin D is converted in the liver to 25(OH)D, which enters the systemic circulation and is converted to 1,25(OH)2D in a variety of end-organ tissues. As shown, 1,25(OH)2D is involved in the regulation of numerous systems. Photo by: Lianne Friesen and Nicholas Woolridge.

4/24/15  

10  

RECOMMENDED DAILY ALLOWANCE: VITAMIN D

Recommended Dietary Allowances (RDAs) for Vitamin D [1]

Age Male Female Pregnancy Lactation

0–12 months* 400 IU(10 mcg) 400 IU(10 mcg)    

1–13 years 600 IU(15 mcg) 600 IU(15 mcg)    

14–18 years 600 IU(15 mcg) 600 IU(15 mcg) 600 IU(15 mcg) 600 IU(15mcg)

19–50 years 600 IU(15 mcg) 600 IU(15 mcg) 600 IU(15 mcg) 600 IU(15 mcg)

51–70 years 600 IU(15 mcg) 600 IU(15 mcg)    

>70 years 800 IU(20 mcg) 800 IU(20 mcg)    

•  Adequate Intake (AI)

•  These guidelines are based on a minimal amount of sunlight exposure

Sources: Sunlight, many factors affect the synthesis of vitamin D including: length of day, cloud cover, time of day, sunscreen, etc. ***Given risk of unlimited sun exposure it is advised to continue with photoprotection Foods highest in Vitamin D: Very few foods contain Vitamin D. The fish liver oils and the flesh of fatty fish (salmon, tuna, and mackarel) contain the highest amounts. Foods that are fortified with vitamin D include: breakfast cereals, milk, and margarine. ***Main source of vitamin D in the standard American diet. The United States mandates the fortification of infant formula. 40-100IU/100kcal

POSITIVE EFFECTS OF VITAMIN D IN THE BODY, WHAT DOES THE EVIDENCE SHOW? The Endocrine Society practice guidelines (2011) for vitamin D

supplementation recommend that maximum effect of the vitamin occurs at levels above 75 nmol/L. They also recommended that adults supplement with at least 1500-2000 IU/day and at least 1000 IU/day for children and adolescents.

Osteoporosis: Studies suggest that there is a small increase in bone mineral density with the supplementation of vitamin D, although studies have not demonstrated a decrease in frailty among the elderly with supplementation.

Vitamin D does show promise in the role of prevention in Type 1 and Type 2 diabetes, hypertension, and multiple sclerosis, although additional studies need to be conducted to prove statistical significance.

4/24/15  

11  

SAFETY/DRUG INTERACTIONS

There is no danger associated with toxicity to vitamin D via sunshine or fortified foods.

Studies demonstrate that the toxicity upper limit of daily supplementation is between 10,000-40,000 IU/day.

Just as with calcium, corticosteroids (prednisone) can impair vitamin D metabolism which over time may lead to the development of osteoporosis.

Weight-loss medication orlistat (alli) can reduce the absorption of vitamin D, along with cholestyramine.

COST

SUPPLEMENTATION: VITAMIN D3, $10-20/3 MONTHS

SUNLIGHT=FREE FORTIFIED FOODS, vary in cost

•  Boxed Cereals:$2-4/box •  Fortified Milk: $4/gallon

Fatty Fish:

•  Salmon: ~$20/4 pounds •  Tuna: ~ $12-16/pound

STILL WANT TO LEARN ABOUT VITMAIN D? CHECK OUT: https://www.vitamindcouncil.org

VITAMIN C/ZINC Vitamin C:

•  Protects indispensable molecules in the body: proteins, carbohydrates, nucleic acids

•  Donates electrons to recipient molecules (reducing agent)

•  Increases the bioavailability of iron from foods •  Concentration of vitamin C is controlled by:

intestinal absorption, tissue transport, and renal absorption

Zinc:

•  Actively involved in the immune response, neurological functions, and reproduction

•  300 enzymes depend on zinc in order to catalyze chemical reactions

•  There are numerous nutritional interactions with zinc, including copper, iron, calcium, and vitamin A.

4/24/15  

12  

RECOMMENDED DAILY ALLOWANCE: VITAMIN C & ZINC

Recommended Dietary Allowances (RDAs) for Zinc

Age Male Female Pregnancy Lactation

0–6 months 2 mg* 2 mg*

7–12 months 3 mg 3 mg

1–3 years 3 mg 3 mg

4–8 years 5 mg 5 mg

9–13 years 8 mg 8 mg

14–18 years 11 mg 9 mg 12 mg 13 mg

19+ years 11 mg 8 mg 11 mg 12 mg

Recommended Dietary Allowances (RDAs) for Vitamin C Age Male Female Pregnancy Lactation 0–6 months 40 mg* 40 mg* 7–12 months 50 mg* 50 mg* 1–3 years 15 mg 15 mg 4–8 years 25 mg 25 mg 9–13 years 45 mg 45 mg 14–18 years 75 mg 65 mg 80 mg 115 mg 19+ years 90 mg 75 mg 85 mg 120 mg Smokers Individuals who smoke require 35 mg/day more vitamin C than nonsmokers.

SOURCES, SUPPLEMENTAL AND DIETARY

Sources: According to the 2001-2001 NHANES study Americans do receive adequate amounts of vitamin c through dietary measures. Whereas the Zinc intake among older adults has been found to be inadequate based on current recommendations, particularly amongst those groups that are food insufficient. Top 10 Foods Highest in Calcium: Top 10 Foods Highest in Zinc: •  Peppers •  Guavas •  Dark Leafy Vegetables •  Kiwi •  Broccoli •  Berries •  Citrus Fruits •  Tomatoes •  Peas •  Papaya

•  Seafood •  Beef and Lamb •  Wheat Germ •  Spinach •  Pumpkin and Squash Seeds •  Nuts (cashews) •  Cocoa & Chocolate •  Pork & Chicken •  Beans •  Mushrooms

4/24/15  

13  

POSITIVE EFFECTS OF VIT. C & ZINC IN THE BODY, WHAT DOES THE EVIDENCE SHOW?

A literature review (2012) found that use of vitamin C and zinc led to a statistically significant decrease in symptoms of rhinorrhea after 5 days of treatment. The product was also better tolerated than standard treatments.

The use of vitamin C may reduce the symptoms and duration associated with the common cold.

Zinc is now a supplement recommended by UNICEF for the treatment of acute diarrhea in childhood.

Zinc shows great promise as a supplement useful in the reduction and severity of the common cold and studies have demonstrated a significant reduction when taken 24 hours after the initial symptoms are experienced. While there is currently not a general recommendation for treatment with zinc for the common cold studies are strong and the evidence continues to grow.

SAFETY/DRUG INTERACTIONS

Vitamin C: • High doses of vitamin C may impact those individuals undergoing

chemotherapy or radiation •  Lipids should be closely monitored in those taking statin medication

and any type of antioxidant

Zinc: • Quinolone and tetracycline antibiotics: both inhibit absorption of zinc

and should be taken at least 2 hours before or 4-6 hours after taking a zinc supplement

• Penicillamine: take zinc 2 hours before or after • Diuretics: increase zinc excretion, patients should be monitored for

their zinc level if taking hydrochlorothiazide

COST

Vitamin C Supplement: $15/3 months Zinc supplement: $5-10/3 months

Vitamin C

•  Peppers: $0.25/each •  Dark Leafy Vegetables: $2.00 •  Broccoli: $2.50/12 ounces •  Berries: $10/48 ounces •  Tomatoes: $2.50/4 pack •  Peas: $0.75/8.5 ounce can

Zinc •  Seafood:price varies •  Wheat Germ:$5.00/12 ounces •  Spinach: 2.00 •  Pumpkin and Squash Seeds:$2.50/5 oz •  Nuts (cashews): $10/26 oz •  Mushrooms: $4.00/16 oz

4/24/15  

14  

B12

•  Part of a group of vitamins called “cobalamins” due to the fact that it contains the mineral cobalt

•  Released by the activity of hydrochloric acid and gastric protease in the stomach.

•  Required for DNA synthesis, formation of blood cells, and neurological functions.

•  The autoimmune disorder, pernicious anemia, if left untreated can cause B12 deficiency

•  While the current measurement of B12 is through a serum test, there is evidence that a better marker would be the measurement of methylmalonic acid, as this is an indication of a metabolic change specific to vitamin B12 status

http://www.aafp.org/afp/2003/0301/p979.html

RECOMMENDED DAILY ALLOWANCE: B12

Recommended Dietary Allowances (RDAs) for Vitamin B12

Age Male Female Pregnancy Lactation

0–6 months* 0.4 mcg 0.4 mcg

7–12 months* 0.5 mcg 0.5 mcg

1–3 years 0.9 mcg 0.9 mcg

4–8 years 1.2 mcg 1.2 mcg

9–13 years 1.8 mcg 1.8 mcg

14+ years 2.4 mcg 2.4 mcg 2.6 mcg 2.8 mcg

* Adequate Intake

4/24/15  

15  

Sources: o  cyanocobalamin and methylcobalamin are the most common forms of

vitamin b12 o  Available as an oral supplement, sublingual tablets or lozenges, as well as

intramuscular injections

Foods Highest in vitamin B12: The majority of Americans consume the recommended daily dose of vitamin B12. Fish, meat, cheese, and eggs (i.e. animal products contain the highest amounts of B12). Fortified foods are available for those who are vegetarians or those who have malabsorption disorders. These same individuals may also benefit from oral supplementation or B12 injections.

POSITIVE EFFECTS OF B12 IN THE BODY, WHAT DOES THE EVIDENCE SHOW?

Studies have demonstrate that vitamin B12 is responsible for lowering homocysteine levels, which suggests a role in cardiovascular disease, however the American Heart Association has stated that at the present time there is inadequate support.

May play a role in cognitive function and dementia, although further studies are needed.

Essential for fatigue and weakness associated with B12 deficiency. It is recommended to screen for vitamin B12 deficiencies in those

suffering from depression. Vitamin B12 deficiency has been linked to Alzheimer's disease and

therefore this should be screened for in the elderly who demonstrate any signs of cognitive decline.

SAFETY/DRUG INTERACTIONS

There have been no associated adverse effects with excess B12 intake from food or supplementation according to the IOM.

Proton pump inhibitors: interferes with B12 absorption, B12 levels should be

monitored in any patient who is taking a PPI H2 receptor antagonists: interferes with B12 absorption, B12 levels should

be monitored in any patient who has been using an H2 blocker for more than 2 years

Metformin: Reduction of B12 absorption, recommended B12 assessment on

those managed with metformin

4/24/15  

16  

COST

Supplement: $10-20/3 months Clams, 3 ounces: $5.99/pound Liver: $2.99/pound Salmon: $20/3 pounds Egg, 1 dozen: $2-4/dozen Yogurt, low-fat: $3-6/32 oz Tuna fish, 3 ounces: $3-5

FISH OIL, OMEGA 3 Composition: polyunsaturated fats There are 3 principal acids which include: alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) Dosing (RDA): 0.5-1.6 g/day Sources: can be taken as a supplement, dietary sources include canola oil, flaxseed oil, fatty fish and shellfish EBR: to date there has been no study to suggest that supplementation protects against heart disease. A diet high in omega 3 rich foods has been shown to reduce the risk of heart disease. Safety: Generally no negative effects, although as omega 3 fish oil contains vitamin A and D it is important to ensure that patients are aware as these can be toxic at high levels Drug Interactions: may interfere with blood clotting agents Cost: $30-50/4 month supply

PROBIOTICS: FAST FACTS

Strong evidence supports the use of probiotics in the reduction of symptoms associated with H. pylori, the treatment of several gastrointestinal condition, necrotizing enterocolitis, irritable bowel syndrome, and the reduction of overall cholesterol levels. The quality of probiotics varies greatly and it is important to recognize the specific ailment of the patient in order to direct them to the appropriate strains of probiotic. The University of Wisconsin has put out an informational sheet on the use of probiotics and prebiotics which can be distributed to patients: http://www.fammed.wisc.edu/sites/default/files/webfm-uploads/documents/outreach/im/handout_probiotics_patient.pdf There are a number of resources available to assist you in choosing the right strain for the needs of the patient. See article by Jason Hawrelak in the Journal of Australian Traditional-Medicine Society (2003). For additional information see also his website: https://www.probioticadvisor.com

4/24/15  

17  

COQ10: FAST FACTS Antioxidant, required for mitochondrial ATP synthesis, which is found in plants, animals, bacteria, and people. Levels do decline with age. Supplement dose ranges from 30-100 mg/day. Average daily dietary intake is 10 mg/day. Foods highest in CoQ10 include: beef, fish, canola oil, chicken, peanuts, pistachio nuts, broccoli, and cauliflower. SHOULD NOT BE USED IN WOMEN WHO ARE PREGNANT OR BREASTFEEDING CoQ10 supplementation has been shown to improve cardiac function. Randomized controlled studies have shown that the use of 100-120 mg/day of CoQ10 reduced systolic blood pressure by 11-17 mm Hg. CoQ10 does interfere with anticoagulant therapy and may decrease the efficacy of this treatment. Statins may decrease the level of CoQ10, however studies are pending to assess if those taking a statin would benefit from supplementation. Studies are currently looking at the affect of CoQ10 supplementation on age-related functional declines, however to date there is no scientific proof that there is an association.

On-line Resources for Additional Information

http://lpi.oregonstate.edu/infocenter/ Linus Pauling Institute Micronutrient Research for Optimal Health http://ods.od.nih.gov/HealthInformation/makingdecisions.sec.aspx National Institutes of Health: Office of Dietary Supplements http://www.drweil.com Dr. Andrew Weil Official Website http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND Natural Medicines Comprehensive Database