Patient Awareness and Knowledge about Bleeding Risks Associated with Common Dietary Supplements

Individuals at risk of metabolic syndrome are more likely to use a variety of dietary supplements

Dietary supplement use has continued to rise. In addition to supplement-drug interactions, it is prudent to consider how dietary supplements may interact with a patient's specific pharmacogenetics. Variations in genes associated with CYP 450 enzymes have evidence of impacting drug metabolism and adverse effects. This research was performed to evaluate CYP P450 enzyme activity of the top 15 dietary supplements used in the USA in order to initiate pharmacogenetic considerations specific to commonly used dietary supplements. The most common dietary supplements used in the USA were obtained from the National Health and Nutrition Examination Survey (NHANES). Primary literature detailing supplement CYP P450 activity was compiled from PubMed using MeSH search terms: supplement name(s), cytochrome P450 enzymes, metabolism, and pharmacokinetics. Additional resources utilized for documented CYP enzyme genotypes were the pharmacogenetic databases from Clinical Pharmacogenetics Implementation Consortium and The Pharmacogenomic Variation Consortium. Of the 15 most common dietary supplements used in the USA, 53% (cranberry, echinacea, garlic, ginkgo biloba, ginseng, melatonin, milk thistle, and valerian) exhibit CYP P450 metabolism, with some having possible induction activity as well. Melatonin and garlic are substrates of CYP1A2 and CYP2C19, respectively. Additionally, there is evidence of echinacea having possible CYP3A4 induction activity. CYP P450 activity is an important consideration for any patient but becomes increasingly critical if patients have certain CYP P450 phenotypes that impact metabolism. These popular supplements have the potential for changes in supplement exposure, and adverse effects based on pharmacogenetic profiles. Furthermore, these sites of metabolism are shared with many medications, setting the stage for possibly more profound interactions between medications and supplements. This paper highlights the mechanisms in which dietary supplements may constitute a risk for patients with certain CYP P450 phenotypes. Further research is needed in the area of dietary supplements and their pharmacogenomic implications.

The prevalence of dietary supplement use varies largely among populations, and previous studies have indicated that it is high in the Danish population compared with other European countries. The diversity in supplement use across countries indicates that cultural and environmental factors could influence the use of dietary supplements. Only few studies investigating the use of dietary supplements have been conducted in the Danish population. The present cross-sectional study is based on 54,948 Danes, aged 50-64 years, who completed self-administrated questionnaires on diet, dietary supplements and lifestyle between 1993 and 1997. A health index including smoking, physical activity, alcohol and diet, and a metabolic risk index including waist circumference, urinary glucose and measured hypertension were constructed. Logistic regression was used to investigate these determinants in relation to the intake of dietary supplements. We found that 71 % of the participants were dietary supplement users; female sex, older age groups and higher educated participants were more likely to be users of any dietary supplements. One additional point in the health index was associated with 19, 16 and 9 % higher likelihood of being user of any, more common and less common supplements, respectively. In the metabolic risk index, one additional point was associated with 17 and 16 % lower likelihood of being user of any supplement and more common supplements, respectively. No significant association was found for less common supplement use. In conclusion, those with the healthiest lifestyle were more likely to use dietary supplements. Thus, lifestyle and dietary composition should be considered as confounders on supplement use and health outcomes.

Background and objectives: The use of dietary supplements is extremely common among cancer patients. It is estimated that 20–90% of cancer patients use some form of dietary supplement. Most often, they are “self-selected” supplements or selected from unverified Internet sources, without consulting a specialist. Components in such supplements can interact with the applied therapy and impact cancer patients’ treatment. The aim of this study was to examine the frequency and type of supplementation used by cancer patients. Methods: A cross-sectional observational study was conducted on 52 cancer patients (mean age: 58 years) by using a study-specific questionnaire, conducted between February and July 2022 at the University Clinical Hospital Mostar, Bosnia and Herzegovina. Results: More than half of the respondents (62%) use some dietary or herbal supplements daily. The most common dietary supplements were probiotics (22%), B complex vitamins (22%), and vitamin D (22%). Patients (46.8%) used supplements based on their own or their family–friend’s recommendation, and 90% of them started to use supplementation during therapy. The main reason for use, as stated by 71.8% of the respondents, was to support immunity. Approximately 56.2% of them said that they had noticed a positive effect on their health. It is concerning that 78.8% of patients did not research the possible side effects and risks of taking supplements during therapy. Conclusions: Doctors, nutritionists, and nurses should improve communication with patients by giving them reliable information and evidence-based recommendations about dietary supplements and complementary therapy in general. During consultations, professionals should offer assistance and discuss potential benefits and risks with the patient in order to achieve a mutually informed decision on dietary supplement use.

Objective: Consumer usage of dietary supplements is prevalent in the United States, and total usage is higher than reported in recent National Health and Nutrition Examination Surveys (NHANES), because these surveys capture usage only in the 30 days prior to the respondent's interview and do not capture occasional and seasonal use throughout the year. We report data from a series of consumer surveys on the full extent of dietary supplement use, on the reasons for supplement use, and on the products most commonly taken, as well as other health habits of supplement users. Methods: The Council for Responsible Nutrition (CRN), a trade association of the dietary supplement industry, has contracted with Ipsos Public Affairs to conduct consumer surveys annually since 2000. The surveys have been administered online since 2007 to about 2000 subjects each year. We report 5 years of data (2007 to 2011) on the prevalence of dietary supplement use, as well as more detailed data from the 2011 survey on the products used, the reasons for using supplements, and other health habits of supplement users. Results: The prevalence of supplement use fluctuated within the range of 64% to 69% from 2007 to 2011, and the prevalence of regular supplement use ranged from 48% to 53%, with no statistically significant differences from year to year. Over the 5-year period, the percentage of respondents who said that they regularly used a variety of supplements increased from 28% to 36%, and the increase from 2010 to 2011 was statistically significant. The percentage of respondents who said that they regularly used only a multivitamin, as opposed to a variety of supplements, declined from 24% to 17%, and the decrease from 2007 to 2008 was statistically significant. Detailed results from the 2011 survey confirm that supplement use increases with age and is higher in women than in men. Vitamin or mineral supplements were used by 67% of all respondents in 2011, specialty supplements by 35%, botanicals by 23%, and sports supplements by 17%. Among supplement users, multivitamins were the most commonly used supplement (71%), followed by omega-3 or fish oil (33%), calcium (32%), vitamin D (32%), and vitamin C (32%). The reasons most often cited for supplement use were for overall health and wellness (58%) and to fill nutrient gaps in the diet (42%). Supplement users were significantly more likely than nonusers to say that they try to eat a balanced diet, visit their doctor regularly, get a good night's sleep, exercise regularly, and maintain a healthy weight. Conclusions: Annual consumer surveys over a period of 5 years show that dietary supplement use is somewhat more prevalent in the United States than has been reported in the NHANES surveys, when occasional and seasonal use are taken into account, in addition to regular use. Most dietary supplement users take a multivitamin, and many take a variety of products. The primary reasons given for supplement use are for overall health and wellness or to fill nutrient gaps. Users of dietary supplements are more likely than nonusers to adopt a variety of healthy habits, indicating that supplement use is part of an overall approach to living healthy.

Dietary Supplement Use Is Associated with Select Serum Nutrient Biomarkers among Postmenopausal Women: Results from a Controlled Feeding Study.

Introduction: The purpose of the study was to determine the prevalence of dietary supplement use, types of physical activities, and aims of supplements users and non-users, knowledge about their side effects, and changes reported due to dietary supplements use in the suburbs of Beirut, Lebanon. Methods: 220 male participants between the ages of 15 and 53 completed a questionnaire on the ingestion of dietary supplements and knowledge about their benefits and side effects. The study population was drawn from seven health and fitness clubs located in the suburbs of Beirut city. Results: Out of the 220 participants, 109 (49.5%) reported taking supplements; protein shakes were the most consumed (49.5%). Participants mainly engaged in strength exercises (56.7%), and users of dietary supplements were found to practice more than non-users. Users of dietary supplements mainly performed physical activity to build muscles while non-user aims were mainly to improve fitness and performance and to lose weight. Participants sought knowledge regarding dietary supplement use from the internet (24.6%), friends (21.1%), or coaches and personal trainers (24.6%), and rarely from licensed dietitians (1.8%). The greatest difference reported after the use of supplements was improved performance and muscle growth (12.8%). Knowledge about supplements was rated to be low and inaccurate, as 57.8% believed supplements have no side effects and 16.5% did not know what the side effects were. Conclusion: There is limited data on dietary supplement use from males in Beirut, Lebanon. This study provides data to contribute to the awareness on the use of dietary supplements specific to this population.

This study examined the usage patterns of dietary supplements during menopause, providing information about type, prevalence, and rationale for use. A survey instrument was distributed to self-identified peri- or postmenopausal women at a San Francisco women's health conference in March 2000. Of the 100 eligible women, 29% used hormone replacement therapy (HRT) alone, 16% used HRT with dietary supplements (Combo group), 32% used dietary supplements alone, and 13% used no product or used supplements excluded in this survey. The most common dietary supplements were soy (29%), ginkgo biloba (16%), and black cohosh (10%). Only 54% of women using dietary supplements reported such usage to their primary care providers. Women using HRT alone reported relief of hot flashes significantly more often than those using dietary supplements alone (63% vs. 30%; p = 0.016). Women using combination therapy reported enhanced improvement in vaginal dryness, libido, and mood compared with those using HRT alone. Perceived quality of life and overall control of menopausal symptoms were highest among women using dietary supplements alone and women using combination therapy, respectively. Satisfaction with menopausal counseling from a primary care provider was significantly greater in women receiving HRT alone ( p = 0.02) and combination therapy ( p = 0.006) compared with women receiving dietary supplements alone. Dietary supplements were frequently used during menopause. Combined use of dietary supplements and HRT seemed to be associated with enhanced relief of certain menopausal symptoms. Women using dietary supplements alone seemed particularly dissatisfied with the menopausal counseling provided by a primary care provider.

Objective:Nationally and internationally, life expectancies continue to increase, and so are age-related cognitive impairment (Stough et al., 2015). As a result, the rise of consumer dietary supplement products has increased significantly in the last 20 years as older adults are inundated with media related to improving cognitive function. However, research on these nootropics and natural supplements reveals mixed efficacy (Brownie, 2009; Stough et al., 2015). Serendipitously, the COVID-19 pandemic has unveiled the necessity for increased healthy equity and screening internationally across health service disciplines (Jensen et al., 2021; Wells & Dumbrell, 2006). This poster encompasses two primary aims: (1) to highlight common international dietary supplements marketed to an older adult population. Next, (2) develop best evidenced-based practices to approach effective use of nutritional information while maintaining a neuropsychologist’s scope of care.Participants and Methods:A literature review was conducted of peer review articles from 2006 to 2022 from the following databases PubMed and Google Scholar. Recommendations were constructed based on identifying and analyzing the emerging themes across identified articles. Keywords include neuropsychology, nootropics, natural supplement use, aging, Vitamin E, Vitamin D, Phosphatidylserine, feedback, cognition, older adults, and international.Results:Although supplement use and regulations may differ by country, current research suggests increased supplement use and inquiries to neuropsychologists (Armstrong & Postal, 2013; Aysin et al., 2021). Literature highlighting the benefit of taking a natural dietary supplement for older adults across the spectrum of cognitive decline has been variable (Brownie, 2009; Haider et al., 2020). Commonly explored vitamins such as Vitamin E, Vitamin D, Vitamin B 12, and Phosphatidylserine have proven to be beneficial in improvements in cognitive domains such as attention and memory for those experiencing mild cognitive impairment (Kang et al., 2022; La Fata et al., 2014; Richter et al., 2013; Van Der Shaft et al., 2013). Therefore, one alternative for defining the utility of supplement usage may be from preventive lens for those with mild or emerging cognitive concerns (Health Quality Ontario., 2013; Joshi & Practice-, 2012). Alternatively, older populations are at risk for malnutrition, which can negatively impact cognition (Well & Dumbrell, 2006).Conclusions:While recognizing their clinical scope, informed neuropsychologists must be up to date on emerging literature on the efficacy of these supplements. Neuropsychologists should consider following these general guidelines when discussing recommendations for older adult clients with varying degrees of cognitive impairment. For example, neuropsychologists should approach alternative treatments as an exploration of the possible risks, costs, and benefits with evidence-based research while balancing the client’s need for hope (Armstrong & Postal, 2013). Neuropsychologists should also have increased awareness of malnutrition screening amongst this population (Gestuvo & Hung, 2012; Wells & Dumbrell, 2006). Other practices should include ongoing consultation and referral to a nutritionist or following up with their primary care physicians to assist further. With these guidelines, Neuropsychologists can be better equipped to provide ethical recommendations to facilitate clients to become informed consumers.

Background:Dietary supplement use received wide attention and interest throughout the world, particularly in Gulf countries, because of advanced economic and industrial growth.Objective:The present study aimed to determine the prevalence and correlates of dietary supplement use among medical students at Jouf University, Saudi Arabia.Methods:For this cross-sectional study, an anonymous self-administered structured questionnaire was distributed among medical students at Jouf University, Saudi Arabia. Out of the 381 medical students, 366 answered the questionnaire with a response rate of 96%. Analysis of data was done using the Statistical Package for Social Science (SPSS) program, version 24. Statistical significance was considered at P values <0.05.Results:Regarding the prevalence of dietary supplement use, 36.3% (n=133) and 29.5% (n=108) of the respondents were previous and current users of dietary supplements, respectively. Multivitamins and vitamin D were the most prevalent dietary supplements used by the participants. The students reported that the internet was the main source of knowledge concerning dietary supplements. The significant predictors of dietary supplement use in the logistic regression analysis were: age >21 years (odds ratio (OR): 3.26; confidence interval (CI): 1.67-10.53), females sex (odds ratio (OR): 2.23; confidence interval (CI): 2.34-6.84), and being in the third academic year or more (odds ratio (OR): 2.58; confidence interval (CI): 1.82-5.37). The most reported reasons for utilizing dietary supplements were nutritional supplementation and health promotion. Nearly three-quarters of the students agreed that dietary supplementation is good for health and recommended others to use them after doctor recommendation.Conclusion:Dietary supplement use was remarkably high among medical students at Jouf University, Saudi Arabia. Consumption of dietary supplements increased significantly among older students, females, and those in the third academic year or more. This study recommends other studies involving students from non-health domain colleges to detect if there is a difference in the prevalence of dietary supplement use within this population.

Dietary supplements that contain ephedra alkaloids (sometimes called ma huang) are widely promoted and used in the United States as a means of losing weight and increasing energy. In the light of recently reported adverse events related to use of these products, the Food and Drug Administration (FDA) has proposed limits on the dose and duration of use of such supplements. The FDA requested an independent review of reports of adverse events related to the use of supplements that contained ephedra alkaloids to assess causation and to estimate the level of risk the use of these supplements poses to consumers. We reviewed 140 reports of adverse events related to the use of dietary supplements containing ephedra alkaloids that were submitted to the FDA between June 1, 1997, and March 31, 1999. A standardized rating system for assessing causation was applied to each adverse event. Thirty-one percent of cases were considered to be definitely or probably related to the use of supplements containing ephedra alkaloids, and 31 percent were deemed to be possibly related. Among the adverse events that were deemed definitely, probably, or possibly related to the use of supplements containing ephedra alkaloids, 47 percent involved cardiovascular symptoms and 18 percent involved the central nervous system. Hypertension was the single most frequent adverse effect (17 reports), followed by palpitations, tachycardia, or both (13); stroke (10); and seizures (7). Ten events resulted in death, and 13 events produced permanent disability, representing 26 percent of the definite, probable, and possible cases. The use of dietary supplements that contain ephedra alkaloids may pose a health risk to some persons. These findings indicate the need for a better understanding of individual susceptibility to the adverse effects of such dietary supplements.

High dietary supplement intakes among Flemish preschoolers

Dietary supplements are commonly consumed but may not be beneficial for everyone. It is known that supplement users have healthy behaviour characteristics but until now concordance between spouses living in the same household has not been investigated and concordance may be an important behavioural determinant. Prospective cohort study, cross-sectional data analysis. European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) in the UK, recruitment between 1993 and 1998. Married (or living as married) participants sharing a household, who attended a health examination and completed a 7 d diet diary were included in the analysis (n 11 060). The age range was 39-79 years. Nearly 75 % of the households in EPIC-Norfolk were concordant in their supplement use, with 46·7 % not using supplements and 27·0 % using supplements. Concordance increased with age; the percentage of concordant couples varied less by other sociodemographic characteristics. Participants who had a spouse who used a supplement were nearly nine times more likely to use a supplement (unadjusted). Depending on participants' sex and type of supplement used, odds ratios for 'supplement use by spouse' in the prediction of participants' supplement use varied between 6·2 and 11·7 adjusted for participants' age, smoking status, BMI, social class, education level and physical activity. 'Supplement use by spouse' is an independent and the strongest predictor of participants' supplement use. This phenomenon can be useful in the design of studies and health interventions; or when assessing risk of excessive intake from dietary supplements.

Dietary supplement use and associated variables among Turkish women

To assess the present use of dietary supplements among the Parkinson disease (PD) population and to determine which dietary supplements are most commonly taken. This cross-sectional study used an online questionnaire that was administered to individuals with PD via support group Web sites. Dietary supplement users also were asked whether they spoke with a healthcare professional about their supplement use. Of the 205 respondents, 83.4% reported taking at least 1 dietary supplement. Although 94 different types of dietary supplements were identified, >50% of participants taking dietary supplements took multivitamins, vitamin D, and vitamin B12 (52.6%, 74.3%, and 56.1%, respectively). Respondents reported taking coenzyme Q10, Mucuna pruriens, folate, vitamin B12, vitamin B6, melatonin, and N-acetylcysteine most commonly for PD. Among supplement users, 29.2% did not discuss their supplement use with a healthcare practitioner. The results of this study demonstrate a high prevalence of dietary supplement use among individuals with PD, in addition to a wide variety of supplements being taken. This study's findings also indicate the need for better dialog between patients and healthcare practitioners regarding the use of dietary supplements.