Natural health products: The Good, The Bad & Maybe Helpful. October 17, 2013 Dragana Skokovic-Sunjic, RPh, NCMP Clinical Pharmacist Hamilton FHT

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1 Natural health products: The Good, The Bad & Maybe Helpful October 17, 2013 Dragana Skokovic-Sunjic, RPh, NCMP Clinical Pharmacist Hamilton FHT

2 Objectives: Regulatory status of natural health products in Canada today Latest information on some of the most commonly used herbals, vitamins and minerals Potentially beneficial natural health products in patients with the history of breast cancer Dragana Skokovic-Sunjic RPh 2

3 Natural, alternative, amazing, safe, organic cures What is available? Where do we find it? Sources of information? Dragana Skokovic-Sunjic RPh 3

4 Problems with natural and herbal products High popular demand Potentially very lucrative and profitable market Non-satisfactory quality control and lack of regulations Misconceptions about safety Dangerous self-medication Adulterated or mislabeled products Dragana Skokovic-Sunjic RPh 4

5 How to avoid fraud If it sounds too good to be true, it probably is Be cautious of testimonials claiming amazing results Watch out for claims such as: - scientific breakthrough - miraculous cure - exclusive product - secret ingredient Dragana Skokovic-Sunjic RPh 5

6 Who do we trust? Health food store recommendations: implications for breast cancer patients Results: - 34 health food stores visited - 33 different products recommended - Average cost $58.09 (CAD) per visit - 68% did not ask about other medications Mills et al Breast Cancer Research Vol 5 No Dragana Skokovic-Sunjic RPh 6

7 Who do we trust? Doctor convicted in fake cancer treatments Christine Daniel faces 150 years in federal prison and $5.5 million in fines for selling phony cures for cancer, diabetes and Alzheimer's, preying mostly on evangelical Christians (Sept 2011) Ex Doctor and Pentecostal minister Dr. Christine Daniel, Who Hawked Phony Cancer Cure on TBN, Gets 14 Years, $1.2 Million Fine (May 2013) Dragana Skokovic-Sunjic RPh 7

8 Natural Health Products and regulations in Canada Natural Health Products Regulations published in the Canada Gazette, Part II on June 18, 2003 Came into force on January 1, 2004 Health Canada Natural Health Products Directorate NPN or EN numbers Compendium of Natural Health Products can be accessed on line Beware of products sold via internet, multilevel marketing companies, unregulated natural health practitioners Dragana Skokovic-Sunjic RPh 8

9 What to look for when selecting NHP? The product label will bear an 8 digit product license number, proceeded by the letters NPN or EN. NPN will indicate that the product has been reviewed by Health Canada for safety, quality and health claims Dragana Skokovic-Sunjic RPh 9

10 How will NHP be labeled? The label will include: - Appropriate and truthful, recommended use and purpose, - Route of administration, dose, duration, - Side effects, contraindications, cautions, warnings - Medicinal and non-medicinal ingredients, - Storage, lot number, expiry date, - Name, address, phone number of the manufacturer, etc. Dragana Skokovic-Sunjic RPh 10

11 So, NHPs are now controlled? October 2013 In the recent study, researchers at the University of Guelph used DNA testing to probe 44 herbal products from 12 companies. Dragana Skokovic-Sunjic RPh 11

12 So, NHPs are now controlled? October 2013 They discovered there was product substitution in 20 of the 44 products tested and only two companies had products without any substitution, contamination or fillers. Scientists also said that some of the contaminants found posed "serious health risks to consumers." Dragana Skokovic-Sunjic RPh 12

13 How about: The Good & Maybe Helpful? Natural health products can be beneficial: To correct deficiencies To regulate immune system response For their potential to prevent disease Dragana Skokovic-Sunjic RPh 13

14 Milk Thistle (Silybum marianum) Seed contains a mixture of active principles called silymarin (flavolignan complex composed of silybinin,silydianin and silychristin) Traditionally has a long history of use, clinical studies since early 1960s Dragana Skokovic-Sunjic RPh 14

15 Milk thistle : What does it do? Actively protects the liver by strengthening the outer membrane of liver cells and preventing toxins from penetrating Stimulates an enzymatic action that in turn increases protein synthesis, enables the liver to form new cells and repair itself German Commission E Monograph 1989 Dragana Skokovic-Sunjic RPh 15

16 Milk thistle : What is the evidence? Protects the liver against toxins Improves liver function in patients with alcohol-induced cirrhosis (lowers mortality rate) Reduces hepatotoxicity of neuroleptic drugs Hepatitis (chronic and acute) - IV administration Reduces likelihood of liver and kidney damage by some medications used in chemotherapy Dragana Skokovic-Sunjic RPh 16

17 Turmeric (Curcuma longa) Active ingredient curcumin Used as a spice Shown anti-inflammatory action Preliminary data indicates few mechanisms in cancer prevention: prevention of spread in inflammatory and triple negative breast cancer Dragana Skokovic-Sunjic RPh 17

18 Omega 3, 6, 9? Omega 3 fatty acids: ALA seed oils (tofu, canola oil, soybeans, nuts, flaxseed) EPA, DHA marine sources (salmon, tuna, mackerel, anchovy, herring, trout, sardine) Omega 6 gamma linoleic acid or GLA (evening primrose oil) Omega 9 oleic acid (olive oil) Dragana Skokovic-Sunjic RPh 18

19 Omega 3 o Benefits of consuming EPA, DHA: Lowers cholesterol Reduces risk of heart attack, strokes, death Slows development of plaque and blood clots o How much to take?»healthy adults: mg daily EPA + DHA»High cholesterol: 2-3g daily Dragana Skokovic-Sunjic RPh 19

20 Vitamin D Bone loss (osteoporosis) Bone disorders caused by low vitamin D levels such as: rickets and osteomalacia Prevents depression, diabetes, multiple sclerosis, Crohn s disease, pain and inflammation in RA Prevents certain forms of cancer (breast, colon, prostate) Prevents falls Dragana Skokovic-Sunjic RPh 20

21 Vitamin D The role of vitamin D as a prevention of breast cancer still under scrutiny How much do we need? How much is too much? Blood levels (25-OH-vitamin D): nmol/l most likely optimal SIGMA recommends : 2,000IU per day for women in Canada Dragana Skokovic-Sunjic RPh 21

22 Vitamin B12 Used to: maintain healthy nerve cells and red blood cells Found in: fish, shellfish, meat, eggs, dairy products Absorbed via active transport in the small intestine (can be affected by stress, medications, malnutrition) Dragana Skokovic-Sunjic RPh 22

23 Vitamin B12 People at risk of having low levels: Vegetarians Long-term metformin use (diabetics) Long term medications to reduce stomach acid Elderly Patient on medication adversely affecting GI function Supplementation available: Oral or sublingual tablets Injection Dragana Skokovic-Sunjic RPh 23

24 Calcium How much do we need to supplement? Assess the dietary intake first! Calcium carbonate Calcium citrate Coral calcium Dragana Skokovic-Sunjic RPh 24

25 Magnesium Magnesium deficiency very common Magnesium supplementation beneficial: - Muscle pain - Muscle spasm (leg cramps, restless legs) - Fibromyalgia - Insomnia - Migraines Dragana Skokovic-Sunjic RPh 25

26 Magnesium Magnesium supplements: - Magnesium oxide - Magnesium citrate - Magnesium bound to amino acids (taurate, bisglycinate) Look for the amount of elemental magnesium per dose Usual dose : mg at bedtime Dragana Skokovic-Sunjic RPh 26

fumarate 300mg Iron polysaccharide150mg Iron heme

27 Iron supplements Iron supplements comparison Ferrous gluconate 300mg Ferrous sulfate 300mg Ferrous fumarate 300mg Iron polysaccharide150mg Iron heme Elemental iron : mg per capsule Dragana Skokovic-Sunjic RPh 27

28 Probiotics Definition: live microorganisms which when administered in adequate amounts confer a health benefit on the host Dragana Skokovic-Sunjic RPh 28

29 Microbiota : What is going on in our gut? Microbial cells in human GI tract equal 10 times the number of human cells in the body In an average adult microbiota weighs 1-2 kg Dragana Skokovic-Sunjic RPh 29

30 Benefits of microbiota Immune function Direct action against pathogenic bacteria Barrier function Metabolic and anti-oxidative role Potential anti-carcinogenic action Dragana Skokovic-Sunjic RPh 30

31 Not all probiotics are the same For overall health: - DanActive - BioGaia For diarrhea: - BioK+ - Florastor For irritable bowel syndrome: - Tuzen - Activia Dragana Skokovic-Sunjic RPh 31

Prepared by decapitating a duck, taking 35 grams of its liver and

32 A word about homeopathy Example: Oscilliococcinum : Treatment for colds and the flu. Prepared by decapitating a duck, taking 35 grams of its liver and 15 grams of its heart and fermenting it for 40 days And diluting up to 200 times Dragana Skokovic-Sunjic RPh 32

33 Dilution process in homeopathy Dragana Skokovic-Sunjic RPh 33

34 Antioxidants? Cruciferous vegetables (cabbage, Savoy cabbage, Brussels sprouts) Green, leafy vegetables (kale, Swiss chard) Cherries, dark skinned berries Or tablets? Dragana Skokovic-Sunjic RPh 34

35 Conclusion Question the source of information Ask: Is it right for me? Do not accept the cookie cutter approach New evidence and data emerging daily Not that long ago: Dragana Skokovic-Sunjic RPh 35

SUPER FOODS IT S HEALTH BENEFITS BY ADITI SHAH, MPH, RD, LWMC

SUPER FOODS IT S HEALTH BENEFITS BY ADITI SHAH, MPH, RD, LWMC Definition Functional food or Super food defined as foods that, in addition to supplying known nutrients, can provide other health benefits