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Supplement Prep Sheet
Name: Holly M. Persaud
Date: February 13, 2020
Please write in the nonbotanical supplement(s) below that you recommended for each case study based upon the Natural Medicines Comprehensive database or the NIH ODS supplement fact sheets
You are caring for a 22-year-old graduate student who says he is fatigued. Further questioning reveals he has not gotten enough sleep and he wonders if there is a supplement that can help him get better rest. What nonbotanical supplement do you recommend?
Possibly Effective: Acetyl-L-Carnitine, Magnesium, NADH, Melatonin, Tyrosine
You are caring for an elderly couple, Mr. & Mrs. C, who are in their 70s. Mrs. C. has recently been diagnosed with Alzheimer’s disease and they wonder if there is a supplement that can help her AD. What nonbotanical supplements do you recommend?
According to the Natural Medicines Database, there are a few therapies with a possibly effective rating. These therapies include Acetyl-L-Carnitine, Huperzine A, Idebenone, Lemon Balm, Panax Ginseng, Phosphatidylserine, Saffron, Sage, and Vitamin E.
Taking acetyl-L-carnitine orally seems to improve some measures of cognitive function and memory in elderly people with age-related cognitive decline.
Taking phosphatidylserine orally can increase cognitive function, global improvement rating scales, and improve behavioral rating scales over 6-12 weeks of treatment. Phosphatidylserine seems to be most effective in patients with less severe symptoms. Phosphatidylserine might lose its effectiveness with extended use. After 16 weeks of treatment, progression of Alzheimer’s disease seems to overcome any benefit of phosphatidylserine. Most clinical studies have used phosphatidylserine derived from bovine cortex. However, most supplements now use soy- or cabbage-derived phosphatidylserine. Clinical studies have not yet evaluated phosphatidylserine from soy or other sources. It is not known if phosphatidylserine from soy and other sources is as effective as bovine-derived products.
Evidence from several clinical studies shows that taking vitamin E may slow the progression of AD. Some clinical research shows that taking all-rac-alpha-tocopherol (synthetic vitamin E) 2000 IU daily is similar to selegiline (Eldepryl), and superior to placebo, for slowing cognitive function decline in patients with moderately severe AD. However, there does not appear to be an additive effect when vitamin E is used in combination with selegiline. Other clinical research shows that taking all-rac-alpha-tocopherol 2000 IU per day reduces the annual rate of decline in activities of daily living in patients with mild-to-moderate Alzheimer disease by 19% compared with placebo. This translates to a delay in disease progression of 6.2 months. This is comparable to the effect of acetylcholinesterase inhibitors (e.g., rivastigmine) in this population. Interestingly, the combination of vitamin E and memantine (Namenda) 20 mg per day is not superior to placebo in this population. Researchers speculate that an interaction between vitamin E and memantine may be to blame for the lack of effectiveness with this combination; however, no studies to date have examined this potential interaction. Retrospective data also suggest that long-term combination therapy with donepezil (Aricept) 5 mg and vitamin E 1000 IU per day may help slow cognitive decline in patients with AD. However, vitamin E doesn’t seem to slow progression from mild cognitive impairment to a diagnosis of probable AD. Patients with mild cognitive impairment who take vitamin E 2000 IU daily for 3 years progress to Alzheimer disease at the same rate as those who take placebo. There is also some interest in using vitamin E to prevent Alzheimer disease, but results are inconsistent. While some population research shows that higher dietary intake of vitamin E is associated with a lower risk of developing Alzheimer disease other population research shows that higher dietary and supplemental intake of vitamin E is not associated with a reduced risk of Alzheimer disease. Also, evidence from a large clinical study that was later converted into an observational study shows that taking vitamin E 400 IU orally daily does not prevent Alzheimer disease compared with placebo in cognitively intact men. However, this study is limited by the fact that the participants were well educated and were assessed for Alzheimer disease in their 60s; the prevalence of Alzheimer disease is typically low in this age group.
You are caring for a teen who has a history of cold sores. She asks you what supplement she can take to reduce the recurrence of cold sores. What nonbotanical supplement do you recommend?
Possibly Effective: Lysine, Zinc
You are caring for a 17-year-old high school student who has frequent URIs in the winter months. He would like to prevent and treat respiratory infections (common cold or other URI) with supplement therapy this winter. What nonbotanical supplements do you recommend?
Possibly Effective: N-Acetyl Cysteine (NAC), Vitamin C, Vitamin D, Zinc
You are caring for an 80-year-old woman who was recently diagnosed with osteoporosis. She asks what supplements she should be taking. What nonbotanical supplements do you recommend?
Likely Effective: Calcium, Vitamin D, Strontium
Possibly Effective: Fish Oil, Magnesium, Silicon, Vitamin D, Vitamin K, and Zinc
You are caring for a 19-year-old female patient who complains of painful breasts during menstruation. What nonbotanical supplement do you recommend?
Possibly Effective: Iodine, Progesterone
You are caring for a 15-year-old female with acne. She asks what supplements she can use to clear up her skin. What nonbotanical supplements do you recommend?
Possibly Effective: Alpha Hydroxy Acids (AHAs), Niacinamide, Zinc
You are caring for a 27-year-old male patient who has a new onset of mild depression, with no suicidal ideation, or past history of mental illness. He does not want to take medication but is open to treatment with OTC supplements. He is not taking any supplements or medications. What nonbotanical supplement(s) do you recommend?
According to the Natural Medicines Database, for depression, lithium has an effectiveness rating for likely effective. Folate + Prozac = better combination, they work together
You are caring for an 18-year-old female client who suffers from migraine headaches and who would like to try a complementary approach for prevention. What nonbotanical supplements do you recommend?
According to the Natural Medicines Database, the only therapy with an effective rating is caffeine.
Taking caffeine orally in combination with acetaminophen, aspirin, and/or sumatriptan is effective for treating migraine headache. Some evidence shows that caffeine in combination with aspirin and acetaminophen may be more effective than sumatriptan in treating a migraine attack. However, taking caffeine 200 mg plus ergotamine seems to be less effective than sumatriptan or calcium carbasalate plus metoclopramide. Caffeine is an FDA-approved product for use with analgesics for the treatment of migraine.
Some clinical research shows that taking coenzyme Q10 orally decreases the frequency of headaches by about 30% and the number of days with headache-related nausea by about 45% in adults. Another study shows that taking coenzyme Q10 (WN Pharmaceuticals, Ltd.) 100 mg daily for 3 months reduces migraine severity, the number of missed work days due to migraines, and the frequency by half in 60% of patients. For reducing migraine frequency by 50% in adults, the number needed to treat (NNT) using coenzyme Q10 100 mg TID for 3 months is three. It can take up to 3 months for a significant benefit. In a meta-analysis of 5 studies, coenzyme Q10 did not reduce the number of migraine attacks per month but did reduce migraine duration and the number of days with migraine in a month. Guidelines from the American Academy of Neurology consider coenzyme Q10 to be possibly effective for migraine prevention.
Most clinical research evaluating riboflavin supplementation alone for migraine prophylaxis in adults with migraines shows that taking riboflavin 400 mg daily for up to 3 months can decrease migraine frequency compared to pretreatment levels, with some research also showing a significant improvement in the frequency, severity, and duration of migraine attacks with riboflavin compared to placebo. In this last study, patients taking riboflavin had 2 fewer migraine attacks per month, 3.5 fewer headache days per month, and an average migraine headache duration 1.5 hours shorter compared to placebo. Riboflavin might also be as effective for reducing migraine headache frequency as the beta-blockers bisoprolol (Zebeta) and metoprolol (Lopressor).
You are caring for an 18-year-old woman with premenstrual syndrome that is affecting her relationships and work. She wants natural treatments only. What nonbotanical supplements do you recommend?
Likely Effective: Calcium
Possibly Effective: Magnesium, Vitamin B6, Vitamin E
You are caring for a patient with diabetic peripheral neuropathy who experiences chronic pain in her lower extremities. What nonbotanical supplement do you recommend?
Possibly Effective: Acetyl-N-Carnitine, Alpha-Lipoic Acid, Coenzyme Q10, and Gamma Linolenic Acid (GLA)
You are caring for a 45-year-old patient who has been newly diagnosed with hyperlipidemia. He asks about supplement therapy. What nonbotanical supplements do you recommend?
Possibly Effective: Alpha-Lipoic Acid, Calcium, Docosahexaenoic Acid (DHA), Magnesium, Vitamin C, and N-Acetyl Cysteine (NAC), Fish Oil
Your 34-year-old patient has hypertension and asks if there is a supplement that can complement her medical treatment. She is only taking hydrochlorothiazide and has no other medical conditions. What nonbotanical supplements do you recommend?
Likely Effective: Potassium
Possibly Effective: Alpha-Lipoic Acid, Calcium, Conjugated Linoleic Acid, Fish Oil, Folic Acid, Gamma-Aminobutyric Acid (GABA), L-Arginine, Vitamin C
Your 65-year-old patient with mild CHF asks if there is a supplement that could be effective. What do you recommend?
Possibly Effective: Coenzyme Q10, L-Carnitine, Propionyl-L-Carnitine, Taurine
You are caring for a 59-year-old patient with macular degeneration who asks if there is any supplement therapy that can help. What nonbotanical supplements do you recommend?
Possibly Effective: Beta-Carotene, Folic Acid, Lutein, MVI, Vitamin B12, Vitamin B6, Vitamin C, Zinc
Please refer to NIH ODS supplement fact sheets, Medline Plus fact sheets (if ODS sheets aren’t available), or the Natural Medicines Comprehensive Database in order to answer each of the following questions. Please post your answers to the assignment box and bring your completed supplement prep sheet to class with you.
Match each mineral or vitamin on the left with the food source on the right that contains the highest amount of that mineral or vitamin (based on NIH –ODS fact sheets)
function, which of the following would be acceptable
mental retardation for the baby.
Match the vitamins on the left with the correct name for its form(s) on the right
anemia caused by vitamin B12 deficiency without correcting the neurological damage caused
by vitamin B12 deficiency.
for all of the following EXCEPT:
effective for all of the following EXCEPT:
the IOM to set Upper Limits (UL) for each of the following supplements EXCEPT:
in the skin.
preferable to antioxidant supplements in the prevention of cancer and cardiovascular disease.
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