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Archive for the ‘Herbal Products/Natural Supplements’ Category

 

How can you help your baby if you are smoking and pregnant?

Tuesday, October 28th, 2014

By Samantha Smolinski, PharmD Student

Approximately 50% of women who smoke before pregnancy continue to smoke after pregnancy. Smoking during pregnancy has been shown to cause some adverse effects on the baby. These adverse effects include lifelong decreases in lung function, an increased risk for asthma, low birth weight, shortened pregnancy terms, miscarriage, and infant mortality.1,2 The standard of care for pregnant women who smoke is to suggest that they quit.3

Many women have difficulty quitting smoking. Research has shown that when women join smoking cessation programs like Freedom From Smoking through the American Lung Association or FreshStart from the American Cancer Society to help them quit smoking, they are more likely to quit due to social support and encouragement.4,5 Women have reported that when they were living with another person who smoked, it was much harder for them to quit smoking and remain a non-smoker. In addition to this, many women claim that they found quitting easier when their significant other was supportive of their decision.6 Another common option to aid the mother in her journey to quit smoking is nicotine replacement therapy. Nicotine replacement therapy involves substituting cigarettes with pure nicotine, so that the patient maintains the same level of nicotine in the blood to reduce withdrawal symptoms. The amount of nicotine the patient receives is gradually reduced overtime until the patient can comfortably quit smoking. The forms for this replacement therapy can come in patches, gums, lozenges (dissolved in mouth), inhalators, nasal sprays, and microtabs. Nicotine replacement therapy increases the chances for someone to quit smoking by approximately 80%.4 However, this therapy may cause some adverse pregnancy outcomes and potential malformations. Although malformations may occur, studies have shown that this side effect may be less harmful than those adverse effects that result from smoking during pregnancy.3 In addition to the potential side effects, nicotine is absorbed faster in pregnant women than in non-pregnant women, which means that standard uses of this therapy may not be applicable to pregnant women.4

Recently, a randomized, double-blind trial was conducted with one hundred fifty-nine newborns of pregnant smokers and seventy-six newborns of pregnant non-smokers. Smoking pregnant women were randomly placed in groups where sixty-three received vitamin C 500 mg and eighty-three received a placebo.1 Vitamin C was chosen for this study because there have been multiple studies that have shown that it has a protective effect on lung function.7 After the women had their babies, pulmonary function tests were performed on the babies within seventy-two hours after birth and again a year later. The tests that were conducted a year later were only for the babies of the smoking pregnant due to institutional review board regulations. The first outcome included the measured pulmonary function tests within seventy-two hours of birth and the second outcome included pulmonary function tests at one year as well as the incidence of wheezing. Results suggested that women who smoked while they were pregnant and taking vitamin C 500 mg improved their newborn pulmonary function and decreased the chance of wheezing within one year when compared to the offspring of women who were pregnant and smoking in the placebo group. This study was conducted because of a prior study that had been done on pregnant rhesus monkeys.1 This study had shown that the offspring of the pregnant monkeys with nicotine treatment and vitamin C supplementation had increased pulmonary functions when compared to the offspring of the pregnant monkeys who were only treated with nictotine.7 Thus, vitamin C can be an inexpensive and simple approach to decrease the adverse effects smoking has on pregnancy.4

Vitamin C supplementation can bring additional benefit to women who are smoking and pregnant. This can help the adverse effects that smoking has on the baby’s lung function after birth. Although quitting is still the best choice for pregnant women and their babies, vitamin C supplementation can be useful by helping the baby if the mother smokes intermittently (through part of the pregnancy or through the entire pregnancy.) My recommendation to patients would be to quit smoking as soon as possible and that the best way to do this is through the support of others. In addition to quitting, they should take a daily 500 mg vitamin C supplement which has shown benefits for the babies of women who smoke during pregnancy. Vitamin C can be found over the counter at a relatively low price.

What changes are you willing to make to help your baby?

 

References:

  1. McEvoy CT, Schilling D, Clay N,et al. Vitamin c supplementation for pregnant smoking women and pulmonary function in their newborn infants: A randomized clinical trial.JAMA. 2014;311(20):2074-2082.
  2. Pollack H, Lantz PM, Frohna JG. Maternal smoking and adverse birth outcomes among singletons and twins.Am J Public Health. 2000;90(3):395-400.
  3. Forinash AB, Pitlick JM, Clark K, Alstat V. Nicotine replacement therapy effect on pregnancy outcomes.Ann Pharmacother. 2010;44(11):1817-1821.
  4. Coleman T. Recommendations for the use of pharmacological smoking cessation strategies in pregnant women.CNS Drugs. 2007;21(12):983-993.
  5. Lando HA, McGovern PG, Barrios FX, Etringer BD. Comparative evaluation of american cancer society and american lung association smoking cessation clinics.Am J Public Health. 1990;80(5):554-559.
  6. Flemming K, Graham H, Heirs M, Fox D, Sowden A. Smoking in pregnancy: A systematic review of qualitative research of women who commence pregnancy as smokers.J Adv Nurs. 2013;69(5):1023-1036.
  7. Proskocil BJ, Sekhon HS, Clark JA, Lupo SL,

Vitamin D: A New Option in the Fight Against Asthma?

Monday, October 27th, 2014

By Charles Snyder, PharmD Student Cedarville University

Most people are either affected by asthma or know of someone close to them who struggles with the condition, which has increased in prevalence in America an estimated 25% every decade since 1960.[1] Asthma is a chronic disease that affects the airways of the body, leading to increased sensitivity, soreness, and swelling of these inner airways and ultimately less air into the lungs. Common symptoms include but are not limited to; wheezing, cough, tightness of the chest and difficulty breathing. Since there is currently no cure for asthma, the goal of treatment is to relieve these chronic symptoms. This is achieved by avoiding common things that can trigger asthmatic attacks such as exposure to pollen, dander and other allergens and by taking inhaled medications. Inhaled corticosteroids, such as Advair®, are aimed at preventing inflammation and swelling of the airways in a long-term capacity. Other anti-asthmatic medications are inhaled at the time of an asthmatic flare up, with a goal of immediately reducing symptoms.[2] As a whole, the current treatments for asthma are fairly effective; however, many patients still struggle to manage their chronic asthmatic symptoms on a day to day basis.

Fox news recently highlighted a new research study that suggests taking vitamin D may have an influence in combating the chronic effects of asthma. [3] The idea that vitamin D levels can affect asthma is a fairly common one. Rates of asthma incidence are statistically higher in northern regions, so it appears that there could be a connection between the northern environment and asthma. Many researchers suspect that the decreased sunlight in these regions, which is responsible for producing the majority of the body’s vitamin D, is leading to the increased asthma rates.[4] It is hypothesized that vitamin D helps to protect against asthma by regulating the immune system. This is accomplished by reducing the number of inflammatory cells (Helper T cells) that produce the symptoms of asthma. These inflammatory cells are also thought to produce another negative effect by reducing the effect of inhaled steroids.[5]

The study was performed by Dr. Saba Arshi at the Medical University of Tehran. This study involved one-hundred and thirty children and adults who were diagnosed with mild to severe asthma. The participants were divided into two groups. One group received treatment for their asthma using a dry powder inhaler, the control group, while the other group was treated with both the dry powder inhaler as well as high doses (100,000 units initially and then 50,000 units per week) of vitamin D for six months. After 28 weeks the researchers conducting the study measured the amount of air that patients could exhale. They found that the group who received the vitamin D, along with the inhaler, had improved by about twenty percent, while the dry powder inhaler only group had improved by seven percent.

There were, however, some limitations to this particular study. First, patients’ adherence to the medications was not measured over the course of the study. This means the regularity of the participants actually taking their assigned treatments is unknown. Second, the number of participants in the study was quite small, one hundred and thirty. Finally, the study only measured the volume of air patients were able to exhale, it did not test whether any asthma specific symptoms were improved over the course of the study.

The Fox news article had this to say about the study’s results, “I think it’s a reasonable hypothesis and their study and some other studies provide evidence it might be true. But I don’t think it’s proven yet.”3 This is a fair analysis of the study. Unfortunately, there simply has not been enough testing done on the relationship between vitamin D levels and asthma incidence to make a definitive statement. Much of the research that has been done has shown conflicting results on the topic4. A recent study published in The Journal of the American Medical Association (JAMA) provided results disagreeing with the study previously discussed. The JAMA article tested whether oral vitamin D supplements increased the effect of an inhaled corticosteroid. However, using variables similar to Dr. Arshi’s study, they found that there was no significant difference in treatment when paired with taking vitamin D.[6] Also worth noting is that a recent systematic review, produced by the Journal of Allergy, Asthma and Clinical Immunology, examined 1081 studies. Out of those studies, only three met the systematic reviews criteria and those three all had conflicting results on whether vitamin D levels played a role in Asthma development and treatment.5 This shows that there is still a lot of discussion occurring about the effect of vitamin D in asthma, and further, definitive data is still needed.

However, vitamin D has a wide range of health benefits such as treating conditions that cause weak bones, helping to raise calcium levels in the blood, and treatment of psoriasis, among others. When taken within the recommended daily dose (approximately 600 international units daily depending on age and weight),[7] there are very few side effects traditionally associated with vitamin D. The described study as well as other studies have not been able to present enough evidence to support using vitamin D to treat asthma. However I feel that vitamin D provides such a wide range of benefits, with no major side effects to asthmatics, that it would be worth trying for people struggling with asthma symptoms. Would you be willing to try vitamin D to see what benefits it could have for you or recommend it to asthma patients?

[1] Brown SD, Calvert HH, Fitzpatrick AM. Vitamin D and Asthma. Dermato-Endocrinology. 2012;2(4):137-145 Accessed September 20, 2014.

[2] National Heart, Lung and Blood Institute. How is asthma treated and controlled. NIH.gov Web site. http://www.nhlbi.nih.gov/health/health-topics/topics/asthma/treatment.html. Published August 4,2014. Updated 2014. Accessed September 20, 2014.

[3] Does vitamin D help with asthma? Fox News Web site. http://www.foxnews.com/health/2014/08/19/does-vitamin-d-help-with-asthma/. Published August 19, 2014. Updated 2014. Accessed September 20, 2014.

[4] Mason R, Sequeira V, Gordon-Thomson C. Vitamin D: the light side of sunshine Eur J Cin Nutr. September 2011;65(9):986-993. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed September 20, 2014.

[5] Rajabbik MH, Lotfi T, Alkhaled L, et al. Association between low vitamin D levels and the diagnosis of asthma in children: A systematic review of cohort studies. Allergy, Asthma & Clinical Immunology. 2014;10(1):1-16.

Therapeutic Research Faculty. Vitamin D. Medline Plus Web site.

[6] Castro M, King TS,Kunselman SJ, et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: The Vida randomized clinical trial. JAMA. 2014;311(20):2083-2091. Accessed September 20, 2014

[7] Therapeutic Research Faculty. Vitamin D. Medline Plus Web site. http://www.nlm.nih.gov/medlineplus/druginfo/natural/929.html. Published July 30, 2014. Updated 2014. Accessed September 20, 2014.

Seeking relief when your child is coughing?

Wednesday, October 22nd, 2014

by Laura Farleman, PharmD candidate

Is your child’s nagging cough keeping you up at night? The honey in your kitchen may be the alternative to drug-laced syrups parents are searching for to calm their children’s coughs. The thick syrup nature of honey helps to soothe the throat and increase saliva, which can help reduce the urge to cough. Although not always severe, cough causes anxiety and disrupts sleep for parents and children. This drives many parents to seek immediate relief for their children. In recent years popular opinion has drifted toward the use of honey, but has research proven this golden nectar effective?

The current standard of care for cough in children under the age of 6 recommends talking to a doctor. In 2008, manufacturers voluntarily updated cough and cold product labels to state “do not use” in children under 4 years of age. There are few options available when treating cough in children under 4 years old without talking to a doctor. Main treatment options for children over the age of 4 have focused on cough syrups, such as Delsym or Benadryl containing dextromethorphan (DM) or diphenhydramine (DPH), respectively.1

Honey for acute cough in children, a Cochrane review published in June 2014 looked at the effectiveness of honey for cough in children compared to two commonly used cough medications. A Cochrane review is an organized review of primary research in human health care and health policy. It is recognized worldwide as the highest standard in evidence-based health care. In other words, Cochrane reviews provide the most reliable source for health care information. However, this Cochrane review is limited by only including two small studies each with high risk of bias. This review included two random-control trials involving 265 children (aged 2 to 18 years old) comparing the effect of honey to DM, DPH and ‘no treatment’ on cough relief.2 According to Honey for acute cough in children, researchers determined honey to be a better option than ‘no treatment’ and diphenhydramine (Benadryl) options. Honey was found to be equal to dextromethorphan (Delsym) for reducing frequency, severity, and impact of cough on sleep quality.2

The first study used for this review was published by Paul et al. in 2007, included 105 children (aged 2-18 years) and found honey to be a better option for treating cough than no treatment. Comparison of honey and DM did not show differences in the 2007 Paul study. 3 Compared to DM and no treatment, parents favored honey for relief of their child’s nighttime cough and sleep difficulty.3 The second study used for this review, Shadkam 2010, included 139 children (aged 2-5 years) with a cough and revealed that a 2.5-mL honey dose before sleep provided greater relief of cough compared to DM and DPH.1

A journal review by Dr. Ron Feise from 2008 about the Paul 2007 study stated that honey was better than no treatment for cough frequency, but DM was not a better treatment than ‘no treatment’.4 According to this journal review, DM used to treat childhood cough is not supported by the American Academy of Pediatrics (AAP)5 or the American College of Chest Physicians (ACCP)6. DM is associated with several adverse side effects in children, such as nausea, vomiting, constipation, and/or dizziness.7 In contrast, honey is generally recognized as safe with the exception of a severe form of food poisoning in children under the age of 1.8 Honey is not appropriate in this age group, because the bacteria in the stomach of infants (less than one year of age) has not fully developed.8 Honey provides a safe and effective option for children (1 year and older) over OTC cough and cold medications, which aren’t recommended for children younger than 6 years old.

Practically, what does this mean? The next time your child develops a cough you might consider grabbing some honey from the kitchen or local grocery store. When your child begins to develop a cough, start by giving your child (12 months or older) ½ teaspoon of honey (2.5 mL), or (if 2 years old or older) two teaspoons (10 mL) of honey. Honey may be taken/given as often as is needed to relieve coughing. The thick syrup of honey coats and soothes the back of the throat, while the sweet taste results in salivation, which thins mucus and reduces the urge to cough. Honey may also help the body fend off colds by alleviating cold symptoms and reducing the length of a cough or cold. In addition to honey, ensure your child drinks enough fluid and consider increasing your child’s intake of vitamin C.9

It is important though, to remember that coughing isn’t completely terrible. It’s the body’s way to clear mucus from the airway. If your child is otherwise healthy and sleeping relatively well, typically there is no reason to suppress a cough. If your child has a fever, prolonged or worsening cough, wheezing, or cold symptoms lasting longer than two weeks please talk to a doctor.10

Have you tried using honey for cough in the past? Did you find it effective? In the future, will you use honey to relieve coughing?

References

 

  1. Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010;16(7):787-793.
  2. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Evidence-Based Child Health: A Cochrane Review Journal. 2014;9(2):401-444.
  3. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM,Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.
  4. Feise R. Journal review II. [commentary on] paul IM, beiler J, McMonagle A, shaffer ML, duda L, berlin CM jr. effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. arch pediatr adolesc med 2007. Journal of the American Chiropractic Association. 2008;45(8):20-1.
  5. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99(6):918-920.
  6. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S.
  7. Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review. 2004;25(4):115-123.
  8. Grant KA, McLauchlin J, Amar C. Infant botulism: Advice on avoiding feeding honey to babies and other possible risk factors. Community Practitioner. 2013;86(7):44-6.
  9. SCHARDT D. Cold front. Nutrition Action Health Letter. 2014;41(2):11-13.
  10. Teitze, JK. Cough. In: Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: an interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012:205-215

 

Calcium Worth The Risk?

Tuesday, December 10th, 2013

By Jordan Long, PharmD Student Cedarville University

For years, calcium has been considered an essential nutrient to have in the daily diet. Intake of calcium is essential for many bodily functions including muscle contraction, nerve transmission, and bone remodeling.1 Some of the benefits from calcium are helping bone growth, prevent loss of bone density, and prevent osteoporosis development.2 But recent reports are questioning the actual efficacy in these different functions and if higher calcium levels could lead to adverse effects due to additional intake through supplementation.  These recent studies led the New York Times to post an article in April of 2013 stating that people should be Thinking Twice about Calcium Supplements.3 The article stated that not only is the efficacy of calcium supplementation in it’s prevention of bone fracture questionable, but calcium supplementation might be harmful. The views presented in this article are hard to believe, since calcium is a very common nutrient found in many foods found in the standard diet. However, recent literature is beginning to provide evidence to back up this view.

Studies have shown that calcium is essential for the increase of bone density in prepubescent children.4 Parents should highly encourage their kids to consume calcium in their diet to have strong bones. But the United States Preventative Risk Task Forces stated that there is currently insufficient evidence that the benefits from calcium supplementation over 1,000mg per day is worth the risk for the primary prevention of fracture in healthy, older woman. They also do not recommend taking less than 1,000mg a day of calcium supplementation, because it is not shown to decrease fracture at these low levels but increases risk of kidney stones.5 The National Institutes of Health recommends optimal calcium intake levels varying from 1,000mg to 1,300mg for anyone over the age of four, depending on age.1 Those numbers include the calcium from dietary intake and any calcium taken as a supplement. A lot of these studies are hard to compare and contrast their recommendations because of the high amount of variation in type of calcium supplementation and complementary supplementation, especially with vitamin D, which also plays an important role in the bones ability to absorb calcium.6

One of the primary concerns with calcium supplementation is that the risks of all cause mortality, attributed mostly to cardiovascular disease. A study observing all cause and cardiovascular mortality due to calcium found that there was an associated increase in all cause, cardiovascular, and ischemic heart disease mortality with people with an average intake of calcium above 1,400mg a day, but these results were not conclusive.7 A few other articles looking at the association of calcium and cardiovascular disease mortality found no hard evidence and said that no causality could be confirmed.8,9 Sadly, a limitation to the research of calcium effects is that randomized clinical trials might be unfeasible. The risks of high supplementation of calcium are to high and could be considered unethical to test for. But is the intake of calcium the issue? The National Institutes of Health states that calcium intake is not involved in the prevalence of cardiovascular issues, but the serum concentrations of calcium.1 Calcium serum concentrations are highly regulated by the body to obtain proper homeostatic balance, using the bones as a reservoir for excess calcium.10 But this balance could be thrown off by increased or decreased calcium intake over longer periods of time.  Even though there is some evidence that calcium supplementation could be reducing incidence of fractures, evidence is increasing regarding the incidence of cardiovascular issues.11

From the research, I would say that patients should be cautioned when thinking about taking a calcium supplement for an extended period of time. The New York Times pointed out some good points, people should try to stay away from supplements as much as possible.3 If someone is below his or her recommended daily value of calcium, higher intake of high-calcium food should be recommended. Some examples of foods that are high in calcium are milk, cheese, yogurt, kale, and spinach.1 The major thing causing problems in people that are taking calcium supplements is that they most likely have an adequate amount of calcium in there normal diet, and the additional supplement is putting them over the recommended daily amount. The supplements themselves might not be necessarily directly causing the higher risk of cardiovascular disease, but it is increasing the calcium levels above the recommended daily amount. People wanting to take calcium supplements should consult their local pharmacist or primary care provider to make sure it is appropriate. For another great resource, check out Dr. Mercola’s article on the relationship between vitamin K2, vitamin D, and calcium (Link found in references section below). It explains the proper balance of these dietary supplements and how to control your calcium levels through them.12

With all of these risks, do you know what your daily calcium intake is? Maybe it’s time you checked for yourself.

 

 

References

1. Dietary Supplement Fact Sheet: Calcium. Offices of Dietary Supplements of the National Institutes of Health Website. http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/#en82. Accessed December 4, 2013.

2. Top Foods for Calcium and Vitmain D. WebMD Website. http://www.webmd.com/food-recipes/guide/calcium-vitamin-d-foods. Accessed on December 4, 2013.

3. Thinking Twice about Calcium Supplements. New York Times Website. http://well.blogs.nytimes.com/2013/04/08/thinking-twice-about-calcium-supplements-2/. Accessed December 3, 2013.

4. Johnston, CC; Miller, JZ; Slemenda, CW; Reister, TK; Hui, S; Christian, JC; Peacock, M. Calcium Supplementation and Increases in Bone Mineral Density in Children. NEJM. 1992;327(2):82-87. Accessed December 4, 2013.

5. Vitamin D and Calcium Supplementation to Prevent Fractures in Adults. U.S. Preventative Services Task Force Website. http://www.uspreventiveservicestaskforce.org/uspstf12/vitamind/finalrecvitd.htm. Published February, 2013. Accessed December 4, 2013.

6. Calcium and Vitamin D; What you need to know. National Osteoporosis Website.

http://nof.org/articles/10. Accessed of December 7th, 2013.

7. Michaëlsson, K; Melhus, H; Lemming, EW; Wolk, A; Byberg, L. Long term calcium intake and rates of all cause and cardiovascular mortality: community based prospective longitudinal cohort study. BMJ. 2013;346(228). Accessed December 4, 2013.

8. Bolland, M; Grey, A; Reid, I. Calcium and Cardiovascular Risks. Australian Prescriber. 2013;36(1):5-8. Accessed December 4, 2013.

9. Van Hemelrijck, M; Michaelsson, K; Linseisen, J; Rohrmann, S. Calcium Intake and Serum Concentration in Relation to Risk of Cardiovascular Death in NHANES III. PLOS One. 2013;8(4): 1-9. Accessed December 4, 2013.

10. Marks, AR. Calcium and the heart: a question of life and death. The Journal of Clinical Investigation. 2003;1(5):597-600. Accessed December 4, 2013.

11. Reid, IR. Cardiovascular Effects of Calcium Supplements. Nutrients. 2013;5:2522-2529. Accessed December 4, 2013.

12. What You Need to Know About Vitamin K2, D and Calcium. Mercola.com Website.

http://articles.mercola.com/sites/articles/archive/2012/12/16/vitamin-k2.aspx. Published in December of 2012. Accessed on December 7th, 2013.

Are you “Pro” Probiotic Supplements?

Thursday, December 5th, 2013

by Heather Evankow, PharmD student

In recent years, the popularity of probiotic supplements has risen. Probiotics are bacteria that help maintain the natural balance of organisms (microflora) in the intestine.1 The idea of probiotics is not a new concept. The idea was first developed around 1900 by the Nobel Prize-winning recipient Elie Metchnikoff. Metchnikoff theorized that the fermented milk products Bulgarian citizens ingested were a major factor in their longer life spans when compared with other countries.2 It was not until the year 1989 when R. Fuller popularized the term “probiotics”.3 Today, probiotics can be seen in the news claiming to improve the immune system, aid in skin health, defend against depression, clear up a bloated gut, prevent urinary tract infections, and even delay allergies.4

The Daily Herald recently released the article, Probiotics are all the rage, and experts say there are results behind the hype. The author, Gabriella Boston, Boston combines the opinions of several healthcare professionals to emphasize the health benefits behind the evolving topic of probiotics.

The first healthcare provider, Megan McCusker, is a dermatologist who believes probiotics are an important treatment therapy for treatment of anything from acne to psoriasis.4 While the Federal Drug Administration (FDA) does not approve any health claims for this supplement, McCusker could recommend 5-20 billion units per day depending on the patient’s needs. There were no clinical research references to show how McCusker developed these recommendations.

A nutritionist Boston featured, Jared Rice, also believes in the benefits of probiotics. Rice has not observed any downsides with his patients taking probiotics, but still advises patients to seek medical attention before taking high doses. Rice believes it is essential to buy the healthiest probiotic supplement. Also, he believes it is important to create a probiotic-friendly body by eating whole grains, bananas, and onions while steering clear of nondigestible carbohydrates.4 Unfortunately, there was no data referenced to confirm the benefits of Rice’s claims.

Ebeth Johnson, a nutritionist and chef, also gave her expert advice for this article. She believes this probiotic trend is here to stay. She encourages incorporating probiotics into your diet by consuming unpasteurized miso, live cultured pickles, tempeh, unsweetened kefir and yogurt, and kombucha teas.5 It is unclear how Johnson came up with these supplement sources. In addition, she also did not mention any specific research to validate the quality of these sources.

While the experts in Boston’s article seem confident in their recommendations of probiotics supplements, the clinical research is still limited for probiotics. The varieties of strains make it problematic in understanding the health benefits.

One of the most researched probiotic strains is Lactobacillus rhamnosus GG (LGG). LGG has been proven to help pediatric patients with pain-related gastrointestinal (GI) disorders in many clinical studies.5 In a 2011 meta-analysis, researchers systematically searched for randomized controlled trials assessing LGG supplementations in children with functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine and functional abdominal pain (FAP).5 The major limitations for this analysis included incomplete outcome data and the number of trials with a small sample size. The results revealed a decrease in severity in pain with the overall study population and the IBS subgroup.5 The frequency was also decreased in the IBS subgroup.

Another hopeful probiotic strain is Streptococcus thermophilus VSL #3. A multicenter, randomized, placebo-controlled, double-blind, crossover study has shown VSL #3 to be successful and safe in helping the lives of children with IBS.6  59 patients from ages 4-18 years of age completed the study with no untoward adverse effects reported. Researchers found no significant difference was found in the stool pattern of patients, but abdominal pain, abdominal bloating, and family life disruption were all significantly more effective to the placebo.6

Have you had any encounters with probiotic supplements? Comment and share your experiences. Please include the main therapy goal, specific probiotic strains, and the dosage.

If you have had no experience with probiotics, based on the information above, would you personally try probiotic supplements? Share your rational.

References

1. “Probiotics – Topic Overview.” WebMD. Healthwise, 04 FEB 2011. Web. 29 Nov 2013. <http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview>.

2. Parvez, S. and Kang S. “Probiotics and their fermented food products are beneficial for health.” Volume 6. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/pdf>.

3. Ouwehand, A., S. Salminen, and E. Isolauri. “Probiotics: an overview of beneficial effects.” Vol 82.Issue 1-4 (2002): 279-289. Web. 29 Nov. 2013. <http://link.springer.com/article/10.1023

4. Boston, Gabriella. “Probiotics are all the rage, and experts say there are results behind the hype.” Daily Herald. N.p., 28 Oct 2013. Web. 29 Nov 2013. <http://www.dailyherald.com/article/20131028/entlife/710289977/>.

5. Horvath, A., P. Dziechciarz, and H. Szajewska. “Meta-analysis: Lactobacillus rhamnosus GG for abdominal pain-related functional gastrointestinal disorders in childhood.” Alimentary Pharmacology & Therapeutics. Vol 6.Issue 12 (2011): 1302-1310. Web. 29 Nov. 2013. <http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2011.04665.x/full>.

6. Guandalini S., G. Magazzu, and A. Chiaro. “VSL#3 improves symptoms in children with irritable bowel syndrome: a multicenter, randomized, placebo-controlled, double-blind, crossover study.” J Pediatrics Gastroenterol Nutr. 2010 Jul;51(1):24-30. Web. 04 Dec. 2013. http://www.ncbi.nlm.nih.gov/pubmed/20453678.

Over the Counter Probiotics May Be Able to Sooth Baby’s Colic

Thursday, December 5th, 2013

by Mallory Martin, PharmD student

This article posted by the BBC, “Probiotics ‘soothe some babies with colic’”,1 explores an option into easing or possibly preventing your baby’s colic. The article describes an analysis of 12 studies looking into probiotics as a treatment for colic. The analysis was done by a team of scientists in Australia and reported in the Jama Pediatrics Journal. However the article didn’t cite where in the journal this article was found. This seemed uncharacteristic and it made it difficult to evaluate their findings. All this aside, their findings were quite exciting because although colic is not a harmful condition to babies and resolves itself after 3-4 months1, it can be quite stressful for caretakers. An option for soothing baby’s colic would be highly valued for this reason.

When attempting to sooth colic, parents can be scared away by ambiguity, not wanting to give something to their baby unless it is proven. “Research shows” is a phrase that may be thrown around a lot, but what people really want to know is whether a treatment is safe for their child and if it is effective. Taking these people into consideration and with the incomplete citation by the BBC article, I wanted to explore several articles published on this topic in an attempt to come to a conclusion on whether or not to recommend probiotics for colic.

Probiotics must first be understood on their own before exploring them as a treatment for colic. Probiotics are a mixture of different microorganisms that when orally ingested are considered to have several overall health benefits.1 The word itself means “promoting life”.2 They generally have very low risk in normal adults because the cultures so closely resemblethe natural flora of the gut. 3 Probiotics are also naturally present in food. Some foods that contain probiotics are fermented vegetable such as sour kraut and most commonly yogurt.2 Probiotics contain many different types of bacteria but among the most common is Lactobacillus reuteri. It is this strain of bacteria that is considered to have the most health benefits. 2

Certain health benefits have been discovered with probiotic use. Probiotics, L. reuteri specifically, has been shown to lower LDL levels, kill bacteria that causes tooth decay, lessen the harmful effects of gingivitis, and lower your likelihood of developing episodic diarrhea or traveler’s diarrhea. Some reports even show that this bacterium can lessen a child’s risk of developing eczema through probiotic-filled breast milk. Studies in women’s health showed that it may help balance the bacteria present in the vagina and lower the risk of yeast infections, bacterial vaginosis, and urinary tract infections. Some additional benefits include its ability to reduce upper respiratory infections when compared to placebo, provide relief to baby’s colic, and reduce bloating and gas.2

Although the results are promising, research in this area is not concrete. Probiotics may have both risks and benefits for different people. Risk for special populations, such as small children and older adults, is unclear since there is little to no research done on these groups.2 So far, healthy, full-term babies who have received high doses of probiotics have not presented with any negative effects.4 However there is some evidence that young children who are pre-term or not fully healthy, such as children with weakened immune systems, catheters or other medical devices inside them, may be at risk if taking probiotics.4 When considering L. reuteri in treatment of colic, one study by Savino concluded that it is inconclusive whether L. reuteri reduces colic but it appears to reduce levels of harmful E. coli. 5,6 Savino performed a follow up study after comparing L.reuteri with simethicone and compared the bacteria against a placebo in treatment of colic.7 This study had a better study design for its desired outcome because the infants involved were chosen based on Wessel’s Criteria, a more systematic approach than the first study. The results concluded that L. reuteri DSM 17 938 at a dose of 108 colony-forming units per day in early breastfed infants improved symptoms of baby’s colic and was well tolerated and safe.7 Some factors that could contribute to the varying results in these studies include the differences in the care the infants received in different homes and different study designs. An article put out by Fox News article reported on this as well. The conclusion was that probiotics may not be effective. However in young infants, they can potentially reduce risk of asthma and eczema.4 This positive effect, while unrelated, is something to consider when evaluating probiotics for your child.

Considering all this information, I would recommend probiotics as a means of treatment for infantile colic. The best option would be for a nursing mother to start a regimen of daily probiotics and allow the probiotics to transfer through the breast milk. However, L. reuteri is available for infants to ingest. Gerber has a colic relief drop that specifically has L. reuteri in it which includes sunflower oil. Gerber also has a powder for formula around 30 dollars for 24 ounces. BioGaia has a straight L. reuteri drop for around 20 dollars for 5 mLs. There are options. Even if it may not be 100% guaranteed to be effective, if your colicky baby is becoming too much to handle and you have tried many other options, I would say it is worth a try. Especially considering no bad effects have been found and several unrelated positive effects have been suggested. Probiotics would be a safe and natural way to go in your attempt to soothe your baby and get a good night’s rest yourself. Some may not agree with me. With the lack of research and uncertainty, risks could exist. Just because no negative effects have been found does not mean that it is completely safe. Would you take that risk with your own child?

References

1. Roberts, M. Probiotics ‘soothe some babies with colic’. The BBC. October 7, 2013. http://www.bbc.co.uk/news/health-24426623. Accessed December 3, 2013.

2. Maier, R. Surprising Benefits of Probiotics. Healthine Web site. April 13, 2013. http://ask.healthline.com/health-slideshow/surprising-benefits-probiotics. Accessed December 3, 2013.

3. Probiotics – Topic Overview. Webmd Web site. February 04, 2011. http://www.webmd.com/digestive-disorders/tc/probiotics-topic-overview. Accessed September 15, 2013.

4. Rettner, R. Are Probiotics Safe for Kids?. Livescience Web site. October 06, 2011. http://www.livescience.com/16426-probiotics-safe-kids.html. Accessed December 3, 2013.

5. Woznicki, K. Probiotics May Reduce Crying From Colic. Webmd Web site. August 16, 2010. http://www.webmd.com/parenting/baby/news/20100816/probiotics-may-reduce-crying-from-colic. Accessed October 15, 2013.

6. Savino F, Cordisco L, Tarasco V, et al. Lactobacillus reuteri DSM 17938 in infantile colic: a randomized, double-blind, placebo-controlled trial. Pediatrics. 2010;126(3):e526-33.

7. Savino F, Pelle E, Palumeri E, Oggero R, Miniero R. Lactobacillus reuteri (American Type Culture Collection Strain 55730) versus simethicone in the treatment of infantile colic: a prospective randomized study. Pediatrics. 2007;119(1):e124-30.

Evidence for Supplement Use to Prevent Cancer or Cardiovascular Disease?

Wednesday, December 4th, 2013

By Tirhas Mekonnen, PharmD Student, Cedarville University

Dietary supplements have been used for various reasons. Dietary supplements such as ascorbate, vitamin E, and ß-carotene, are reducing agents and thereby, detoxify reactive oxygen intermediates in the laboratory.1 Researchers are studying to find out if consumption of food rich in these antioxidant compounds could potentially reduce the risk for certain types of cancers as well as other chronic health problems like cardiovascular disease.  However, clinical trials with antioxidants as dietary supplements have failed to show clear beneficial effects.1

This article on Medpage Today by Todd Neale discussed a systematic review that investigated the use of mineral and dietary supplementation for primary prevention of cardiovascular disease or cancer.2 The review evaluates 24 randomized, controlled trials and 2 cohort studies that examined the benefits and harms of using vitamin and mineral supplements for primary prevention of CVD, cancer, or all-cause mortality in healthy individuals without known nutritional deficiencies.3 The study found that except for two clinical trials, there was only “a small borderline-significant benefit” from multivitamin supplements on cancer (but only in men), limited evidence supports any benefit from vitamin and mineral supplementation for the prevention of cancer or cardiovascular disease”.3 Although the review looked at many studies there are some limitations.

One of the limitations is that the review included short term studies that analyze the use of dietary supplements.3 However, those short-term studies may not confirm or indicate the outcomes of chronic use of dietary supplements. For example, the median follow up time of the study titled, “Randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals” was only for seven and half years.4 The review also consists of studies done in various countries. However, poor eating habits, tobacco use, consumption of alcohol, and many other variables may differ from one country to the other country.  These variables are risk factors for chronic heart disease or cancer.

Other sources have also not found consistent evidence to recommend minerals and dietary supplements for the primary prevention of cardiovascular disease and cancer.  An article titled “Nutrient supplements and cardiovascular disease” discussed associations between carotenoids, folic acid, and vitamin E with CVD risk.5 As the article illustrated, previous researchers thought that vitamin E, due to its antioxidant effect, may reduce CVD. However, the article also noted more recent randomized placebo-controlled interventional trials do not support the original assumption regarding vitamin E.5 The article also pointed out that “With few exceptions, a large series of primary and secondary prevention trials have reported no significant benefit of moderate-to high-dose vitamin E supplementation of cardiovascular outcomes”.5

In addition, the use of dietary supplement folate and its association with cardiovascular health benefit was discussed in another review article by Ulrich and Potter et al. This article also is consistent with the previous reviews and studies mentioned above. “The prevention of cardiovascular disease was assumed to be another health benefit of increased folate intake; unfortunately, the results from randomized controlled trials with actual disease outcomes provide no evidence for such an effect.”6 Therefore, there is currently a lack of evidence to suggest that folate prevents cardiovascular disease or cancer.

In conclusion, after reading these reviews and studies, I agree with Mr. Todd Neale, that there is no clear answer for the following question: Is there clear evidence to recommend minerals and dietary supplements for the primary prevention of cardiovascular disease?  I would like to get your professional opinion on this matter. Please participate if you have found studies that do have a better explanation as to whether to recommend or to not recommend dietary supplements for the primary prevention of cardiovascular disease or cancer.

References

  1. Harvey R, Ferrier D. Lippincott’s illustrated Reviews. 6th ed. Wolters Kluwer Health, Philadelphia, PA/Lipincott Williams & Wilkins; 2011.
  2. Neale T. USPSTF: Evidence for Supplement Use Lacking. Medpage Today. Published: Nov 11, 2013 Retrieved from http://www.medpagetoday.com/Cardiology/Prevention/42842?xid=nl_mpt_DHE_2013-11-12&eun=g388495d0r&userid=388495&email=dr.usman23@gmail.com&mu_id=5381424
  3. Fortmann S, Burda B, Senger C, Lin J, Whitlock E. Vitamin and Mineral Supplements in the Primary Prevention of Cardiovascular Disease and Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine. 2013; published on-line doi:10.7326/0003-4819-159-12-201312170-00729. 
  4. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, et al. The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med. 2004;164(21):2335-42. [PMID: 15557412]
  5. Lichtenstein A. Nutrient supplements and cardiovascular disease: a heartbreaking story. J. Lipid Res. 200; 50:(S429-S433).Available from: http://www.jlr.org/content/50/Supplement/S429.full
  6. Ulrich M, Potter J. Folate Supplementation: Too Much of a Good Thing? Cancer Epidemiology Biomakers & Prevention Feb 2006;15:189. Retrieved from http://cebp.aacrjournals.org/content/15/2/189.full

Herbal Supplements: The Whole Truth

Monday, December 2nd, 2013

by Olumami Amaye, PharmD student

Herbal supplements come in all forms. They may be taken internally as pills or powders, dissolved into tinctures or syrups, or brewed in teas. Ointments, shampoos, or poultices may be applied to the skin, scalp, or mucous membranes. What puzzles me, however,  are the unlisted ingredients in the supplements. In fact, an article published by Live-Science on October 11th, 2013 discusses a new study which found that herbal supplements contain unlisted ingredients and may pose a health hazard to consumers.1

In the United States, herbal and other dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods. This means that they do not have to meet the same standards as drugs and over-the-counter medications for proof of safety, effectiveness, and what the FDA calls Good Manufacturing Practices. The active ingredient(s) in many herbs and herbal supplements are not known. There may be dozens, even hundreds, of such compounds in an herbal supplement. In 2011, some researchers conducted a study to verify the contents of 5 known herbal products: St John’s wort, Asian ginseng, echinacea, garlic and ginkgo.2  What they found was so alarming that it forced the European Union (EU) to change some legislation on herbal supplement products.3 Some herbal supplements have been found to be contaminated with metals, unlabeled prescription drugs, microorganisms, or other substances, the researchers said.3

However, in a recent article in the Archives of Internal Medicine, DM Marcus and AP Grollman stated that “Even when the Food and Drug Administration (FDA)” identifies an unsafe product, it lacks authority to mandate its removal from the market because it must meet the very high legal requirement to demonstrate a ‘significant or unreasonable’ risk.3 According to the article published by Live-Science on October 11th, 2013 BMC medicine studied a very new technique “ called DNA  barcoding test” where they analyzed 12 companies herbal products. However, out of the 12 companies that manufacture herbal supplements only 2 products were found to have no substitution, contaminants or fillers.4 The Newmaster et al. study also found that one product labeled as St.John’s wort was substituted with senna alexandrina. It contained only senna barcodes and no St. John’s wort barcoding.1  From my understanding of senna, it’s a stimulant laxative agent which if not properly used can cause  adverse effects such as diarrhea, abdominal pain, skin disorders and blistering.5 Several herbal products contained Parthenium hysterophorus (feverfew), which can cause swelling and numbness in the mouth, oral ulcers and nausea. It also reacts with medications metabolized by the liver and may increase the risk of bleeding, especially if taken with blood-thinning medications, the researchers said.1

The findings of the study are also consistent with earlier studies. For examples, one study shows   51 (75%) of 68 products contained none of the key safety messages, while other studies also share similar results.6   In light of these and other studies conducted in North American and European countries, I believe there should be some regulations in place for testing and approval of herbal products.  Personally, after reading this article I felt that using supplements can be dangerous to a person’s health. I would be very cautious before putting one of these into my body for any reason. I have learned that the improper use of supplements might lead to some health issues.

The limitations to this study are the use of new DNA barcoding methods, lack of barcode library, and not listing the names of herbal supplement manufacturers. The DNA barcoding is not generally accepted by herbal product manufacturers and no set standards are in place for industries to follow. The study also failed to list the herbal products that were tested and the brands or companies that are following unethical activities and false advertising. By not listing the companies involve, the study might mislead other consumers to think that all herbal supplements are totally bad.

Would you take herbal supplements? Do you think they are beneficial to your health?,

 

References:

  1. Newmaster S, Grguric M, Shanmughanandhan D, Ramalingam S, Ragupathy S. DNA barcoding detects contamination and substitution in North American herbal products. BMC Medicine [serial online]. November 2013;11(1):18-35. Available from: Academic Search Complete, Ipswich, MA. Accessed November 12, 2013.
  2. Marcus DM, Grollman AP. The consequences of ineffective regulation of dietary supplements. Arch Intern Med. 2012 Jul 9;172(13):1035-6. PubMed PMID: 22777632.
  3. Linde K, Berner MM, Kriston L. St John’s wort for major depression. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000448.
  4. Rettner, Rachael. Herbal Supplements Often Contain Unlisted Ingredients. LiveScience, October 11th, 2013. Available at http://www.livescience.com/40357-herbal-products-unlisted-ingredient.html.   Accessed November 12, 2013.
  5. Krinsky, D. L., Berardi, R. R., & Ferreri, S. P. (2011). Handbook of nonprescription drugs: An interactive approach to self-care (17th ed.). Washington, D.C: American Pharmacists Association.
  6. Raynor D, Dickinson R, Knapp P, Long A, Nicolson D. Buyer beware? Does the information provided with herbal products available over the counter enable safe use?. BMC Medicine [serial online]. August 9, 2011;9:94. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed November 12, 2013.

Exercise to Save Your Knees

Monday, December 2nd, 2013

by Jeniffer George, PharmD student

An estimated 27 million adults in the United States suffer from osteoarthritis of the knee or hip which is commonly seen in patients 65 and older.1 Osteoarthritis is the breakdown in cartilage that covers the ends of the bone to where they meet and form a joint to allow movement.1 As of today, researchers have not found a set cure for arthritis, however, mild pain relief can be found from the use of NSAIDS, acetaminophen and combination products such as glucosamine and chondroitin. In addition, with the increase in obesity in the United States, exercise can relieve stress that is placed on the knees for patients with osteoarthritis. A survey conducted by the Centers for Disease Control and Prevention showed 53% of patients with arthritis didn’t walk at all for exercise, and 23% meet the current recommendation for activity—walking for at least 150 minutes a week.2 So the question I pose is: as future pharmacists, should we recommend glucosamine and chondroitin or exercise to patients with osteoarthritis?

For almost 20 years, the nutritional supplement glucosamine and chondroitin has been marketed to the public for joint health. Glucosamine is an amino sugar that can help renew cartilage while chondroitin is thought to be a complex carbohydrate that helps cartilage retain water.3 Glucosamine and chondroitin are found as natural substances in and around the cells of cartilage.3

NPR recently released an article that presented a study published by the New England Journal of Medicine (NEJM) and another study by the Journal of American Medical Association (JAMA). The study found in NEJM, involved 1,583 randomly selected patients receiving glucosamine and chondroitin with placebo.4 They found that glucosamine/chondroitin, in comparison with placebo seemed to show no effect on patients with osteoarthritis, however, a smaller subgroup characterized with moderate to severe pain showed a significant reduction of knee pain after the use of glucosamine. The study was conducted well, however, patients measured at baseline reported having mild knee pain, as compared with that in classic studies of osteoarthritis, in which a criterion for entry was a disease flare after the discontinuation of NSAIDs.4 In general, the evidence on glucosamine/chondroitin is varied, leaving it difficult to answer if the use of supplements are proven to be effective.

The second study presented in JAMA, included 399 participants that are overweight and presented with knee osteoarthritis. Participants in the study endured 18 months of combined intense diet and exercise modifications to see if there would be an increase in knee function and reduction in pain. Participants in the diet and exercise and diet groups had greater reductions in Interleukin 6 (used to measure inflammation) levels than those in the exercise group; those in the diet group had greater reductions in knee compressive force than those in the exercise group.5 The article does a great job on emphasizing the importance of exercise, however, patients with moderate to severe osteoarthritis, who may have difficulty exercising were excluded from the study.

I agree with most of the content in the article and seem to agree with the studies associated with the material. As a future pharmacist, I would recommend using glucosamine and chondroitin in conjunction with exercise while living a healthy dietary lifestyle to help patients with osteoarthritis. It is human nature to avoid doing things when you are in pain. Patients with osteoarthritis may avoid exercise when a hip, knee, or other joints hurt. As shown in the NEJM study, patients with moderate-to-severe pain saw a reduction in pain after using glucosamine and chondroitin. Recommending glucosamine and chondroitin can help patients have temporary relief in pain, which can enable them to engage in low impact activities, get the heart rate up and burn calories. If exercise is not an option for the patient, guiding the patient in dietary modifications can help in weight reduction. Other treatment options include: rest which helps reduce stress and tension that is put on the knees, hot and cold therapy to help increase blood flow and reduce inflammation near the joint area, and to avoid standing in one position for an extended time.

With studies like these, would you suggest glucosamine and chondroitin as a form of therapy? How can you advise a patient that is adamant on not losing weight due to the pain they are experiencing?

 

References

 

  1. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/research/results/gait/qa.htm. Published May 2002. Updated October 2008. Accessed November 1, 2013.
  2. Skerrett PJ. Exercise is good, not bad, for arthritis. Harvard Health Publication Web site. http://www.health.harvard.edu/blog/exercise-is-good-not-bad-for-arthritis-201305086202. Published May 8,2013. Accessed November 21, 2013.
  3. Patti Neighmond. National Public Radio. National Public Radio Website. http://www.npr.org/blogs/health/2013/10/14/231451187/exercise-may-help-knees-more-than-glucosamine-and-chondroitin?utm_content=socialflow&utm_campaign=nprfacebook&utm_source=npr&utm_medium=facebook. Published October 14, 2013. Accessed November 1, 2013
  4. Clegg DO, Reda DJ, Harris CL, et al. Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis. N Engl J Med. 2006;354(8):795-808.
  5. Messier SP, Mihalko SL, Legault C, et al. Effects of Intensive Diet and Exercise on Knee Joint Loads, Inflammation, and Clinical Outcomes Among Overweight and Obese Adults With Knee Osteoarthritis: The IDEA Randomized Clinical Trial. JAMA. 2013;310(12):1263-1273. doi:10.1001/jama.2013.277669.Accessed November 1, 2013.

 

Vitamin B Supplements Can Lower Your Risk of Stroke

Tuesday, November 26th, 2013

by Jessica Amtower, PharmD student

Vitamin B supplements have been known for their many uses. For example, some B vitamins help cells burn fats and glucose for energy, while others help make neurotransmitters like serotonin.1 To get as much benefit as possible, it’s recommended that you need all of the B’s, but they are still beneficial alone. Some B vitamins have previously been noted to possibly lower the risk of stroke. According to the CDC, strokes are the leading cause of death in the United States, killing nearly 130,000 Americans each year—that’s 1 of every 18 deaths.2

CNN recently published an article stating that Vitamin B supplements could potentially help reduce the risk of a stroke.  The study promoting this information was published in the journal Neurology, where researches conducted a meta-analyses from the results of 14 clinical trials involving 54, 913 participants.3 The study concluded that patients taking a vitamin B supplement had a 7% reduced risk of stroke compared to those who were taking a supplement. This reduced risk of stroke was due to lowered homocysteine levels in the blood, which are associated with hardening and narrowing of the arteries as well as increased risk of heart attacks, strokes, and blood clot formation.4 Several meta-analyses have been published since 2010 looking at the effects of therapy to lower homocysteine levels with B vitamin supplementation on vascular disease risk. However, this new study included studies that were omitted from previous reports and adopted stricter inclusion criteria.5

According to an author of the study, Xu Yuming of Zhengzhou, University in Zhengzhou, China, previous studies have conflicting findings regarding the use of vitamin B supplements and stroke or heart attack.6 He states, “Some studies have even suggested that the supplements may increase the risk of these events.” While it was found that participants had a reduced risk of stroke, the supplements did not reduce the severity of the strokes or the risk of death.6 Scientists have admitted that more research needs to be done in the area, but many stroke specialists still feel this is a positive step forward.

Dr. Teshamae Monteith, an assistant professor of clinical neurology at the University of Miami School of Medicine says, “I think this is an exciting study, because we need more treatments for stroke. I believe safe options are necessary, but I don’t think people should start ingesting large amounts of Vitamin B to avoid strokes.” In light of the article background and information regarding supplements and stroke, I would agree with Dr. Monteith in that this is a step in the right direction, but we shouldn’t just start recommending it constantly. Although there is plenty of scientific literature stating that B vitamin supplementation for homocysteine reduction significantly reduced stroke events4, more research is required to solidify these findings. After further research on vitamin B supplements, I would personally recommend them. Vitamin B supplements are beneficial for health issues such as stress, anxiety, depression, dementia, Alzheimer’s disease as well as many others.6 According to the USDA, many Americans don’t get enough B vitamins, as deficiencies in folic acid, B12 and B6 are especially common.1 Many Americans are unaware of these deficiencies only because they are not currently presented in a physical ailment. B vitamin supplements are more helpful than most realize, and aren’t going to cause harm. Water-soluble B’s are found to be very safe. Patients should always check with their primary care physician before adding a dietary supplement to their medication regimens.

When searching for limitations within the research, it was rather difficult to find anything. Typically, with meta-analyses you would look for limitations such as sample size, study methods, or exclusion/inclusion criteria. This study had a rather large sample size of over 54,000 participants, ruling this out as being a possible limitation. The inclusion/exclusion criteria were very broad to include studies where vitamin B was shown effective and studies where it wasn’t. The only thing I can seem to find as a limitation is that B vitamin supplement has yet to be defined as a standard of care when dealing with reduction of the risk of stroke. Practitioners are unaware of any benefit due to it not being a standard of care.

With this newly discovered research, many patients are going to be asking questions about the safety and effectiveness of B vitamin supplements. If these supplements were to truly reduce the risk of stroke, would you take them on a regular basis? As a student pharmacist, and current intern, would you feel comfortable recommending this to patients?

References

  1. Challem J. The Benefits of B Vitamins. In Whole Living: Body and Soul in Balance. http://www.wholeliving.com/134086/benefits-b-vitamins. Published 2005. Accessed November 15,2013.
  2. CDC. Stroke Facts and Statistics. Center for Disease Control and Prevention. http://www.cdc.gov/stroke/facts_statistics.htm. Published October 16, 2012. Accessed November 15, 2013.
  3. Wadas-Willingham V. Vitamin B may lower stroke risk. CNN Health. http://thechart.blogs.cnn.com/2013/09/19/vitamin-b-may-lower-stroke-risk/. Published September 19, 2013. Accessed November 15, 2013.
  4. Yan J., et al. Vitamin B supplementation, homocysteine levels, and the risk of cerebrovascular disease: A meta-analysis. Neurology. September 18, 2013; 81(15):1298-1307. Doi: 10.1212/WNL.0b013e3182a823cc.
  5. Anderson P. Vitamin B Supplements May Lower Stroke Risk. Medscape: Medical Students. http://www.medscape.com/viewarticle/811260. Published September 18, 2013. Accessed November 15, 2013.
  6. Whiteman H. Vitamin B may reduce risk of stroke. Medical News Today. http://www.medicalnewstoday.com/articles/266247.php. Published September 20, 2013. Accessed November 15, 2013.