Tag Archives: dietary supplements

Energy Drinks – Are Those Shots Really Safe?

Beverages like Red Bull, Rockstar, Monster Energy, 5-Hour Energy, Mountain Dew Kickstart, and Full Throttle are touted to increase energy, improve mental alertness, and enhance physical endurance. Some of these products are marketed as beverages while others are marketed as dietary supplements.

According to the Center for Disease Control and Prevention, between 2007 and 2011, the number of energy drink-associated emergency room visits doubled. In 2011, one in 10 of them resulted in a hospitalization. Some college students will unsafely consume energy drinks along with alcohol or other products/drugs (e.g., marijuana, OTC or prescription medications).

Ever looked at the nutrition label on the back of one of these products? They contain more than just caffeine and sugar, namely B vitamins, amino acids (taurine and carnitine), and other dietary supplements -> green tea extract, guarana, yohimbine, green coffee bean extract, bitter orange, glucuronolactone, ginkgo biloba, and ginseng. A single 16-oz bottle may contain up to 62 grams of added sugar, more than the maximum amount recommended in one day (15 teaspoonfuls – 250 calories).

In smaller quantities, caffeine may boost energy and alertness. In larger quantities, caffeine can negatively affect the cardiovascular system. Taurine may boost metabolism. In theory, extra carnitine may impact fat burn. The body is typically not deficient in endogenous carnitine, so it’s a waste of your money. Guarana contains caffeine. Green tea extract contains caffeine and the antioxidant EGCG. Green coffee bean extract contains caffeine. Yohimbine and bitter orange are central nervous system stimulants.

Ginseng does not impact energy and may lower blood sugar in diabetics – diabetics should be careful with its use. Ginkgo biloba has not been clinical proven to improve energy. Water soluble B vitamins protect nerves but may not improve energy. Thankfully, they will be eliminated by the kidney if taken in excess.

Glucuronolactone, a component of connective tissue, is metabolized into glucuronic acid and is touted to ‘detoxify’ (what?) in the body, a nebulous claim that is unproven in humans. It has no impact on energy.

Possible side effects from energy drinks include, but are not limited to, rapid heartbeat, heart palpitations, heart attack, and headaches. Caffeine and other stimulants may also be associated with anxiety, sleep problems, digestive problems, and dehydration.

If you feel you need to consume energy drinks, a good health rule is to consume them in moderation and remember that there may be negative outcomes. Talk it over with your primary care physician. Be healthy, eat whole foods, get ample restorative sleep, and stay safe.

REFERENCES:

Higgins. Energy beverages: content and safety. May Clin Proc 2010:85:1033-1941.
Sankararaman. Impact of energy drinks on health and well-being. Current Nutrition Reports 2018;7:121-130.
Uliah. Energy drinks and myocardial infarction. Cureus 2018;10;e2658

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Cathy Rosenbaum PharmD RPh MBA CHC 10/12/18©

 

 

Finding Gluten-Free Nutrition, Dietary Supplements, and Medications

Non-celiac gluten intolerance and celiac disease are becoming more common. Celiac disease is a chronic autoimmune disorder caused by a genetic intolerance to gluten. Non-celiac gluten intolerance is diagnosed in people who do not have celiac disease, but have intestinal or extra-intestinal symptoms related to ingestion of gluten-containing grains.

Both conditions are treated by avoiding gluten containing foods. Finding ‘gluten free’ nutrition is becoming easier to do, but eliminating gluten from one’s diet can be a complex and time-consuming process.

Gluten is the protein component of wheat (e.g., including spelt, kamut, semolina, and triticale), barley (e.g., including malt), and rye. When a person with celiac disease or non-celiac intolerance ingests gluten, specifically the antigenic gluten constituent called gliadin, it can cause intestinal inflammation, diarrhea, abdominal pain, bloating, weight loss, fatigue, and iron deficiency anemia. Food malabsorption and nutritional deficiencies result.

Over time, these conditions can cause liver disease, defective gallbladder emptying, and osteoporosis. Celiac disease may be a reversible cause of osteoporosis. Adherence to a gluten-free diet is one way to help suffers minimize overall symptoms and to maintain maximal bone mineral density.

For perspective, oats are considered a type of gluten grain, but do not have the antigen that other gluten grains above do. Thus, oats do not induce an immune reaction in the small intestine of people with celiac disease. However, many commercial oat products are contaminated with wheat, barley, or rye and it’s important to carefully read their labels. Look for products that are certified to contain less than 20 ppm of gluten (FDA’s ‘gluten free’ definition).

Consumption of as little as 10 mg-50 mg gluten daily can lead to a clinical relapse in people with these conditions. Celiac disease may increase the risk of developing some types of cancer (e.g., T cell lymphoma and intestinal adenocarcinoma) if gluten restrictions are not maintained or gluten intake is only partly restricted.

It is important to find out where gluten resides in foods. This means not only reading food labels on products you purchase for home but also on foods you consume from fast food establishments and restaurant dining. Soups, sausages, and ice cream may contain hidden amounts of gluten as fillers. Talk with your grocer and restaurant owners before you consume questionable food items.

Watch out for the gluten content in herbs, other dietary supplements, and medications.

Gluten-Free Foods
Consuming foods certified to be ‘gluten free’ will help keep the daily gluten total to under 50 mg and not cause symptoms for most people with celiac disease. Gluten-free grains include rice, millet, corn, quinoa, sorghum, and buckwheat. For more information, visit http://glutenfreecooking.about.com/od/gettingstarted/a/hiddengluten.htm
or http://www.glutenfreeliving.com/nutrition/ingredients.

Gluten-Free Herbs and Other Dietary Supplements
It would be impossible to find information about the gluten content in over 60,000 products on the worldwide market. One can contact dietary supplement manufacturers directly for more information on gluten content before taking any of these products, including vitamins.

Gluten-Free Medications
Over-the-counter and prescription medications may contain gluten in the list of inactive ingredients. For example, sweeteners used in medications may be hidden sources of gluten. Some manufacturers cannot guarantee their medications are gluten-free because the suppliers of raw materials can not do so, making it even more difficult for consumers to figure out what is safe to take and what is not.

A great resource for determining the overall ingredient content in medications, including whether or not gluten is present, can be found online at www.glutenfreedrugs.com .

Another online medication reference comes from the National Institutes of Health at www.dailymed.nlm.nih.gov. Go to the site, type in the generic name of the medication you want to review, then scroll down to the name of the manufacturer of that particular product, then click on ‘description.’ Scroll down to the inactive ingredients and look for gluten.

A third way to find more information about your medication’s gluten content is to call the medication manufacturer directly. Be sure to have the medication’s lot number available when you call.

Finally, click on https://www.ncbi.nlm.nih.gov/pubmed/?term=Gluten+content+of+the+top+200+medications+of+2009%3A+a+follow+up+to+the+influence+of+gluten+on+a+patient%E2%80%99s+medication+choices for “Gluten content of the top 200 medications: follow up to the influence of gluten on a patient’s medication choices” by AR King in Hosp Pharm 2013:48:736-43.

By Cathy Rosenbaum PharmD MBA RPh CHC

OTC Diagnostic Tests – Hair Analysis & Antioxidant Testing – What Can They Tell Us?

There’s been an explosion of “alternative” diagnostic methods claiming to identify nutrient deficiencies, detect environmental toxins, predict serious diseases before they emerge, and help guide health conscious individuals in their diet and supplement choices.

Look through any consumer-oriented health magazine and you’ll likely see lots of ads and articles referencing iridology, bio-impedance testing, hair analysis, applied kinesiology, meridian analysis, oxidative stress measurement and a host of other diagnostics.

The popularity of these alternative self-diagnosis methods is part of the broader movement toward patient self-empowerment, self-care and personal responsibility. Many people know they’re not eating balanced diets rich in vitamins, minerals, and antioxidants. Their concerns for health are warranted, and in many cases nutritional supplementation is reasonable.

But are these testing methods valid? Can they really provide the sort of guidance consumers eek?

Hair Analysis

Techniques for measuring minerals, metals and other substances in hair have been around for decades. Advocates say they can indicate chronic mineral and nutrient deficiencies thus identifying which nutrients should be supplemented. Others use hair analysis to detect toxic heavy metals like mercury or lead, to guide detoxification protocols.

The American Medical Association and other mainstream medical societies have been categorically dismissive of hair analysis. In 1994, AMA issued a statement indicating that it “opposes chemical analysis of the hair as a determinant of the need for medical therapy and supports informing the American public and appropriate governmental agencies of this unproven practice.”

While it is unlikely that hair analysis can accurately detect vitamin/mineral deficiencies or imbalances, it can screen for exposure to heavy metals like mercury, lead, and aluminum.

Normal hair levels for minerals or heavy metals have not been well established. The truth is that over time, heavy metals like mercury, found in the earth’s crust and in our environment, do find their way into our hair, blood, and body. Here’s one scenario. Hair analysis may serve as an initial screen for mercury exposure. Then based on the type of mercury suspected (e.g., organic or inorganic), blood and/or urine levels may more accurately represent potentially toxic amounts in the body. Researchers would use additional tests to confirm these levels (i.e., cold vapor atomic absorption spectrophotometry). Surprisingly, it’s rare to find a person with no mercury in her/his body. Many people without amalgam dental fillings can have a blood mercury level of 5 mcg/L based on exposure from the environment.

Mineral and vitamin imbalances in the body (i.e., calcium, zinc, iron, copper, manganese) may be due to multiple factors such as improper diet, medication usage, stress, and genetics. Common medications like birth control pills may deplete zinc and some B vitamins; corticosteroids deplete calcium, selenium, and zinc. Histamine-2 receptor antagonists for ulcers may deplete iron, zinc, and vitamin B12. If the results of a hair analysis indicate a low level of minerals, it is prudent to screen for and address the root cause of the problem before recommending dietary supplements to replace them. An initial next step would be a blood test.

Next, since hair has no blood supply and grows slowly, mineral levels in hair do not correlate with the amount of minerals in other body tissues. Contrary to what consumers may believe, a hair analysis will not reflect a person’s most recent diet or health status. Further, many people color their hair, expose it to sun, chemicals in pool water, and hair dryer heat, all of which can affect the function of the hair follicle as well as alter the analysis of a given hair sample. Traces of substances we eat, drink or breathe may end up in our hair, but so will many other things, making it difficult to glean meaningful information about nutritional needs from hair studies alone (Seidel S. JAMA 2001;285;67-72).

There is also the big question of reference standards. Regardless of the specific analytic techniques used by commercial laboratories, hair analytic techniques must be validated against a standard reference. Not all clinical labs use a reference. Examples of reliable analytical methods used to measure and verify substances in the hair include the following: cold vapor atomic absorption (used for methyl mercury); inductively coupled argon plasma mass spectrometry (methyl mercury); inductively coupled argon plasma optical emission spectrometry (trace elements); neutron activation analysis (trace elements); X-ray fluorescence (mercury); and proton induced X-ray emission spectrometry (good for discerning external hair contamination from internal hair follicle contamination). Only a trained scientist can understand the differences among these tests and it’s important to note which is used when interpreting hair analysis.

A better approach to diagnosing mineral deficiencies involves measuring blood levels of iron, calcium, zinc, plasma copper, and manganese to assist in nutritional recommendations addressing clinically significant deficiencies. Multi-elemental hair analysis may hold a clue or two regarding a person’s heavy metal exposure or nutritional status, but it should not take the place of a thorough health history, medication & dietary supplement history, and physical exam.

Oxidative Stress and Antioxidant Testing

The concept of oxidative stress has gotten a lot of media attention, as researchers learn more about how free radicals contribute to the aging process and chronic diseases. Likewise, the public has shown tremendous interest in antioxidants and their role in preventing free radical oxidative damage. These concerns have spawned wide consumer interest in tests to assess oxidative stress levels and antioxidant capacities.

In principle, there’s nothing unreasonable about this. The body does produce several measurable markers of oxidative stress, including 8-isoprostane, a prostaglandin-like compound; oxysterols (i.e., 7-ketocholesterol, 7B-hydroxycholeserol); allantoin, the product of uric acid oxidation by purine catabolism; Total hydroxyoctadecadienoic acid (tHODE), a measure of hydrogen donor capacity; and thiobarbituric acid reactive substances (TBARS), measured with an assay utilizing malondialdehyde (MDA).

Natural antioxidants found in our bodies, thought to counteract reactive oxygen species, include erythrocyte superoxide dismutase, glutathione peroxidase, lipid hydroperoxide, and selected protein carbonyl groups. Common dietary antioxidants found in foods as well as supplements include vitamin C, vitamin E, vitamin A, beta carotene, and many others, all of which can be measured to some degree of accuracy.

But what can measuring these constituents tell us, and can measurements really be used to guide supplementation regimens?

Blood Antioxidant Measurements: Many consumers are asking about their ‘antioxidant health’ in an effort to stave off free radical cellular damage from high levels of oxidative stress. Clinical testing labs offer a wide range of tests for the various natural antioxidants listed above, as well as exogenous antioxidants from dietary supplements like co-enzyme Q 10, vitamin A, vitamin E, selenium, and beta carotene. Legitimate testing methods may be used to guide a physician, naturopath, or pharmacist to make nutritional or dietary supplement recommendations.

Each of the antioxidant tests could cost you over $100. It’s wise to check with your insurance carrier to find out if tests are covered before your physician prescribes them.

FRAP Test: The total antioxidant “power” of blood plasma can be defined by way of an assay called the FRAP test, measuring ferric reducing/anti-oxidant power in µmol/L. There are several published clinical studies of FRAP testing. One small study indicates the need to differentiate test results by gender (Chung W. Atherosclerosis 1998;136:78). Another demonstrates how the FRAP test may be used to evaluate the antioxidant effectiveness of wine (Katalini V. Food Chemistry 2004;86:593-600). Results of the FRAP test may have more application to food analysis than clinical practice, and may not correlate well with antioxidant deficiencies in the body.

Skin Carotenoid Test: This test has been widely popularized in recent years by Pharmanex, a multi-level, network-marketing supplement company that has made biophotonic scanning of carotenoids in the skin a cornerstone of its sales strategy.

The test, called “Bioscan,” makes use of the fact that carotenoids in human skin resonate with a certain wavelength of blue laser light, releasing a light signal of altered wavelength that can be easily measured.

Pharmanex representatives use the Bioscan as a way of detecting antioxidant deficiencies in their prospective clients. The client receives a piece of paper, a Bioscan Certificate, with his/her “Skin Carotenoid Score.” The score is mapped on a color bar ranging from low to high, then given a numerical value. Generally, if the value is low, the individual’s intake of carotenoid-containing food and/or supplements is low, and the representative encourages the prospective client to increase their intake, preferably with Pharmanex products. The Bioscan is a legitimate test for skin carotenoid levels but cannot predict total body stores or nutritional deficiencies.

Leaving aside the ethical question of using a test like this to sell supplements, there is the clinical question of whether the level of skin carotenoids, a single class of antioxidant compounds in our diets, accurately represents an individual’s overall dietary intake of foods containing potentially thousands of different flavonoid-like constituents found in nature? Further, can carotenoid levels alone be used to guide nutrition-based strategies? The carotenoid test is a snapshot of one nutritional day not a trend over months or years and may have little clinical bearing beyond an initial screening tool regarding your nutritional status.

A well-balanced diet including vitamins and minerals, while imperative for optimal health seems to be difficult for most Americans to maintain. Dietary supplements do offer an alternative, and research tells us that antioxidant-rich dietary supplements or foods have promise in the area of cancer prevention, cardiovascular health, and memory health. However, we do not know the optimal dose for each nutrient/ingredient for prevention of these conditions according to a National Institutes of Health-funded study (Huang H. Ann Intern Med 2006;145:372-385.).

There are legitimate reasons to question some of the testing methods that have captured consumers’ interest. But it is also important to recognize that in seeking out these tests, consumers are revealing their health concerns and demonstrating a wish to make changes.

More long-term research is needed to confirm endogenous (internal) as well as exogenous (from our diet) baseline antioxidant status, as well as confirm the magic combination of antioxidants, doses, and duration of therapy necessary to help prevent certain diseases. A lot of the tests consumers are seeking are probably not able to provide them the guidance they need.

Rather, seek out well-trained clinical pharmacists and naturopathic physicians, as well as clinical laboratories with high integrity and solid analytical testing methodologies to help better serve you in your health journey. Of course, start with good nutrition including colorful fruits and vegetables high in antioxidant value.

Contributing Author: Cathy Rosenbaum PharmD MBA RPh CHC

Grapefruit Interactions with Medication

Certain prescription and/or OTC medications and dietary supplements may negatively interact with grapefruit juice, grapefruit, Seville oranges, pomelos, and tangelos due to chemicals in the fruits.

Fruit chemicals are thought to block enzymes in the body that metabolize medication in the small intestine, thereby causing the medication to hang around longer than expected. Interestingly, these fruits may also interfere with transporters in the body, causing medication to be less well absorbed into the bloodstream, and may reduce medication or supplement effects. Sound confusing? It’s complicated.

Product classes involved in unwanted interactions include, but are not limited to:

-Antihistamines (e.g., Allegra)
-Antianxiety
-Antihypertensives
-Cholesterol-lowering ‘statins’
-Corticosteroids for Crohn’s disease and ulcerative colitis
Dietary supplements

Only some of the medications and supplements in each of the categories can be affected by the fruit/juices. Every person may react differently based on the amount of fruit they consume, the medication or supplement type/dose taken, and the individual’s natural ‘enzyme levels.’

Don’t worry, but do get educated about how and when to properly take your medications and supplements to be safe. Enjoy healthy nutrition. Talk with your pharmacist about what’s best for you!

Beyond Use Dates on Prescription/OTC Medications & Dietary Supplements

Expiration dates on OTC & prescription medications and dietary supplements typically fall between 12 – 60 months after product production. Pharmaceutical manufacturers are required by law to establish these dates but do not have to study product stability and potency beyond those dates.

A recent study published in JAMA Internal Medicine using eight medications containing 15 active ingredients demonstrated product potency for decades beyond the original expiration dates. Another study in the military concluded the same results for 100 medications after 15 years.

The U. S. government has a Shelf Life Extension Program to extend dates on federal stockpiles for the military. But this is the exception to the rule in a special population to save the government money in repurchasing.

The bottom line for consumers is this – > follow the product manufacturer’s established expiration date stamped on the OTC bottle or prescription vial. Follow these same guidelines for your dietary supplements as well.

Keep all of these products in a cool, dry, dark place in your home.

Vitamins, Are They Safe?

A recent review of multiple studies indicates that mega-dosing of fat soluble vitamins (A, E, D) and some water soluble vitamins (C, folic acid) may not help prevent disease and can potentially cause harm. Please talk with your doctor or pharmacist about the right combination and dosage of multiple vitamins and other dietary supplements for your health needs. Everyone is unique and different!

– Hamishehkar, Ranjdoost, et al. Vitamins, Are They Safe? Adv Pharm Bull 2016:6(4):467-477.

Polypharmacy Is Not Jolly!

Polypharmacy Is Not Jolly! By Cathy Rosenbaum PharmD MBA RPh CHC

Hallelujah. The healing paradigm is finally shifting in the U.S. The time is ripe for doctors to rethink how they prescribe medications. Less is more. As a fellow health care professional, I believe medical students should be taught to utilize drugs sparingly, as only one of many, customizable tools in their future healing quivers.

Envision a country where you as the patient could be asked by your doctor to select from a menu of non-invasive, evidence-based holistic healing regimens when needed. That’s right, you would choose! Aromatherapy, guided imagery, spiritual retreats, Yoga, Tai Chi, personality testing, and acupuncture would be covered by insurance or included as part of your total office visit fee. Doctors would collaborate with evidence-based non-traditional medicine practitioners for your good.

Seniors over age 65 years represent 12% of the U.S. population and consume 32% of prescription medications. Many take five or more prescription medications, intentionally combining them with other over-the-counter medications and multi-ingredient dietary supplements. Boomers, we need to collectively push back against that machine.

Everything changes. Our body’s physiologic clock resets as we mature in the life journey. We become more sensitive to the effects of medications. Talk with your doctor about this list of possible options the next time you go to the office.

• Sleep Restoration – drink a cup of chamomile tea, lavender tea, or decaffeinated green tea before bedtime; try a few minutes of slow, deep breathing as you retire to inhale life-giving oxygen and calm you down from the day’s challenges
• Stress/Anxiety – repeat affirming statements about your life blessings (we all have them); read up on the benefits of acupressure
• Weight Loss – eat apples and drink water for snacks; walk around the dining room table and up/down home stairs for ½ hour a day (yes, and let your neighbors see you through the window)
• Arthritis Pain/Inflammation – talk with your doctor about the appropriateness of glucosamine HCL or turmeric dietary supplements instead of a years worth of NSAIDs like Naprosyn and Motrin that can damage the kidney, heart, and stomach
• Viral Colds – eat chicken noodle soap; try zinc lozenges, as directed on the package label, at the first sign of symptoms
• General Health – exude a positive attitude; teach your family to grow, cook, and eat from the Mediterranean diet (e.g., olive oil, colorful fruits and vegetables, moderate wine consumption, nuts); prefer whole (not processed) foods for your nutrition regimen, locally grown in your own organic garden or community supported agriculture farm

New Year’s Resolutions

Consumers:

• Let your feet do the shopping. Choose a primary care physician that thinks out of the box and is open to integrative health principles & practices (see the Academy for Integrative Health and Medicine @ www.aihm.org )
• Don’t expect to get a prescription medication every time you leave the doctor’s office
• Incorporate medicinal herbal spices and teas into your nutritional regimen for health and taste
• Take charge of holistic you in your body mind and spirit
• Get educated on the exciting integrative health and healing paradigm (visit www.NIHseniorhealth.gov, www.babyboomers.com, www.lifereimagined.com)

Physicians:

• Be aware of all medications and dietary supplements your patients are taking; supplements act like drugs and have interactions and side effects that you must acknowledge and manage
• Treat your patient as an equal partner in the decision-making process and consider his/her point of view before prescribing any medication
• Try prescription drug reduction strategies (one medication as opposed to several, lowest dose possible)
• Try drug holidays (e.g., FLEX study with Fosamax for osteoporosis)
• Try evidence-based, alternate drug regimens (e.g., every other day Zocor for high cholesterol)
• Promote healthy nutrition to your patients at every office visit; discuss connection to eating whole foods and a healthy immune system

Pharmacists:

• Explain to your patients the importance of shopping at one pharmacy for all prescription medications
• Get educated on nutrition and dietary supplements,
• Recommend medicinal herbal teas instead of OTC medications whenever appropriate
• Talk consumers out of taking antibiotics for viral infections

Summary
Integrative health and medicine is here to stay. Take a lifelong learning class in your local community. Teach your grandchildren about it as your contribution to the family legacy. Be a part of the health evolution revolution. Happy New Year!

Dr. Rosenbaum has authored and just published, Don’t Sweep It Under the Drug! Integrating Evidence-Based Body Mind & Spiritual Practices into Your Health & Wellness Tool Kit, available on www.Amazon.com. Her book is the Xulon Press Fall 2015 Second Place Winner of the Christian Authors Award, Category: Health.