Herbs and Dietary Supplements

[All4MyDaughter]

Advertisement - Members don't see this ad

We are doing a unit on herbal products at school. I'm interesting in getting the opinion of others on dietary supplements, what you think of their efficacy/utility and whether or not you recommend them to patients.

If there is enough interest I can post some of what we discuss in class: what the different products are typically used for, how they have been rated (A-F) for efficacy for different indications, drug interactions, etc. It might be a good way for me to study it.

 

[Farmercyst]

We are doing a unit on herbal products. I'm interesting in getting the opinion of others on dietary supplements, what you think of their efficacy/utility and whether or not you recommend them to patients.

If there is enough interest I can post some of what we discuss in class: what the different products are typically used for, how they have been rated (A-F) for efficacy for different indications, drug interactions, etc. It might be a good way for me to study it.

Most of what I know about them I learned in Biochemisty and in one lecture. Needless to say I voted for none of the above. (not enough info to make an informed recommendation.) The studies on most of the supplements I've read seem contradicory. A few months ago they had one that said Echinacea was useless. The glucosamine/chondroitin was one my biochem teacher hit on, she said studies re: the benefits were inconclusive at this point, though I know my grandmother is taking it and would recommend it. There was one of the herbals that had BP effects, can't remember which one, I thought SJW, but I could be wrong there.

 

[firstcitizen]

I have a question about just taking a daily multivitamin. I used to take a multivitamin w/o iron but recently bought centrum and realized that it as 18 mg of iron. I eat foods such as oatmeal, cereals, dark greens, etc. that contain plenty of iron, so would I be overdoing it with the 18 mgs?

 

[All4MyDaughter]

I have a question about just taking a daily multivitamin. I used to take a multivitamin w/o iron but recently bought centrum and realized that it as 18 mg of iron. I eat foods such as oatmeal, cereals, dark greens, etc. that contain plenty of iron, so would I be overdoing it with the 18 mgs?

I'm not really sure, and SDN is not for personal medical advice. Sorry! You might check with your pharmacist or physician. 🙂

 

[All4MyDaughter]

Most of what I know about them I learned in Biochemisty and in one lecture. Needless to say I voted for none of the above. (not enough info to make an informed recommendation.) The studies on most of the supplements I've read seem contradicory. A few months ago they had one that said Echinacea was useless. The glucosamine/chondroitin was one my biochem teacher hit on, she said studies re: the benefits were inconclusive at this point, though I know my grandmother is taking it and would recommend it. There was one of the herbals that had BP effects, can't remember which one, I thought SJW, but I could be wrong there.

Later on, after more people vote I will post some of the ratings for efficacy for different indications. I was surprised by some of them.

 

[PhatPharm]

Given the fact that herbals and supplements are unregulated and the product could contain anything else or none of the active ingredient, I would'nt recommend anything unless I'd seen tests on it by an independent lab, or somehow knew that it was legit.

Is there something those of you who recommend herbals know that I don't know.

 

[All4MyDaughter]

Given the fact that herbals and supplements are unregulated and the product could contain anything else or none of the active ingredient, I would'nt recommend anything unless I'd seen tests on it by an independent lab, or somehow knew that it was legit.

Is there something those of you who recommend herbals know that I don't know.

Some herbal products have been rated and tested by an independent lab. We've learned about four different rating organizations:

The United States Pharmacopeia has the Dietary Supplement Verification Program.

The National Sanitation Foundation offers the International Dietary Supplement Certification.

Consumerlab.com has the Approved Quality Product Seal.

The National Nutrition Foods Association grades suppliers on an A-C scale based on manufacturing facilities but doesn't evaluate the end product.

 

[twester]

We got a presentation on supplements last week. I'd definitely recommend fish oils to a patient. It's well-studied and looks to be effective in lowering triglyceride levels (although it's expensive). I'd recommend glucosamine for someone with mild osteoarthritis although it needs more study.

I'd not recommend any of the others. St. John's Wort, in particular, has too many drug-drug interactions. Echinacea may be effective in boosting the immune system during illness, but is probably not useful as a preventative (and may be dangerous with long-term administration).

Supplements from labs that have been verified by the US Pharmacopaeia and Consumer Lab are trustworthy in spite of a lack of FDA oversight. National Sanitation Foundation certification is problematic because they seem to have conflicted interests. At least, that's the information I was presented.

Thanks for the thread, A4MD. I was skeptical about the value of supplements before, but my thinking is starting to turn around somewhat.

 

[All4MyDaughter]

We got a presentation on supplements last week. I'd definitely recommend fish oils to a patient. It's well-studied and looks to be effective in lowering triglyceride levels (although it's expensive). I'd recommend glucosamine for someone with mild osteoarthritis although it needs more study.

I'd not recommend any of the others. St. John's Wort, in particular, has too many drug-drug interactions. Echinacea may be effective in boosting the immune system during illness, but is probably not useful as a preventative (and may be dangerous with long-term administration).

Supplements from labs that have been verified by the US Pharmacopaeia and Consumer Lab are trustworthy in spite of a lack of FDA oversight. National Sanitation Foundation certification is problematic because they seem to have conflicted interests. At least, that's the information I was presented.

Thanks for the thread, A4MD. I was skeptical about the value of supplements before, but my thinking is starting to turn around somewhat.

Our presentation did not address the issue of reliability of the agencies providing the ratings of supplements.
That's good info to have; thanks for posting.


Fish Oil has the following ratings for specific indications:

Hypertension A
Hypertriglyceridemia A
Secondary heart disease prevention A

Primary cardiovascular disease prevention B
Protection from cyclosporine toxicity in transplant patients B
Rhuematoid arthritis B

Appetite/weight loss in cancer patients D
Diabetes D
High cholesterol D

 

[Moxxie]

I'm taking a class on Alternative & Complementary Medicine right now, but so far we haven't gotten a lot on herbal supplements yet. (We've had speakers talking about chiropracty, chinese medicine, even foot zonology).

I should know a lot more about cinnamon within a week, though - I have to give a presentation on it on the 11th. So far, from what I've learned in other classes, though, are that fish oils are generally an OK thing to recommend. I also voted for ginger (it has helped me with motion sickness) and garlic (OK for cholesterol and a somewhat decent insect repellent). I don't know enough about any of the others - except that I don't think that I would recommend St. John's Wort to most people - too many possible interactions.

 

[All4MyDaughter]

A: Strong Scientific Evidence
Statistically significant evidence of benefit from more than 2 RCTs OR 1 RCT + 1 meta-analysis, OR multiple RCT with a majority showing statistically significant evidence of benefit with supporting evidence in basic science, animal studies or theory.

B: Good Scientific Evidence
Statistically significant evidence of benefit from 1-2 RCTs OR evidence of benefit from more than one meta-analysis OR evidence of benefit from more than one cohort/case-control/non-randomized trials AND with supporting evidence in basic science, animal studies or theory.

C: Unclear or Conflicting Scientific Evidence
Evidence of benefit from more than one RCT without adequate size, power, statistical significance or quality of design by objective criteria, OR conflicting evidence from multiple RCTs without a clear majority of the trials showing evidence of benefit or ineffectiveness, OR evidence of benefit from more than one cohort/case-control/non-randomized trials AND without supporting evidence in basic science, animal studies, or theory OR evidence of efficacy only from basic science, animal studies, or theory.

D: Fair Negative Scientific Evidence
Statistically significant negative evidence (lack of benefit) from cohort/case-control/non-randomized trials AND evidence in basic science, animal studies or theory suggesting a lack of benefit.

F: Strong Negative Scientific Evidence
Statistically significant negative evidence (i.e. lack of evidence of benefit) from more than one properly randomized adequately powered trial(s) or high quality design by objective criteria.

Lack of Evidence


Reference: Not cited in the presentation. I think it is from this website: http://www.herbmed.org/ but I believe you have to get the pro-version to see the ratings. I'm trying to confirm this.

RCT = randomized controlled trial

 

[Requiem]

I went with ginger, fish oils and garlic.

 

[dgroulx]

I'm taking herbals right now, too. Our professor is from Germany. They have something called Commission E which is like our FDA. They've done lots of research on herbal meds. Some of them are actually classified and marketed as drugs over in Europe. They have to meet a certain standard with regards to ingredients, preparation methods, etc. In the US, they can sell you snake oil.

It looks like many herbal drugs have some efficacy. You just need to know what you are getting.

 

[sdn1977]

The garlic effect on cholesterol was pretty well debunked in February's Annals of Internal Medicine. The study, done at Stanford, which was well designed didn't show any effect on any lipid level.

Likewise, the only well designed studies on glucosamine & chondroitin do not show any effect either.

Those studies, which are not very well designed & use quality of life indicators, rather than objective measurements, only show improvement after 3 months. Thats a lot of money!

But...those who believe won't be swayed. If they ask me, I give my honest opinion and ALWAYS ask if they've been recommended to take it by their physician (which is usually a no).

 

[WVUPharm2007]

Valerian is the shiznit.

 

[sdn1977]

A: Strong Scientific Evidence
Statistically significant evidence of benefit from more than 2 RCTs OR 1 RCT + 1 meta-analysis, OR multiple RCT with a majority showing statistically significant evidence of benefit with supporting evidence in basic science, animal studies or theory.

B: Good Scientific Evidence
Statistically significant evidence of benefit from 1-2 RCTs OR evidence of benefit from more than one meta-analysis OR evidence of benefit from more than one cohort/case-control/non-randomized trials AND with supporting evidence in basic science, animal studies or theory.

C: Unclear or Conflicting Scientific Evidence
Evidence of benefit from more than one RCT without adequate size, power, statistical significance or quality of design by objective criteria, OR conflicting evidence from multiple RCTs without a clear majority of the trials showing evidence of benefit or ineffectiveness, OR evidence of benefit from more than one cohort/case-control/non-randomized trials AND without supporting evidence in basic science, animal studies, or theory OR evidence of efficacy only from basic science, animal studies, or theory.

D: Fair Negative Scientific Evidence
Statistically significant negative evidence (lack of benefit) from cohort/case-control/non-randomized trials AND evidence in basic science, animal studies or theory suggesting a lack of benefit.

F: Strong Negative Scientific Evidence
Statistically significant negative evidence (i.e. lack of evidence of benefit) from more than one properly randomized adequately powered trial(s) or high quality design by objective criteria.

Lack of Evidence


Reference: Not cited in the presentation. I think it is from this website: http://www.herbmed.org/ but I believe you have to get the pro-version to see the ratings. I'm trying to confirm this.

RCT = randomized controlled trial

I think you'd have a hard time finding A for any of them.

I'd be interested if they tell you there are.....I'd have to read it myself.

 

[sdn1977]

Valerian is the shiznit.

👍 👍

How about Airborne???? Anyone on that bandwagon?

 

[cycloketocaine]

My GI doctor wants me to take Fish Oils for my Crohn's. I do, but it dosen't really help. Oh well, I might not have any intestines after this, but my heart is going to be in great shape!!!!

 

[All4MyDaughter]

I think you'd have a hard time finding A for any of them.

I'd be interested if they tell you there are.....I'd have to read it myself.

There were three A's for fish oil (listed above). I've emailed the professor for documentation about where the ratings came from. I'm going to list some more in a few minutes.

 

[All4MyDaughter]

The top four at this point are fish oils, glucosamine/chondroitan, garlic and ginger.
I listed evidenced based ratings (as provided in my course) for fish oils above.
Here are the others:

Glucosamine:
Mild to moderate knee osteoarthritis A
Osteoarthritis in general B
Other uses C

Chondroitan:
Osteoarthritis A
Opthalmologic uses B
Coronary artery disease C
Interstitial cystitis C
Psoriasis C
Enhancement of iron absorption C


Ginger:
Hyperemesis gravidarum B
Nausea/vomiting of pregnancy B
Nausea/vomiting (chemo, post-op) C
Motion sickness/seasickness C
Rheumatic disease C

Garlic:
High cholesterol B
Diabetes D
Gastric/duodenal ulcers D
Other uses C

 

[dgroulx]

The garlic effect on cholesterol was pretty well debunked in February's Annals of Internal Medicine. The study, done at Stanford, which was well designed didn't show any effect on any lipid level.

The formulation was changed in 1993. The current formula of capsules does not show any effect. The active component breaks down immediately. We were told that if you chewed 5-20 cloves of raw garlic every day, it would lower your cholesterol a little, but no one would ever do that.

Red Rice Yeast however, does work for cholesterol. It's the statin molecule before being tweeked by drug companies.

 

[sdn1977]

The formulation was changed in 1993. The current formula of capsules does not show any effect. The active component breaks down immediately. We were told that if you chewed 5-20 cloves of raw garlic every day, it would lower your cholesterol a little, but no one would ever do that.

Red Rice Yeast however, does work for cholesterol. It's the statin molecule before being tweeked by drug companies.

Red Rice Yeast used to contain lovastatin, among about 20 other compounds.

The FDA ruled in 1999, that since it had a drug component, it could not be a food. This was overturned in that same year.

However, the Court of Appeals in 2000 overturned that ruling and all Red Rice Yeast was pulled. If there is any on the shelf, it does not contain a cholesterol lowering drug.....and labels no longer claim that it does.

 

[dgroulx]

Red Rice Yeast used to contain lovastatin, among about 20 other compounds.

The FDA ruled in 1999, that since it had a drug component, it could not be a food. This was overturned in that same year.

However, the Court of Appeals in 2000 overturned that ruling and all Red Rice Yeast was pulled. If there is any on the shelf, it does not contain a cholesterol lowering drug.....and labels no longer claim that it does.

I've definitely seen it on shelves, though I haven't picked one up and looked at the label. The one we learned about was Monascus purureus. I'll have to check the label and see if our product contains the same species of yeast as in Europe. It has a structure called Monacolin K that has a statin-like structure. That product showed a pretty sizeable reduction in LDL during a 2005 European study. Since herbals are classified as drugs over there, it may be a different species altogether.

 

[MisS GaNglia]

Hey there sorry for interfering ...But I have chosen Garlic since it's a natural Antibiotic containg more than 33 synergistic phytochemicals........plus I think most of the people take it naturally in diet....

 

[sdn1977]

I've definitely seen it on shelves, though I haven't picked one up and looked at the label. The one we learned about was Monascus purureus. I'll have to check the label and see if our product contains the same species of yeast as in Europe. It has a structure called Monacolin K that has a statin-like structure. That product showed a pretty sizeable reduction in LDL during a 2005 European study. Since herbals are classified as drugs over there, it may be a different species altogether.

You have a link to that study?

 

[eelo]

The garlic effect on cholesterol was pretty well debunked in February's Annals of Internal Medicine. The study, done at Stanford, which was well designed didn't show any effect on any lipid level.

quote]

Cholesterol? I take garlic for the vampires.

;-)

 

[sdn1977]

The garlic effect on cholesterol was pretty well debunked in February's Annals of Internal Medicine. The study, done at Stanford, which was well designed didn't show any effect on any lipid level.

quote]

Cholesterol? I take garlic for the vampires.

;-)

In that case👍 !

I hear it also gets rid of those "dates" you just want to get rid of quick

 

[Hokie Grad]

We are doing a unit on herbal products at school. I'm interesting in getting the opinion of others on dietary supplements, what you think of their efficacy/utility and whether or not you recommend them to patients.

If there is enough interest I can post some of what we discuss in class: what the different products are typically used for, how they have been rated (A-F) for efficacy for different indications, drug interactions, etc. It might be a good way for me to study it.

Just a word of caution. I used to work as a formulation scientist for a drug development company. One of my first assignments was to act as an onsite formulation consultant at a very large dietary supplement company (one that everybody would recognize). I witnessed some very suspect practices in regards to labeling and quality assurance. Long story short, after seeing the inner workings of one of these companies I would not touch their products and caution my family against them. I’m sure there are some companies that are trying to do the right thing with regards to efficacy, quality, safety, but unfortunately in my five years in industry I have not come across one. Until they are held to similar standards as drugs, I would not recommend them to anyone.

 

[dgroulx]

You have a link to that study?

Do you have access to Pub Med?

European Journal of Endocrinology, Vol 153, Issue 5, 679-686
Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia

 

[dgroulx]

Cholesterol? I take garlic for the vampires.

;-)

They studied that in Norway. They couldn't find vampires, so they used leeches. It turns out that the leeches were attracted to the hand smeared with garlic. It took 14.9 seconds to attach to the garlic hand and 44.9 seconds to attach to the plain hand.

 

[sdn1977]

Do you have access to Pub Med?

European Journal of Endocrinology, Vol 153, Issue 5, 679-686
Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia

Yeah I do & I looked it up. Hmmmm......79 subjects (small population) studied for 8 weeks (small duration) eating a diet of this rice, which altho double blinded with placebo rice....no comment was made on the diet in general. Nor was the active ingredient itself was isolated in this rice.

Since the authors themselves acknowledged the study duration was not long enough to make any conclusions to efficacy & did not even look at safety.....I'd have a hard time recommending anything based on this study, particularly since we know controlling diet will control serum lipids to a certain extent. I'm surprised it is being used in a pharmacy school for documentation of a nutritional supplement.🙁

 

[pion]

How about Airborne???? Anyone on that bandwagon?

http://www.sciam.com/article.cfm?ch...F2-99DF-3BE657CAD1649375&pageNumber=1&catID=2

IMO all it's good for is the zinc and vitamin c, and you definitely don't want to take as much as they advise.

 

[twester]

Cholesterol? I take garlic for the vampires.

;-)

For vampires, the pt should wear several cloves around their neck and also hang it over their bed. Everybody knows that vampires like to feed on our patients in the middle of the night while they're sleeping and looking all vulnerable and such.

Sorry writing assignment overload this afternoon.

Back to our regular thread...

 

[All4MyDaughter]

Yesterday in class we received a list of supplements that are considered unsafe. The list does not say by whom it was compiled. Anyone have any experience with any of these?

Borage
Chaparral
Coltsfoot
Comfrey
DHEA
Ephedra
Germander
Jin Bu Huan
Kava Kava
Lobelia
Pokeweed
Sassafras
Yohimbe

 

[Farmercyst]

Yesterday in class we received a list of supplements that are considered unsafe. The list does not say by whom it was compiled. Anyone have any experience with any of these?

Borage
Chaparral
Coltsfoot
Comfrey
DHEA
Ephedra
Germander
Jin Bu Huan
Kava Kava
Lobelia
Pokeweed
Sassafras
Yohimbe

Ephedra is well known. I've heard of chaparral, but only in the terrain type. I know Bugs Bunny likes to say sassafras. That's about all I can contribute, if you can call this a contribution. Probably not worth a penny for my thoughts.

 

[All4MyDaughter]

Ephedra is well known. I've heard of chaparral, but only in the terrain type. I know Bugs Bunny likes to say sassafras. That's about all I can contribute, if you can call this a contribution. Probably not worth a penny for my thoughts.

Here's a penny, but I want some change. 😛

 

[All4MyDaughter]

http://www.quackwatch.org/01QuackeryRelatedTopics/dhea.html

 

[Farmercyst]

Here's a penny, but I want some change. 😛

I think even England got rid of the halfpence, I'd could shave some copper off the edges. I hear copper is somewhat important in your diet too.

 

[sdn1977]

Yesterday in class we received a list of supplements that are considered unsafe. The list does not say by whom it was compiled. Anyone have any experience with any of these?

Borage
Chaparral
Coltsfoot
Comfrey
DHEA
Ephedra
Germander
Jin Bu Huan
Kava Kava
Lobelia
Pokeweed
Sassafras
Yohimbe

Your best bet with these is to look them up on Micromedex.

But, here are a few references:

www.cfsan.fda.gov/~dms/dspltr06.html (comfrey)

www.cdc.gov/MMWR/preview/mmwrhtml/mm5147a1.htm - 24k (kava kava)

nccam.nih.gov/health/yohimbe/ - 14k (yohimbe)

www.mdanderson.org/departments/nutrition/display. cfm?id=0B72796C-F6DA-11D4-810400508B603A14&method=di... - 54k (sassafras)

Pretty much - either the fda, cdc, nih or one of the major research centers for toxicology will have reported on them.

You can search one by one, but you might have better luck with faster results using Micromedex.

good luck

 

[Farmercyst]

From the NIH Office of Dietary Supplements

http://dietary-supplements.info.nih...ion_About_Individual_Dietary_Supplements.aspx

It looks interesting.

 

[Añejo]

I use Omega-3s, which I'm sure I'd be crucified for at school since I didn't base my decision to use the drug on 36 peer reviewed articles.

 

[wolingfeng]

I mean, why dont we just eat the raw galic or ginger instead of buying the manufactured "herbal product" from those companies? I do believe things like garlic and giners are healthy vetegables for your body, but in order to attain a theraputic goal for a disease, I think it's good to trust in western medicine.

 

[Avrelian]

The garlic effect on cholesterol was pretty well debunked in February's Annals of Internal Medicine. The study, done at Stanford, which was well designed didn't show any effect on any lipid level.

Well, debunked or not, I still do have a relative in his early thirties, who weights 350 pounds, eats unbelievable amounts of meats/fatback/eggs , salt, drinks a lot, smokes, has a history of a heart desease in the family, stressful job,
and his blood pressure is 110-120/70-80, no complaints over anything. No colds, no flu, ever. He eats RAW garlic, every day, with almost every meal, up to a head a day, never less than a half. And it is not a supplement, he just likes it a lot.

 

[Farmercyst]

Well, debunked or not, I still do have a relative in his early thirties, who weights 350 pounds, eats unbelievable amounts of meats/fatback/eggs , salt, drinks a lot, smokes, has a history of a heart desease in the family, stressful job,
and his blood pressure is 110-120/70-80, no complaints over anything. No colds, no flu, ever. He eats RAW garlic, every day, with almost every meal, up to a head a day, never less than a half. And it is not a supplement, he just likes it a lot.

That's the thing with diet. There are genetic factors at play as well. My grandfather loved butter by the spoonful, eggs, everything fried, plus Ice Cream. Smoked at least a pack a day until my grand mother died. He died at 80 years old, and not of a heart attack. He got oral cancer and radiation treatments which killed his tastebuds and he basically starved himself to death. He ate garlic regularly, took pills as well. In the early thirties he may not have to worry too much just yet, wait till early 50's when they body isn't able to keep up anymore, wear and tear on internal organs, etc catches up with him.

 

[Avrelian]

He died at 80 years old, and not of a heart attack. He got oral cancer and radiation treatments which killed his tastebuds and he basically starved himself to death.

I've heard somewhere that if a male has a healthy heart when he is 70, thats almost a guaranty that he will die of cancer. So may be all that colesterol is not that bad after all.
As for my guy, sooner or later it does catch up with anyone, of course. Neverthless I find it hard to believe that those 6-10 cloves a day of garlic has nothing to do with his condition. He had 130/80 when he was 4 -5 years old younger and 70 pounds lighter and didnt eat it as much.

 

[ButlerPharm.D.]

In regards to Fish oils we were told that they can be beneficial in reducing Triglyceride levels but that they may cause a modest increase in LDL and that in order for the patient to even see benefit from this they would need to modify their diet to reduce their in take of Omega-6 FA's (meats) in order to see the reduction.

In regards to Kava, I have found the following on the FDA's website, "Kava (Piper methysticum) is a plant indigenous to the islands in the South Pacific where it is commonly used to prepare a traditional beverage. Supplements containing the herbal ingredient kava are promoted for relaxation (e.g., to relieve stress, anxiety, and tension), sleeplessness, menopausal symptoms and other uses. FDA has not made a determination about the ability of kava dietary supplements to provide such benefits. Liver-related risks associated with the use of kava have prompted regulatory agencies in other countries, including those in Germany, Switzerland, France, Canada, and the United Kingdom, to take action ranging from warning consumers about the potential risks of kava use to removing kava-containing products from the marketplace. Although liver damage appears to be rare, FDA believes consumers should be informed of this potential risk.... In the U.S., FDA has received a report of a previously healthy young female who required liver transplantation, as well as several reports of liver-related injuries. "

 

[AnonFaculty]

Yesterday in class we received a list of supplements that are considered unsafe. The list does not say by whom it was compiled. Anyone have any experience with any of these?

Borage
Chaparral
Coltsfoot
Comfrey
DHEA
Ephedra
Germander
Jin Bu Huan
Kava Kava
Lobelia
Pokeweed
Sassafras
Yohimbe

I did the research on ephedra. We had one subject with sinus tachycardia in that study. The rest all had prolonged QTc intervals on ECG, suggesting an increased risk for drug induced arrhythmia. Most likely related to CPVT (a calcium phenomenon) as opposed to Torsade des Pointes.

The newer products (with green tea) should also be considered potentially dangerous. The active ingredient in green tea ,epigallocatechin or EGCG, blocks a protein channel known as KCNA5, which is an atrial specific (i.e. its not in the ventricle) repolarizing current involved in the electrical recovery of the atria from a heart beat. Mutations in this KCNA5 channel have been found in patients with familial atrial fibrillation. It is unclear if the drugs blocking KCNA5, including some in development, could phenocopy the mutation. In short, it may be possible, but is not proven, that block of KCNA5 , by EGCG or other drugs may promote, rather than suppress atrial fibrillation in certain circumstances.

That said, if as a pharmacist anyone recommends any supplements other than fish oil, there isn't any evidence to support that. Fish oil is the only supplement with a recommendation from the AHA. Glucosamine/Chondroitin is questionable. I would be very careful educating patients so as not to come as being a part of "the establishment."

There is a very nice article in Clin Pharm Ther from a task force on herbal supplements. The lead author was Morrow JD.

 

[dgroulx]

Kava Kava - the active ingredients are kavalactones that bind to GABA receptors. Their is an additive effect with other CNS depressants. There are several species of Kava and without government regulation you don't know what you are getting. Also, formulations that use the stem of the plant have had higher toxicity than those that use the root or rhizome.

There were 91 documented cases of liver toxicity with it's use, compared to 70,000 annual cases of Tylenol induced liver toxicity (US Poison Control).

 

[DrugDealer]

Another thing about kava...it's apparantly in some of those combo products you can buy at gas stations and truck stops...you know those little plastic bags with 4 or 5 brightly colored capsules...so you can consume it without even knowing it...

I read a magazine article (trashy magazine, not scientific magazine) last summer (right after we learned about kava at school!) about a girl who bought one of these during a long road-trip and had liver failure.

There was a dollar store next to the Target I did a rotation at. I went over there once on my lunch break, and they had kava for just a $1. Scary.