1. Go to the Office of Dietary Supplements Fact Sheet and Box 12-7 for Garlic -
ID: 82569 • Letter: 1
Question
1. Go to the Office of Dietary Supplements Fact Sheet and Box 12-7 for Garlic - https://ods.od.nih.gov/factsheets/list-all/Garlic/, is there good evidence to support Ellen’s use of garlic?
2. Collect the same information for Gingko, should she continue taking Gingko?
3. Collect the same information for St. John’s Wort- what should she know if she continues taking this?
4. List her medications and possible nutrient interactions
5. Ellen is taking a blood thinner (Warfarin), what foods should she watch because intake of Vitamin ________?
6. List potential at risk populations for dietary supplements
7. What is the most common reason to use CAM (in the United States)?
8. You recommend that Ellen consider Massage – what category of Holistic (NCCIH) therapy is this considered?
9. Would you recommend Ellen use green tea? Why?
10. What will you discuss with Ellen regarding her calcium supplement usage and her history of cardiovascular disease?
CLINICAL CASE STUDY Ellen is a 60yearold female who was referred from her primary care pro- Typical dietary intake includes the following vider for evaluation of her dietary supplements. Medical history includes Breakfast Total cereal with milk and calcium fortified orange juice for hypertension, hypercholesterolemia, osteopenia, mild depression, and a diet coke memory problems. Two years ago, she had angioplasty (PTCA with a Lunch: Frozen entree-beef and br with rice and stent placement in her coronary artery. Ellen is a retired school teacher. Strawberry yogurt and coffee with milk married, and has two grown children. Her neighbor works in a Dinner Meatloat, mashed potatoes with gravy and carrots. Glass of red wine store and recommended some herbs and supplements to address Ellen's Dessert Chocolate ice cream, coffee with milk health concerns. At the initial consult Ellen reports she is taking the following supple- Questions to consider: 1. Using the Office of Dietary Supplements Fact sheets (ODS websitel ments: calcium carbonate 1200 mg/d, garlic (Allium sativum) 500 mg/d. identify what each dietary supplement Ellen is taking is used for and if it Ginkgo biloba 240 mg/d, and St. John's wort (Hypericum perforatum)900 mgd. Her prescription medications include warfarin, simvastatin, sertra has good evidence to support Use. 2. List any potential drug nutrient interactions (DNI) Ellen may have with line, and atenolol. her current concomitant use of medications and dietary supplements Height: Weight lbs BMI: 28.4 Blood pressure readings: 13492. 14095 "This is higher than it usually is" 3. Looking at Ellen's labs, is there any evidence she may be having adug nutrient interaction (DNI)? Ellen reports. 4. Does Ellen need to be taking a calcium supplement Are there any potential risks with taking 1200 mg/day with apositive history of candor Total cholesterol: 284 mg vascular disease (CVD)? HDL: 36 mg/dl 5. Write a PES statement for your top concern based on your assessment LDL: 140 mg/dl Prothrombin times (NR) has been inconsistent latelyExplanation / Answer
Ans 1) Garlic is used as dietary supplement for many diseases including high blood cholesterol, high blood pressure and common cold. It helps in lowering blood cholesterol levels but it is still under debate. It is seen that there is chance that bad cholesterol may not be decreased at all. There are many side effects associated with garlic like increase bleeding risk, stomach upset and there is not much evidence that it might help with high blood pressure and cholesterol problem. Hence, the evidence is not enough to support Ellen’s use of garlic.
§ Ans 2) Today, the extract from ginkgo leaves is used as a dietary supplement for many conditions, including dementia, eye problems, intermittent claudication (leg pain caused by narrowing arteries), tinnitus, and other health problems. It is believed but evidences say something else. It is seen that Gingko does not prevent slow dementia or cognitive decline. There is no evidence also on the fact that the Gingko helps with enhancement of memory in people or prevent risk of heart attack, stroke etc. Hence, it is not of much use if Ellen continues taking Gingko.
Ans 3) St Johns Wort is known to cure depression and is widely studied for its benefits of overcoming depression. It is used for treating depression, lung ailments, insomnia etc. The results for using it for treating depression is mixed which is why Ellen can continue its intake as she is diagnosed with mild depression.
Ans 4) Warfarin, Simvastatin, Sertraline and Atenolol
Warfarin – Vitamin K reduces the effectiveness of Warfarin and one must avoid taking food rich in VitaminK.
Simvastatin – Grape fruit majorly interferes with the drug and may cause skeletal muscle breakdown.
Ans 5 ) Ellen must avoid food that are rich in Vitamin K as she is on warfarin drug. She must avoid eating or drinking food including spinach, kale, parsley, collard green, mustard greens, green tea etc.
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