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Early introduction of lipids to parenterally-fed preterm infants. Early trophic feeding versus enteral fasting for very preterm or very low birth weight infants. Early versus delayed enteral nutrition support for burn injuries.

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Early versus delayed enteral nutrition support for critically ill adults. Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Early versus late administration of amino acids in preterm infants receiving parenteral nutrition. Education of family members to support weaning to solids and nutrition in infants born preterm. Education of family members to support weaning to solids and nutrition in later infancy in term-born infants. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under.

Educational interventions for the management of cancer-related fatigue in adults. Effect of cocoa on blood pressure. Effect of longer-term modest salt reduction on blood pressure. Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding. Effect of taurine supplementation on growth and development in preterm or low birth weight infants. Effect of the treatment of Type 2 diabetes mellitus on the development of cognitive impairment and dementia. Effects and safety of periconceptional oral folate supplementation for preventing birth defects.

Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Effects of restricted caffeine intake by mother on fetal, neonatal and pregnancy outcomes. Effects of total fat intake on body weight. Eicosapentaenoic acid EPA, an omega-3 fatty acid from fish oils for the treatment of cancer cachexia. Enhanced glucose control for preventing and treating diabetic neuropathy.

Enhanced recovery protocols for major upper gastrointestinal, liver and pancreatic surgery. Enteral iron supplementation in preterm and low birth weight infants. Enteral lactoferrin for the treatment of sepsis and necrotizing enterocolitis in neonates. Enteral nutrition for maintenance of remission in Crohn's disease.

Enteral nutrition formulations for acute pancreatitis. Enteral nutritional therapy for induction of remission in Crohn's disease. Enteral tube feeding for cystic fibrosis. Enteral tube feeding for older people with advanced dementia. Enteral versus parenteral nutrition for acute pancreatitis. Enteral zinc supplementation for prevention of morbidity and mortality in preterm neonates. Environmental and behavioural modifications for improving food and fluid intake in people with dementia.

Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Erythropoietin with iron supplementation for preoperative anaemia in non-cardiac surgery. Extra fluids for breastfeeding mothers for increasing milk production. Fasting for haemostasis in children with gastrointestinal bleeding. Fat supplementation of human milk for promoting growth in preterm infants. Feed thickener for infants up to six months of age with gastro-oesophageal reflux. Feeding interventions for growth and development in infants with cleft lip, cleft palate or cleft lip and palate.

Fermented milk for hypertension. Fiber and bulking agents for the treatment of chronic constipation. Fish oil for induction of remission in ulcerative colitis. Fish oil for kidney transplant recipients. Fish oil supplements for rheumatoid arthritis. Fish oil supplements for the prevention and treatment of hypertension in adults. Fish oil-based lipid emulsions versus standard lipid emulsions for prevention of parenteral nutrition-associated liver disease in children. Fish oil-based lipid emulsions versus standard lipid emulsions for treatment of parenteral nutrition-associated liver disease in children.

Flavonoids for treating venous leg ulcers. Fluid restriction for treatment of preterm infants with chronic lung disease. Fluid supplementation for neonatal unconjugated hyperbilirubinaemia. Fluid therapy for acute bacterial meningitis. Fluoridated milk for preventing dental caries. Fluoride for treating postmenopausal osteoporosis. Fluoride supplementation with tablets, drops, lozenges or chewing gum in pregnant women for preventing dental caries in the primary teeth of their children.

Fluoride supplements tablets, drops, lozenges or chewing gums for preventing dental caries in children. Folate for depressive disorders. Folate supplementation in people with sickle cell disease. Folate supplementation in women of reproductive age. Folic acid and folinic acid for reducing side effects in patients receiving methotrexate for rheumatoid arthritis.

Folic acid for fragile X syndrome. Folic acid supplementation during pregnancy for maternal health and pregnancy outcomes. Folic acid supplementation for the prevention of anaemia in preterm neonates. Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people. Food fortification with multiple micronutrients: impact on health outcomes.

Food supplementation for improving the physical and psychosocial health of socio-economically disadvantaged children aged three months to five years. Formula versus donor breast milk for feeding preterm or low birth weight infants. Updated Formula versus maternal breast milk for feeding preterm or low birth weight infants.

Fortification of condiments and seasonings with iron for preventing anaemia and improving health. Fortification of maize flour with iron for controlling anaemia and iron deficiency in populations. Fortification of rice with vitamins and minerals for addressing micronutrient malnutrition. Fortification of staple foods with vitamin A for vitamin A deficiency. Fortification of staple foods with zinc for improving zinc status and other health outcomes in the general population. Fortification of wheat and maize flour with folic acid for population health outcomes. Garlic for peripheral arterial occlusive disease.

Garlic for preventing pre-eclampsia and its complications. Garlic for the common cold. Garlic for the prevention of cardiovascular morbidity and mortality in hypertensive patients. Gastrostomy feeding versus oral feeding alone for children with cerebral palsy. Glucosamine therapy for treating osteoarthritis.

Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients. Glutamine for induction of remission in Crohn's disease. Glutamine supplementation for critically ill adults. Glutamine supplementation for young infants with severe gastrointestinal disease. Glutamine supplementation to prevent morbidity and mortality in preterm infants. Green and black tea for the primary prevention of cardiovascular disease.

Green tea Camellia sinensis for the prevention of cancer. Green tea for weight loss and weight maintenance in overweight or obese adults. Growth monitoring in children. Health system and community level interventions for improving antenatal care coverage and health outcomes. High versus low medium chain triglyceride content of formula for promoting short-term growth of preterm infants.

High versus standard protein content of human milk fortifier for promoting growth and neurological development in preterm infants. High versus standard volume enteral feeds to promote growth in preterm or low birth weight infants. High-carbohydrate, high-protein, low-fat versus low-carbohydrate, high-protein, high-fat enteral feeds for burns. Higher versus lower amino acid intake in parenteral nutrition for newborn infants. Higher versus lower protein intake in formula-fed low birth weight infants. Higher versus lower sodium intake for preterm infants.

Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age. Home parenteral nutrition for people with inoperable malignant bowel obstruction. Homocysteine lowering interventions for peripheral arterial disease and bypass grafts.

Homocysteine-lowering interventions for preventing cardiovascular events. Honey and lozenges for children with non-specific cough. Honey for acute cough in children. Human growth hormone and glutamine for patients with short bowel syndrome. Hypertonic salt solution for peri-operative fluid management. Immunonutrition as an adjuvant therapy for burns. Immunonutrition for acute respiratory distress syndrome ARDS in adults. Immunonutrition for patients undergoing surgery for head and neck cancer.

Immunotherapy oral and sublingual for food allergy to fruits. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Individual patient education for people with type 2 diabetes mellitus. Inositol for depressive disorders. Inositol in preterm infants at risk for or having respiratory distress syndrome.

Instruments for assessing readiness to commence suck feeds in preterm infants: effects on time to establish full oral feeding and duration of hospitalisation. Integrated management of childhood illness IMCI strategy for children under five. Intensive versus conventional glycaemic control for treating diabetic foot ulcers. Interaction of calcium channel blockers and grapefruit juice in healthy adults. Interactive computer-based interventions for weight loss or weight maintenance in overweight or obese people. Interconception care for women with a history of gestational diabetes for improving maternal and infant outcomes.

Intermittent iron supplementation for improving nutrition and development in children under 12 years of age. Intermittent iron supplementation for reducing anaemia and its associated impairments in adolescent and adult menstruating women. Intermittent oral iron supplementation during pregnancy. Internet-based interventions for the secondary prevention of coronary heart disease. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews.

Interventions for growth failure in childhood Crohn's disease. Interventions for heartburn in pregnancy. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Interventions for ketosis during labour. Interventions for leg cramps in pregnancy. Interventions for lowering plasma homocysteine levels in dialysis patients. Interventions for lowering plasma homocysteine levels in kidney transplant recipients.

Interventions for metabolic bone disease in children with chronic kidney disease. Interventions for nausea and vomiting in early pregnancy. Interventions for oropharyngeal dysphagia in children with neurological impairment. Interventions for pregnant women with hyperglycaemia not meeting gestational diabetes and type 2 diabetes diagnostic criteria.

Interventions for preventing bone disease in kidney transplant recipients. Interventions for preventing eating disorders in children and adolescents. Interventions for preventing falls in people with multiple sclerosis. Interventions for preventing mastitis after childbirth. Interventions for preventing obesity in children. Interventions for preventing postpartum constipation. Interventions for preventing weight gain after smoking cessation.

Interventions for promoting adherence to fluid intake and dietary salt restriction in people with end-stage kidney disease. Interventions for promoting participation in shared decision-making for children and adolescents with cystic fibrosis. Interventions for promoting the initiation of breastfeeding. New Interventions for supporting the initiation and continuation of breastfeeding among women who are overweight or obese. Interventions for the prevention of nutritional rickets in term born children.

Interventions for the treatment of decreased bone mineral density associated with HIV infection. Interventions for the uptake of evidence-based recommendations in acute stroke settings. Interventions for treating burning mouth syndrome. Interventions for treating constipation in pregnancy. Interventions for treating hyperemesis gravidarum.

Interventions for treating painful nipples among breastfeeding women. Interventions for weight reduction in obesity to improve survival in women with endometrial cancer. Interventions in the management of serum lipids for preventing stroke recurrence.

Interventions in the workplace to support breastfeeding for women in employment. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in children and adults with overweight or obesity. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. Interventions to improve water quality for preventing diarrhoea. Interventions to improve water, sanitation, and hygiene for preventing soil-transmitted helminth infection.

Interventions to prevent and treat corticosteroid-induced osteoporosis and prevent osteoporotic fractures in Duchenne muscular dystrophy. Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers. Interventions to reduce weight gain in schizophrenia. Intravenous iron versus oral iron versus no iron with or without erythropoiesis- stimulating agents ESA for cancer patients with anaemia: A systematic review and network meta-analysis. Intravenous nutrients for preventing inadvertent perioperative hypothermia in adults.

Iodine fortification of foods and condiments, other than salt, for preventing iodine deficiency disorders. Iodine supplementation for the prevention of mortality and adverse neurodevelopmental outcomes in preterm infants. Iodine supplementation for women during the preconception, pregnancy and postpartum period.

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Iodised salt for preventing iodine deficiency disorders. Iron for the treatment of restless legs syndrome. Iron supplementation for breath-holding attacks in children. Iron supplementation for reducing morbidity and mortality in children with HIV. Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia. Iron therapy for pre-operative anaemia. Iron therapy in anaemic adults without chronic kidney disease.

Isoflavones for hypercholesterolaemia in adults. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Ketogenic diet for primary brain and spinal cord tumours. Ketogenic diets for drug-resistant epilepsy. L-acetylcarnitine for treating fragile X syndrome. L-carnitine for cognitive enhancement in people without cognitive impairment.

Lactase treated feeds to promote growth and feeding tolerance in preterm infants. Lactoferrin for the post-operative management of term neonates after gastrointestinal surgery. Lactose avoidance for young children with acute diarrhoea.

Diet in the Prevention and Treatment of Common Cancers

Lecithin for dementia and cognitive impairment. Lifestyle changes for treating psoriasis. Lifestyle changes in women with polycystic ovary syndrome. Lifestyle interventions for acute gout. Lifestyle interventions for chronic gout. Lifestyle interventions for the treatment of urinary incontinence in adults. Lifestyle interventions for the treatment of women with gestational diabetes. Lifestyle modification for obstructive sleep apnoea.

Lipid-based nutrient supplements for maternal, birth, and infant developmental outcomes. Lipid-lowering for peripheral arterial disease of the lower limb. Long chain polyunsaturated fatty acid supplementation in infants born at term. Long-term effects of weight-reducing diets in people with hypertension. Long-term effects of weight-reducing drugs in people with hypertension. Long-term non-pharmacological weight loss interventions for adults with prediabetes.

Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus. Longchain polyunsaturated fatty acid supplementation in preterm infants. Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. Low glycaemic index diets for the prevention of cardiovascular disease.

Low glycaemic index or low glycaemic load diets for overweight and obesity. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Low protein diets for non-diabetic adults with chronic kidney disease. Low-fat diets for acquired hypercholesterolaemia. Lycopene for the prevention of prostate cancer. Magnesium for acute traumatic brain injury.

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Magnesium for alcohol withdrawal. Magnesium for skeletal muscle cramps. Updated Magnesium for treating sickle cell disease. Magnesium supplementation for the management of primary hypertension in adults. Magnesium supplementation in pregnancy. Magnesium-based interventions for people with chronic kidney disease.

Marine-derived n-3 fatty acids therapy for stroke. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Maternal glucose administration for facilitating tests of fetal wellbeing. Maternal nutrient supplementation for suspected impaired fetal growth.

Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants. Medical and dietary interventions for preventing recurrent urinary stones in children. Medically assisted nutrition for adult palliative care patients. Mediterranean-style diet for the primary and secondary prevention of cardiovascular disease. Metabolomics for improving pregnancy outcomes in women undergoing assisted reproductive technologies.

Methods of milk expression for lactating women. Micronutrient supplementation for children with HIV infection. Micronutrient supplementation in adults with HIV infection. Micronutrient supplementation in pregnant women with HIV infection. Modified dietary fat intake for treatment of gallstone disease. Modifying the consistency of food and fluids for swallowing difficulties in dementia. Momordica charantia for type 2 diabetes mellitus. Monosodium glutamate avoidance for chronic asthma in adults and children.

Mulberry therapy for type 2 diabetes mellitus. Multi-nutrient fortification of human milk for preterm infants. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Multiple micronutrient powders for home point-of-use fortification of foods in pregnant women.

Multiple risk factor interventions for primary prevention of cardiovascular disease in low- and middle-income countries. Multiple risk factor interventions for primary prevention of coronary heart disease. Multiple-micronutrient supplementation for women during pregnancy. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. Nasogastric versus nasojejunal tube feeding for severe acute pancreatitis. Neonatal vitamin A supplementation for the prevention of mortality and morbidity in term neonates in low and middle income countries.

Newborn screening for galactosaemia. Newborn screening for homocystinuria. Niacin for primary and secondary prevention of cardiovascular events. Non-nutritive sucking for gastro-oesophageal reflux disease in preterm and low birth weight infants. Non-nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Non-pharmacological interventions for people with epilepsy and intellectual disabilities.

Non-surgical interventions for eosinophilic esophagitis. Nut consumption for the primary prevention of cardiovascular disease. Nutrient-enriched formula milk versus human breast milk for preterm infants following hospital discharge. Nutrient-enriched formula versus standard formula for preterm infants. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Nutrition support in hospitalised adults at nutritional risk. Nutritional advice for improving outcomes in multiple pregnancies.

Nutritional interventions for liver-transplanted patients. Nutritional interventions for preventing and treating pressure ulcers. Nutritional interventions for preventing stunting in children birth to 59 months living in urban slums in low- and middle-income countries LMIC. Nutritional interventions for reducing gastrointestinal toxicity in adults undergoing radical pelvic radiotherapy. Nutritional interventions for reducing morbidity and mortality in people with HIV.

Nutritional interventions for survivors of childhood cancer. Nutritional labelling for healthier food or non-alcoholic drink purchasing and consumption. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. Nutritional supplementation for hip fracture aftercare in older people. Nutritional supplementation for stable chronic obstructive pulmonary disease. Nutritional supplements for patients being treated for active visceral leishmaniasis. Nutritional supplements for people being treated for active tuberculosis.

Nutritional support for acute kidney injury. Nutritional support for critically ill children. Nutritional support for head-injured patients. Nutritional support for liver disease. Nutritional support in children and young people with cancer undergoing chemotherapy. Omega 3 fatty acid for the prevention of cognitive decline and dementia. Omega 3 fatty acids fish oil for maintenance of remission in Crohn's disease.

Omega 3 fatty acids fish oil for maintenance of remission in ulcerative colitis. Omega 3 fatty acids for preventing or slowing the progression of age-related macular degeneration. Omega-3 and omega-6 polyunsaturated fatty acids for dry eye syndrome. Omega-3 fatty acid addition during pregnancy. Omega-3 fatty acids for bipolar disorder. Omega-3 fatty acids for cystic fibrosis.

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    He has done clinical studies in Colombia, Iran, Egypt, Saudi Arabia and the United States which provides a broad international view of public health. He has served in the military reserve hospital for 17 years with extensive training in medical responses to disasters as the chief biochemistry officer of a general hospital, retiring as a Lt. He is a distinguished member of several national and international nutrition, immunology, and cancer societies. He has edited over biomedical reference books and papers and chapters.

    His teaching and research focuses on alcohol, tobacco, and drugs of abuse in heart function and disease in mouse models. Its concise, up-to-date review of research and benefits of herbs and supplements makes it essential for useful conversations that clinicians can have with patients using these products. Score: 80 - 3 Stars. We are always looking for ways to improve customer experience on Elsevier. We would like to ask you for a moment of your time to fill in a short questionnaire, at the end of your visit. If you decide to participate, a new browser tab will open so you can complete the survey after you have completed your visit to this website.

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    View on ScienceDirect. Editors: Ronald Watson. Hardcover ISBN: Imprint: Academic Press. Published Date: 27th January Page Count: If the ingredient or product has been shown to have some special ability to cure, mitigate, or treat an illness, the dietary supplement manufacturer would have to file a new drug application with the FDA.

    FDA procedures for drug approval, including safety and efficacy, require significant review of these substances. Dietary supplements and herbs are not to be used as treatments. Although general health claims are allowed, medical claims are not. Research of homeopathic preparations has shown that active ingredients may be diluted so greatly that it is difficult to extract and identify them in the lab.

    Products in this category often are found on store shelves beside FDA-approved over-the-counter drugs, contributing to misleading perceptions about effectiveness. Omega-3 polyunsaturated fatty acid dietary supplements include a combination of eicosapentaenoic acid EPA and docosapentaenoic acid DPA , which are found in many fatty fish. Omega-3 prescription products often are recommended for patients with high triglyceride blood levels.

    The theory of benefit in heart disease has been studied in large randomized, controlled studies, including a recent Cochrane review. Although there appears to be some benefit in patients with high triglyceride levels, the combination of ECA and DPA has been associated with increased low-density lipoprotein levels. Although these studies have shown no effect in moderate or severe anxiety, there continues to be ongoing research with the use of higher doses. Eating garlic in bulb form or taking an added supplement of allicin the active ingredient in garlic each day has not been shown to achieve the theoretical benefits of garlic.

    No garlic supplement has been shown to provide cholesterol-lowering or other immune benefits in randomized, controlled trials. There is a clear risk of bleeding when garlic is combined with warfarin or other herbs, such as Gingko biloba , which has blood-thinning qualities. Probiotics have been the subject of significant questions regarding efficacy and contamination. In , a newborn in a Connecticut hospital received a contaminated probiotic while being treated per hospital protocol. The infant acquired necrotizing enterocolitis and died. Although the proprietary mix was supposed to contain three live strains of bacteria, it also contained the mold Rhizopus oryzae.

    Little evidence currently exists to demonstrate significant benefit associated with treating infants with probiotics. For healthy adults, consuming yogurt with live cultures may provide adequate nutritional benefits. However, the FDA warned healthcare providers about using dietary supplements containing live bacteria or yeast in patients with compromised immune systems. However, the FDA is aware that in the practice of medicine, some providers recommend products that are marketed as dietary supplements for use as drugs e.

    Cinnamon active component: cinnamaldehyde has been touted for lowering blood sugar and reducing lipid levels at a daily dose of 1 to 6 grams. Coaches and trainers may recommend supplements to athletes to boost their abilities to perform. Healthcare professionals should consider the complexities of performance enhancers, their physiologic and psychotropic effects, and potential interactions.

    The hype of supplement labels and internet promotion to enhance metabolism 34 motivates users to choose popular performance supplements, even combining them for similar effects. Products marketed to improve strength or endurance commonly are adulterated. Monitoring current FDA alerts is critical. Caffeine and caffeine-like substances are a type of potentially harmful ingredient that boosts metabolism and is an amphetamine-like alternative that can cause tachycardia, irritability, coma, and death. Powdered caffeine products have a narrow range of positive effects, and it does not take much powder to cause death.

    Amino acids, protein, creatine, caffeine, and caffeine-like amphetamine alternatives can boost metabolism while they increase the heart rate and respiratory rate and generally affect multiple organ systems. Chromium, promoted for weight loss, can increase metabolism. However, claims that patients taking it can eat anything and still lose weight are not true. To lose and maintain weight, eating fewer calories and increasing activity are the keys. At doses of mcg per day, chromium is associated with heightened lung cancer risk.

    Bitter orange, an ephedra alternative, has been found to contain synephrine, which increases heart rate while raising blood pressure. Body-building products containing DMAA, an illegal ingredient similar to bitter orange and ephedra and touted as a natural stimulant, cause great concern when patients take them alone or with caffeine or caffeine alternatives. In , a marathon runner died after consuming a powder containing DMAA. Inadequate oversight, along with internet sales to consumers wanting to try hyped substances, puts patients at risk.

    Treating migraine headaches, cramps, neuralgia, and other chronic problems, such as lower back or shoulder pain, can be very challenging. Treating pain is one of the target categories for homeopathic remedies. For centuries, homeopathic remedies in China and India have contained ingredients such as cobra venom.

    Prevent Alzheimer's Disease - Pillar 1: Diet and Supplements

    Another area of contention regarding dietary supplements is using them for treating concussions. Online advertisements for preventing concussions, reducing the effects of concussions, or improving recovery from concussions have increased in the past five years, with manufacturers overstepping regulations to suggest benefit. Many of the products include ingredients with skullcap, curcumin, creatine, and vitamins C, D, and E. Additionally, resveratrol, omega-3 fatty acids, and melatonin have been studied in animals or are under investigation for possible benefits.

    Several studies in humans are underway, but are not yet complete. A recent conclusion of a study on drug-supplement interactions in older adults suggested that primary care providers routinely should ask questions of patients about use of supplements and herbs to mediate and avoid potential interactions with prescription medications. Clinicians can affect outcomes positively by recommending patients discontinue unnecessary therapies with which significant interactions and adverse effects are likely. Medical foods are specially formulated for the dietary management of a disease that has distinctive nutritional needs not met by diet alone.

    Intended to be used under physician supervision, medical foods are not registered with, reviewed by, or approved by the FDA. Three weeks ago, she began experiencing yellowing of her skin, increased blood pressure, forgetfulness, and elevated liver transaminase levels. She states that nothing has changed in her life, but that she is taking a food recommended by her rheumatologist and she needs to call the pharmacist for more. The mixture contains baicalin and catechin flavonoids, which elevate serum aminotransferase and can cause acute liver toxicity and acute hepatitis with jaundice.

    The proprietary mixture of plants and herbs includes Scutellaria baicalensis skullcap and Acacia catechu catechin , both of which are linked to acute liver toxicity. The flavocoxid case demonstrates that some patients do not consider a medical food worthy of sharing, which is understandable. Questioning can enlighten both the physician and the patient and greatly clarify the situation. Patients always should be coached to bring all medication bottles, along with any products they take daily or occasionally for their health.

    Dietary supplements and homeopathic remedies are here to stay. Additional investigation is needed, but the majority of these manufacturers do not pay for research efforts. Instead, the National Institutes of Health, foundations, independent agencies, and nongovernmental organizations cover the costs.

    Many powerful lobbies and wealthy manufacturers are helping to support the myths. Primary care providers should be aware of the FDA website BeSafeRx, which is an online campaign to identify and avoid fraudulent online pharmacies.

    Tools & Tips

    See Table 5 for a list of websites that may be helpful to clinicians. In addition, it is important to check supplement verification systems such as U. It is important that providers learn as much as possible and be aware of the gaps in understanding about many of these substances. By implementing these strategies, providers can help ensure positive outcomes possible and trusting relationships with their patients. National Center for Complementary and Integrative Health. National Institute on Aging. Food and Drug Administration. National Institutes of Health.

    American Pharmacists Association. Dietary Supplement Health and Education Act of Registered pharmacists can serve as key partners in the search for credible, accurate information on remedies and supplements. Patients should avoid purchasing from online sources unless the site includes the VeriSign seal, indicating it complies with U. The FDA advises against conducting blind searches on the internet. Clinicians should connect to respected organizations; look at clinical guidelines and review randomized, controlled trials; and perform online searches of federal agency sites, academic associations, and Google scholar to make decisions regarding worthiness of treatments.

    Using modern techniques of motivational interviewing and ask-tell-ask, clinicians can elevate the partnership tremendously. Financial Disclosure: To reveal any potential bias in this publication, and in accordance with Accreditation Council for Continuing Medical Education guidelines, Dr. Hocum reports he is an employee of Bayer U. Sheppard Solomon author , Ms. Coplin executive editor , Ms. Mark executive editor , and Ms. Hatcher editorial group manager report no financial relationships with companies related to the field of study covered by this CME activity.

    Reprints Share. Keywords dietary. Executive Summary More than half of Americans are using supplements or over-the-counter medications. Dietary supplements — which include vitamins, minerals, herbs, botanicals, and amino acids — are subject to the Dietary Supplement Health and Education Act of The supplements are not intended for prevention, treatment, or cure of diseases. No research reports or manufacturer-generated production reviews are required, but the U. Food and Drug Administration does regulate the good manufacturing practice of supplements.

    Homeopathic treatments follow the premise that small doses treat or potentially cure illness while high doses of the same substance can cause illness. The Australian National Health Medical Research Council concluded that there is no reliable evidence that homeopathic remedies are effective for any health condition. The National Institutes of Health Office of Dietary Supplements offers tools for developing patient-focused conversations.

    Myth or Fact?