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
Case study # 1:
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
Case study # 2:
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, the progression of Alzheimer’s disease seems to overcome any benefit of phosphatidylserine. Most clinical studies have used phosphatidylserine derived from the 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 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’s 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’s disease other population research shows that higher dietary and supplemental intake of vitamin E is not associated with a reduced risk of Alzheimer’s 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.
- Case study # 3:
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
- Case study # 4:
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
- Case study # 5:
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
- Case study # 6:
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
- Case study # 7:
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
Case study # 8:
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
- Case study # 9:
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).
- Case study # 10:
You are caring for an 18-year-old woman with a 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
- Case study # 11:
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)
- Case study # 12:
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
- Case study # 13:
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
- Case study # 14:
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
- Case study # 15
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
- Beta carotene supplementation is men who smoke were associated with:
- higher rates of lung cancer in the CARET and ATBC trials.
- 90% reduction in subsequent occurrence of small-cell lung cancer.
- no change in lung cancer rates
- a higher risk of jaundice in those receiving beta-carotene
- A 59-year-old woman with PMH GERD, resolved since on a PPI which she continues to take, comes to your office for dietary and nutritional recommendations. Her DEXA scan and 25(OH)D level were WNL. Her diet is devoid of calcium. With the information you have so far, which dietary supplement regime would be most appropriate for this patient?
- Calcium carbonate, 1200 mg at bedtime, with 400 IU of vitamin D daily
- Calcium citrate, 600 mg twice times a day with 600 IU of vitamin D daily
- Calcium carbonate, 500 mg twice a day, with 5,000 IU of vitamin D daily
- Calcium carbonate 1200 mg at breakfast, with 10,000 IU of vitamin D daily
- Excess intake of Vitamin A is associated with a reduced risk for osteoporosis.
- You are caring for a 25 year old woman with PMS who says her friend told her to take 250 mg of Vitamin B6 daily. What is the MOST important response to make to her?
- “That dose is correct.”
- “That dose is too high.”
- “That dose is too low.”
- “B6 does not improve symptoms of PMS.”
- You are caring for an 82-year-old vegetarian who displays numbness and tingling in her hands and feet, difficulty maintaining balance, poor memory, and soreness of her mouth and tongue. What vitamin deficiency do you suspect?
- Vitamin A
- Vitamin C
- Vitamin B12
- Vitamin D
- You are caring for a postmenopausal woman who has a normal CBC. She asks for your advice about taking an iron supplement. What is your best initial response?
- “Yes, take an iron supplement”
- “I do not recommend that you take an iron supplement.”
- The HOPE and HOPE-TOO trial investigators (JAMA, 2005. Volume 293, pages 1228-1347) demonstrated that in patients with vascular disease or diabetes mellitus, long-term vitamin E supplementation does not prevent cancer or major cardiovascular events and may increase the risk for heart failure.
- Which of the following deficiencies can lead to hypothyroidism (select two)?
- The Tolerable Upper Intake Level for folate from supplements or fortified foods in a 10-year-old girl is 800 mcg per day.
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)
- Zinc – G. Almonds Red pepper
- Selenium – D. Brazil Nuts Broccoli
- Iron – H. Oysters Black eyed peas
- Calcium – K. Yogurt Brazil Nuts
- Folate – C. Black Eyed Peas Carrots
- Chromium – B. Broccoli Wheat germ oil
- Vitamin A – E. Carrots Dry roasted almonds
- Vitamin C – A. Red Peppers Oysters
- Vitamin E – F. Wheat Germ Oil Canned White Beans
- Vitamin D – J. Salmon Salmon
- Magnesium – Canned White Beans K. Yogurt
- All of the following are true when considering calcium levels in a patient EXCEPT:
- Natural intake of calcium via food is superior to calcium supplements.
- Calcium absorption requires an acidic stomach environment.
- Calcium levels in bone are dependent on their ability to bind to the collagen matrix.
- Medications do not alter calcium metabolism and absorption.
- If a manufacturer wanted to make a legal claim about calcium and its impact on bone
function, which of the following would be acceptable
- “prevents or relieves osteoporosis”
- “prevents bone fragility in postmenopausal women”
- “helps build healthy bones”
- “works with HRT to promote healthy bones in women”
- All of the following are true about iodine deficiency EXCEPT:
- Iodine deficiency is a common worldwide problem.
- The most recognized form of iodine deficiency is goiter.
- Iodine deficiency can lead to hypertension during pregnancy for the mother and mental retardation for the baby.
- Iodine deficiency promotes ovulation and enhances fertility.
Match the vitamins on the left with the correct name for its form(s) on the right
- Vitamin A F a. cholecalciferol and ergocalciferol
- Vitamin B1 J b. ascorbic acid
- Vitamin B2 H c. phytonadione
- Vitamin B3 E d. alpha-tocopherol
- Vitamin B5 G e. niacin and niacinamide
- Vitamin B6 I f. retinol
- Vitamin B12 K g. pantothenic acid
- Vitamin C B h. riboflavin
- Vitamin D A i. pyridoxine, pyridoxal, and pyridoxamine
- Vitamin E D j. thiamine
- Vitamin K1 C k. cobalamins
- According to the NIH ODS Vitamin D Fact Sheet for Health Professionals, what serum 25-Hydroxyvitamin D (25(OH)D) concentration is generally considered adequate for bone and overall health in healthy individuals?
- < 30 nmol/L
- 31-50 nmol/L
- > 50 nmol/L
- > 125 nmol/L
- What is the RDA for calcium for a 17-year-old pregnant female you are seeing today for a good visit?
- 1,000 mg
- 1,200 mg
- 1,300 mg
- 1,500 mg
- What is the RDA for vitamin D for a 72-year-old male patient in your practice?
- 200 IU
- 400 IU
- 800 IU
- 1,000 IU
- Magnesium depletion/deficiency may occur with each of the following EXCEPT:
- Loop diuretics
- Thiazide diuretics
- Magnesium based antacids or laxatives
- The Tolerable Upper Intake Levels for supplemental magnesium for adults > 19 years old is:
- 250 mg/day
- 350 mg/day
- 500 mg/day
- 1,000 mg/day
- The Recommended Daily Allowance (RDA) for Vitamin D for a 4-year-old female is:
- 200 IU
- 400 IU
- 600 IU
- 600 IU
- Lycopene is most commonly consumed by Americans through intake of:
- Tomatoes and tomato products
- Pink grapefruit
- The World Health Organization (WHO) considers which of the following to be the most prevalent nutritional disorder in the world?
- Iodine deficiency
- Iron deficiency
- Vitamin C deficiency
- Vitamin B deficiency
- All of the following are true about Vitamin B6 EXCEPT:
- Excess B6 supplement intake can cause neuropathy.
- The upper tolerable intake level (UL) set by the IOM for B6 for all adults is 100 mg/day.
- There is strong and consistent evidence that lowering homocysteine levels with B6, B12 or folic acid can prevent coronary heart disease.
- Alcoholics and older adults are more likely to have inadequate vitamin B6 intakes than other segments of the population.
- Your patient with atrial fibrillation is taking warfarin daily. In your education related to consumption of Vitamin K rich foods, which of the following responses is MOST indicated?
- Avoid foods that are high in vitamin K.
- Maintain consistent consumption of vitamin K sources in your diet each day.
- You may eat vitamin K-rich foods in varying quantities each day as they do not affect INR levels or subsequent Coumadin dosing.
- Eat large amounts of vitamin K-rich foods as available in your market since green vegetables are good for you.
- All of the following are true regarding Vitamin C EXCEPT:
- Vitamin C enhances the absorption of iron.
- Vitamin C levels are lower in smokers (and those exposed to secondhand smoke) than non-smokers, prompting the IOM to recommend that smokers have a 35 mg higher intake of vitamin C than non-smokers.
- Tolerable Upper Intake Levels of Vitamin C for adults > 19 years old is 4,000 mg.
- A high intake of vitamin C supplements may cause diarrhea, nausea, and abdominal cramps.
- All of the following are true about Niacin EXCEPT:
- Niacin deficiency may occur in people with poor diet, alcoholism, or carcinoid tumors.
- A common side effect of high-dose niacin treatment is a flushing reaction.
- Niacin reduces cholesterol.
- Taking alcohol with niacin may reduce the flushing reaction.
- Hypervitaminosis A (high storage levels of Vitamin A) has 4 major adverse effects that include each of the following EXCEPT:
- Birth defects
- Liver abnormalities
- Increased bone mineral density
- CNS disorders
- The IOM advises that “beta carotene supplements are not advisable for the general population”.
- All of the following are true about Vitamin D EXCEPT:
- The tolerable Upper Intake Level of vitamin D for adults is 4,000 IU/day.
- Serum 25-Hydroxyvitamin D (25OHD) levels < 12 ng/mL are associated with vitamin D deficiency.
- Epidemiologic data suggest that vitamin D levels could affect cancer risk
- Excessive vitamin D levels have not been associated with any harm.
- Large amounts of folic acid can mask vitamin B deficiency by correcting the megaloblastic
anemia caused by vitamin B12 deficiency without correcting the neurological damage caused
by vitamin B12 deficiency.
- According to the NIH ODS, which of the following food sources is highest in B12?
- Beef liver
- Groups who are at risk for vitamin D deficiency include:
- Breastfed infants
- Older adults
- Obese people
- People with darkly pigmented skin
- All of the above
- According to Medline Plus, evidence supports that thiamine is effective or possibly effective
for all of the following EXCEPT:
- Preventing kidney disease in people with type 2 diabetes
- Preventing cataracts
- Treatment of Wernicke-Korsakoff syndrome
- Improving athletic performance
- According to Medline Plus, evidence supports that riboflavin is effective or possibly
effective for all of the following EXCEPT:
- Preventing migraine headaches
- Preventing cataracts
- Treatment of Wernicke-Korsakoff syndrome
- Preventing and treating riboflavin deficiency
- Each of the following groups is at risk of zinc inadequacy EXCEPT:
- GI digestive disorders such as ulcerative colitis, Crohn’s disease, and short bowel syndrome
- Formula-fed infants
- Excess intake from supplements in healthy individuals has caused harm prompting
the IOM to set Upper Limits (UL) for each of the following supplements EXCEPT:
- Vitamin A
- Vitamin B12
- Vitamin B6
- Vitamin C
- Zinc deficiency is associated with all of the following EXCEPT:
- Growth retardation
- Loss of appetite
- Impaired immune function
- Major sources of Alpha Linolenic Acid include:
- salmon, herring, and mackerel
- flaxseed oil, canola oil, and walnuts
- whole grains and unprocessed carbohydrates
- green leafy vegetables
- Vitamin D is manufactured when sunlight alters the chemical structure of _______________
in the skin.
- fatty acids
- A whole food diet that includes vegetables, fruits, multi grains, and omega-3 fatty acids is preferable to antioxidant supplements in the prevention of cancer and cardiovascular disease.