by: Chris D’Adamo, Ph.D. - Assistant Professor and Director of Research; University of Maryland Center for Integrative Medicine Dietary supplementation is growing in popularity. While most Americans take at least one dietary supplement, many people are confused by the regulation, safety, and efficacy of the supplements that they consume. Dr. D’Adamo will clarify these issues and present the latest research on specific dietary supplements that are effective as well as those that may be best to avoid. Learn about popular dietary supplements that are being taken for a wide variety of health conditions — ranging from arthritis, to immune system enhancement, to depression — and become a more informed consumer when choosing supplements.

1. Supplement Your
Dietary Supplement IQ
Chris D’Adamo, Ph.D.
Assistant Professor
Department of Family & Community Medicine
Department of Epidemiology & Public Health
Director of Research
Center for Integrative Medicine

2. Presentation Outline
Overview of Dietary Supplements
Definition
Regulation
Supplements to Generally Consider
Multivitamin
Vitamin D
Omega-3 Fatty Acids
Probiotics
Supplements to Avoid
Potential for tainting with pharmaceuticals

3. Presentation Outline
Supplement & Drug Interactions
Supplements for Special Situations
People taking statins, beta-blockers, acid-blocking drugs
Vegetarians
Pregnant women
Evidence-Informed Supplements for Specific Concerns
Joint Health
Digestion
Checklist: Informed Supplement Consumer
Immune System
Heart Health
Liver Health
Depression
Sleep

4. Dietary Supplements Defined
What is a dietary supplement?
1994 Dietary Supplement Health and Education Act
(DSHEA)
A product (other than tobacco) intended to supplement diet
Contains one or more dietary ingredients and taken orally
Vitamins, minerals, herbs or other botanicals, amino acids
Vitamins Minerals Herbs Amino Acids
Immune System

5. Regulation of Dietary Supplements
Federal Regulation of Dietary Supplements
Food and Drug Administration (FDA)
Supplements regulated as food
 Pre-DSHEA assumed safe, post-DSHEA provide safety evidence
Labeling and claims requirements
 Ingredient names & amounts, directions for use, no health claims, etc.
2007 Good Manufacturing Practices (GMP)
 Quality standards for manufacturing, preparation, storage, facility
Federal Trade Commission (FTC)
Regulate marketing of supplements

6. Regulation of Dietary Supplements
Federal Regulation of Dietary Supplements
No universal regulation of supplement content
“Don’t know what you’re getting”… in many cases, true!
Many dietary supplement companies hire 3rd
party
laboratories for product purity certification
Contains specified ingredients
No contaminants
Dissolves properly
GMP compliant
Some 3rd
party labs better than others
NSF-certified gold standard

7. Supplements to Consider

8. Multivitamin: Overview
Most common dietary supplement
33% of Americans take multivitamin
Usually contain at least 13 vitamins &
15 minerals most important to nutrition
How multivitamins are used
Generally capsule or tablet orally once per day
Powders, liquids, multiple daily doses less common
Best taken with meal
Many of nutrients lipid-soluble, need fat for absorption

9. Multivitamin: Types
RDI-centric
RDI of most important vitamins/minerals
Reference Daily Intake – replaced RDA in 1997
Prevent micronutrient deficiency in most people
"% Daily Value" on food & supplement labels
Widely available
Higher potency
Exceeds RDI for many vitamins/minerals
Why? RDI prevent deficiency disease…
not to promote optimal health!
Higher in vitamin D, B-vitamins, vitamin C, etc.
Health stores, clinical practices, Amazon, etc.

10. Multivitamin: Favorable Research
Improves nutritional status
 2000 Journal of American College of Nutrition, 2009 European Journal Clinical Nutrition
Reduces risk of birth defects
 2001 Epidemiology, 2002 Epidemiology, 2002 Pediatrics, 2003 Pediatrics
Associated with weight loss & decrease in body-fat %
 2010 International Journal of Obesity Research
Reduced risk of macular degeneration & cataracts
 2007 American Journal of Clinical Nutrition, 2008 Ophthalmology
Reduces risk of heart attack
 2010 American Journal of Clinical Nutrition
Reduces risk of colon cancer
 2002 Cancer Epidemiology, Biomarkers, & Prevention
Reduces risk of all-cause mortality and cancer mortality
 2011 European Journal of Nutrition

11. Multivitamin: Unfavorable Research
No benefit in some studies
No reduction in risk of cancer or cardiovascular disease
 2009 Archives of Internal Medicine
No reduction in risk of breast cancer
 2010 Public Health Nutrition, 2010 American Journal of Clinical Nutrition
Slight increase in non-cancer, non-CVD mortality
Lots of media coverage… but study flawed and over-interpreted
 2011 Archives of Internal Medicine
 Direct conflict with 2011 European Journal of Nutrition Study!

12. Multivitamin: Recommendations
Does brand make a difference? YES!
Cheap brands use cheap vitamin/mineral forms
Affects absorption and effectiveness
Natural vitamin forms better absorbed than synthetic
 Natural vitamin E twice absorption of synthetic
Certain vitamin forms more effective than others
 Vitamin D3 superior to vitamin D2
Certain mineral binding salts better absorbed than others
 Magnesium citrate much better absorption than magnesium oxide

13. Multivitamin: Recommendations
How to choose a good brand?
www.multivitaminguide.org
 Ranking based on: composition, bioavailability, synergistic effect, potency
 101 of most common multivitamins in United States
Comparative Guide to Nutritional Supplements
 Lyle MacWilliam, biochemist, commissioned by Canadian Minister of Health
 Scientific analysis of 510 multivitamins available in United States & Canada

14. Multivitamin: Recommendations

15. Multivitamin: Recommendations
Quality is key! Consult rankings
Whole-food based multivitamins also good choice
 Synergy between hundreds of food components!
Always consume with meal
Important fat-soluble nutrients
Poor absorption in absence of fat
Be an informed consumer! Choose/avoid the following…
Vit E: d-alpha tocopherol (natural) NOT dl-alpha tocopherol
(synthetic)
Vit E: look for "mixed tocopherols" and/or "gamma tocopherol"
Vitamin D3 NOT vitamin D2
Methylcobalamin form of B12 NOT cynacobalamin form of B12
Avoid oxide binding salts (magnesium citrate NOT magnesium oxide)

16. Vitamin D: Overview
A uniquely important vitamin
Hormone-like activity (secosteroid)
Controls expression of over 200 genes
Vitamin D active in most biological systems
Musculoskeletal system
 Classically emphasized role
Endocrine system
Nervous system
Cardiovascular system
Digestive system
Immune system

17. Vitamin D: Sources
Sun exposure
UVB light converted to vitamin D3 in skin
D3 transported to liver, metabolized to 25(OH)D
 Also called calcidiol… measured most vitamin D blood tests
25(OH)D converted to calcitriol in kidneys
 Calcium metabolism… remaining calcitriol & calcidiol → health benefits
20,000 international units (IU) from 30 minutes sun exposure
 Only spring and summer if north of Atlanta
Limited amount from foods
D3 from oily fish, eggs, butter, cheese, fortified milk/cereals
 Vitamin D fat-soluble… needs fat for absorption
 10-100 IU: depending upon source
Supplements deliver much higher doses… up to 5,000+ IU per pill

18. Vitamin D: Reference Daily Intake
Current RDI varies
Up to age 50: 200 IU
Age 51-70: 400 IU
70 and older: 600 IU
Amount to prevent vitamin D deficiency
Rickets
 Softening of bones → deformities, fractures, etc.
 Most common in children… rare in United States
 Also occurs in adults… called osteomalacia
Amount to prevent chronic disease… much higher!
Call to substantially increase RDI to at least 1,000 IU
Explosion in vitamin D research

19. Vitamin D: Favorable Research
Prevents bone disorders (osteoporosis, fractures, etc.)
 2009 Cochrane Systematic Database Review
Reduced risk of cancers (breast, colon, prostate, etc.)
 2004 American Journal of Clinical Nutrition, 2009 Cancer Epidemiology
Improved survival among colorectal cancer patients
 2012 Cancer Epidemiology, Biomarkers and Prevention
Reduced risk and better control of diabetes
 2010 Diabetes, Obesity, & Metabolism, 2010 Diabetes Care
Reduced risk of obesity
 2010 Obesity, 2010 Diabetes, 2009 Journal of American Dietetic Association
Help weight loss & improve cardiovascular risk factors
 2012 British Journal of Nutrition
Reduced risk of cardiovascular disease
 2009 Archives of Internal Medicine, 2010 American Journal of Cardiology

20. Vitamin D: Favorable Research
Improve depression & Seasonal Affective Disorder
 2008 Journal of Internal Medicine, 1999 Journal of Nutrition, Health, & Aging
Reduced risk of Crohn’s disease, rheumatoid arthritis,
multiple sclerosis and other auto-immune disorders
 2010 Journal of Rheumatology, 2007 American Journal of Clinical Nutrition
Stimulate immune system to prevent infection
 2010 American Journal of Clinical Nutrition
Decreased risk of all-cause mortality
 2008 Archives of Internal Medicine

21. Vitamin D: Unfavorable Research
Vitamin D supplementation not beneficial in some trials
Breast cancer – 2009 Breast Cancer Research and Treatment
Heart attack – 2007 Circulation
 Between 200 – 400 IU vitamin D used… very low dose
No risks of high serum vitamin D in observational studies
Unless extremely high concentrations over 100 ng/mL
 Increased risk of atrial fibrillation “excess” 25(OH) D > 100 ng/mL
 Vitamin D increases calcium absorption… too much calcium in blood?
No evidence of harm from typical vitamin D supplements
Fat-soluble, but safe at even at very high intake
 Acute D3 toxicity intake ≈ 176,000,000 IU… 440,000 400 IU capsules
 Only toxic cases manufacturing mistakes (extremely rare)

22. Vitamin D: Recommendations
Convincing evidence: recommend 25(OH)D test to everyone!
Vitamin D inadequacy extremely common
 Between 36-100% depending on group, 2006 Mayo Clinic Proceedings
Supplementation most important for people who…
Live north of Atlanta (in fall & winter)
 Cannot synthesize from sun
Have darker skin tone
 Less efficient synthesis in skin
Older adults
 Greater risk of osteoporosis & other chronic diseases
Avoid sun or wear sunscreen
 Most vitamin D from sun exposure
Have low serum 25(OH)D
 Everyone should have vitamin D tested… inexpensive and major risk-factor!

23. Vitamin D: Recommendations
Not much difference by price or brand
Gel capsule preferable to tablet
Vitamin D fat-soluble… better absorption
Take with food
Vitamin D fat-soluble
Vitamin D3 preferable to D2
D3 (cholecalciferol) more effective than D2 (ergocalficerol)
 2004 Clinical Endocrinology & Metabolism
Serum 25(OH)D target range ≈ 40 ng/mL (100 nmol/L)
More research needed for optimal threshold… most people low!

24. Omega-3 Fats: Overview
Class of polyunsaturated fatty acids (PUFA)
Common structure (C=C in n-3 position)
Three nutritionally important omega-3 fats
Alpha-linolenic acid (ALA)
 One of two essential fatty acids
 “Short-chain”… converts to “long-chain”
Eicosapentaenoic acid (EPA)
 Long-chain omega-3
Docosahexaenoic acid (DHA)
 Long-chain omega-3
Health benefits of EPA and DHA most studied
Precursor to eicosanoids… anti-inflammatory effects

25. Omega-3 Fats: Sources
Vary by type of omega-3
ALA
Nuts, seeds, vegetables
 Flax seed, chia seed, walnuts, leafy greens
EPA/DHA
Oily fish
 Salmon, sardines, mackerel, tuna, etc.
Other animal products
 Depends on animal's diet… grass-fed beef and pastured eggs
Seaweed
 Generally DHA only
Fortified foods
 Milk, yogurt, cereals, etc.

26. Omega-3 Fats: Rationale
Standard American Diet ("SAD") low in Omega-3
Evolved on diet with ≈ even omega-6:omega-3 (1:1)
"Paleo-style diet" - Fish, grass-fed meat, vegetables, fruits, etc.
Both omega-6 & omega-3 necessary
 Linoleic acid (omega-6) an EFA
 Imbalance affects inflammatory cascade… especially if too much omega-6
 Standard American Diet…
20:1 omega-6:omega-3!
 MUCH higher in many cases
Recent changes… industrialization of food supply
 Grain-fed beef, soybean oil, corn oil, etc.
Thought to play role in auto-immune & inflammatory conditions

27. Omega-3 Fats: Favorable Research
More clinical research than any vitamins
All studies below RCT’s or reviews of RCT’s
Improved many auto-immune conditions
Rheumatoid arthritis, Irritable Bowel Syndrome, asthma, etc.
 2009 Cochrane Systematic Review, 2005 Nutrition, 2000 American Journal
of Clinical Nutrition, 2000 European Respiratory Journal
Reduced blood pressure
 2002 Journal of Hypertension
Lowers triglycerides
 2009 Nutrition and Health
Decreased cardiovascular disease events and mortality
 2006 American Journal of Clinical Nutrition, 2008 British Medical Journal,
2009 Clinical Cardiology, 2009 Annals of Internal Medicine

28. Omega-3 Fats: Favorable Research
Helps treat depression
 2009 & 2010 Journal of American College of Nutrition
Helps manage bipolar disorder
 2009 European Journal of Clinical Nutrition
Prevention of psychotic disorder among high-risk
 2010 Archives of General Psychiatry
Reduction in ADHD symptoms
 2009 Journal of Attention Disorders
Decreased cognitive decline in older adults
 2011 Journal of Nutrition, Aging, and Health

29. Omega-3 Fats: Unfavorable Research
Some clinical trials found no benefit
ADHD
 2001 Journal of Pediatrics
Cognitive performance
2008 Neurology
Schizophrenia
 2001 American Journal of Psychiatry
No clinical studies showing harm
But be aware of potential interaction with anticoagulants

30. Omega-3 Fats: Recommendations
Convincing evidence: recommend to most people
Not recommended for people on anticoagulant drugs
 Coumadin, etc.
 Omega-3 supplements can thin blood
Most important for people who…
Don’t eat fatty, cold-water fish
 Vegetarians/vegans… ALA poorly converted to EPA/DHA
 Flounder, catfish, etc. no omega-3
Have autoimmune or chronic inflammatory conditions
Have high triglycerides or are at high risk for heart disease
Eat Standard American Diet

31. Omega-3 Fats: Recommendations
Supplement with ALA or DHA/EPA?
Flaxseed oil (ALA) vs. fish oil (EPA/DHA)
Fish oil superior to flaxseed oil
ALA conversion to EPA/DHA very poor!
Only 8 to 20% ALA converted to EPA/DHA
 2008 Nutrition Reviews
Most omega-3 benefits from EPA/DHA
Krill oil another good source of EPA/DHA
If vegetarian/vegan
Consider algae-based omega-3 supplement

32. Probiotics: Overview
Probiotics defined: World Health Organization
“Live micro-organisms… administered in adequate
amounts, confer beneficial health effect on the host”
Probiotics can be bacteria or yeasts
Bacteria much more abundant… bigger role in health
Primarily colonize or transiently act in gastrointestinal tract
Why are gut bacteria important?
Over 100 trillion bacteria in gut
Ten times amount of cells in human body!
500 different species of bacteria in gut
Critical role in metabolism and immune system

33. Probiotics: Important Varieties
Three classifications of probiotics
Genus – broadest
Species – more specific
Strain – most specific
Most probiotic supplements classified by genus & species only
Lactobacillus
One of most common bacterial genera in gut
Convert lactose & other sugars to lactic acid
Can help some with lactose intolerance
Acidic environment inhibits harmful bacteria
Over 100 species
Indicated by L. _______
Some of most important: L. acidophilus, L. casei, L. reuteri, L. brevis

34. Probiotics: Important Varieties
Bifidobacterium
Another common bacterial genera in gut
Inhibit pathogenic bacteria
Competes for resources & produces lactic acid
29 species identified
Indicated by B. _______
Some of most important: B. longum, B. breve, B. animalis
Saccharomyces
Common fungal genus in gut
Most yeast damage gut, e.g. Candida Albicans
Some species compete with pathogens
Indicated by S. _______
S. Boulardii prevents/treats GI disorders

35. Probiotics: Dietary Sources
Fermented foods
Component of most traditional diets
Asian
Miso and natto
 Fermented beans/grains… often soy
 L. acidophilus (miso) & B. natto (natto)
Kimchi
 Fermented cabbage, radishes, etc.
 L. kimchii
Kombucha
 Fermented tea
 S. cerevisiae

36. Probiotics: Dietary Sources
European
Yogurt
 Fermented dairy
 Cow, goat, sheep milk
 L. bulgaricus & Streptococcus thermophilus
Kefir
 Also fermented dairy
 More probiotic species than yogurt
 L. rhamnosus, B. longum, S. florentinus, etc.
Sauerkraut
 Fermented cabbage
 L. plantarum, L. mesenteroides, etc.

37. Probiotics: Dietary Sources
African
Ogi
 Fermented grains… often corn
 L. brevis, L. acidophilus, etc.
Currently in United States…
Primarily yogurt
Traditional products available health food stores
 Kefir, kimchi, kombucha, etc.

38. Probiotics: Supplement Rationale
Americans consume few fermented foods!
Commercial yogurt not optimal source
Often high in sugar… feeds yeast & pathogens
Relatively low bacterial count
100 million lactic acid bacteria per serving… 100 trillion bacteria in gut

39. Probiotics: Favorable Research
Most clinical research of all dietary supplements
All clinical trials or reviews of clinical trials
Major species listed for each outcome
Regulates bowel function
Effective against diarrhea… especially antibiotic-associated
 L. rhamnosus GG, S. Boulardii, L. Bulgaricus and many others
 2012 Journal of American Medical Association
Effective against constipation
 B. lactis, L. casei
 2010 World Journal of Gastroenterology

40. Probiotics: Favorable Research
Effective treatment for some Inflammatory Bowel Disease
Ulcerative Colitis
 B. Animalis, B. Breve, L. Acidophilus and combinations
 2010 Proceedings of the Nutrition Society, 2010 Annals of Pharmacotherapy
Crohn’s Disease
 Evidence not as convincing… some success with L. Rhamnosus
 2009 Current Pharmaceutical Design
Effective treatment for Irritable Bowel Syndrome
 L. Acidophilus, B. Breve, B. Bifidum, S. Boulardii and combinations
 2010 Journal of Nutrition

41. Probiotics: Favorable Research
Effective treatment for other autoimmune conditions
Eczema and allergic rhinitis
 L. Acidophilus, B. Lactis, L. Sakei
 2010 American Journal of Clinical Dermatology, 2010 Pediatric Pulmonology
Improve immunity in healthy individuals
Reduces risk of common cold
L. paracasei, L. plantarum, L. Bulgaricus
Younger adults
 2010 European Journal of Nutrition
Older adults
 2010 British Journal of Nutrition

42. Probiotics: Unfavorable Research
Ineffective in some trials for certain conditions
Crohn’s Disease
2008 Digestive Disease and Sciences
Pancreatitis (feeding tube)
2008 Lancet
No evidence of harm from oral probiotic supplementation
Not necessarily harmless… more research needed

43. Probiotics: Recommendations
Recommend to people eating Standard American Diet
Usually not necessary if consume variety of fermented foods
Don’t typically need to take on an ongoing basis
 Cycle on and off occasionally... few times a year or specific situations
Most important for people who…
HAVE BEEN ON ANTIBIOTICS!
 Critical to replenish flora & prevent side-effects
Have digestive problems and/or food intolerances
Will be travelling out of the country
 Prevent diarrheal disorders
Have an autoimmune condition
Are at high risk for infections
 Especially useful during flu season

44. Probiotics: Recommendations
Core product: contains genus & species variety
Especially Lactobacillus & Bifidobacterium
Occasionally rotate products for increased variety
Specific conditions: single-species okay
S. boulardii, L. GG, etc. for diarrhea
Choose high potency products
At least 5 billion colony forming units (CFU)
≥ 10 billion preferable… especially after antibiotics
Many products contain over 100 billion CFU
Remember… 100 trillion bacteria in gut!

45. Probiotics: Recommendations
Choose refrigerated product during summer
Probiotics die if exposed to high temperatures
Refrigerating extends life & assures potency
Choose products that specify strain
Most specify genus and species
Best products also specify strain!
Choose products supported by research
Probiotic supplements vary tremendously
Trust those supported by research
Company can point to studies

46. Supplements to Avoid

47. Supplements to Avoid
Most supplements safe… but some may pose risk
Especially products tainted with pharmaceuticals
Three classes of supplements most likely to be tainted
Weight-loss supplements
Not likely to be effective long-term
Cannot replace healthy diet & exercise habits
Often stimulant-based… contraindications?
Especially among overweight
Some products tainted with sibutramine
Active ingredient in Reductil (withdrawn by FDA)
Increases blood pressure, pulse, potential risk for CVD events
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingM

48. Supplements to Avoid
Sexual-enhancement supplements
Some products tainted with tadalafil or sildenafil
Active ingredients in Cialis and Viagra
Can interact with nitrates to cause low blood pressure
 http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineS
Bodybuilding supplements
Some products tainted with anabolic steroids
Often marketed as containing “steroid-like” components
Have caused liver or kidney problems
 http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineS
Tainted products rare… but can pose health risk!

49. Supplement and Drug Interactions

50. Supplements and Drug Interactions
St. John’s Wort and Antidepressants
Synergy: increased risk of serotonin syndrome
Red Yeast Rice and Statins
Synergy: increased risk of muscle & liver problems
Calcium/magnesium/zinc and Antibiotics
Reduced absorption: antibiotic may not work as well
Ginkgo Biloba and Anticoagulants
Increased bleeding risk
Fish Oil and Anticoagulants
Increased bleeding risk

51. Supplements for Special Situations

52. Supplements for Special Situations
Coenzyme Q10 for people on statins or beta-blockers
aka “CoQ10”
These medications deplete CoQ10
Coenzyme Q10 supplementation recommended
 2006 Annals of Pharmacotherapy
Also good idea to take with Red Yeast Rice
Why is supplementing with CoQ10 important?
Critical in muscle function… particularly heart
Reduces cardiovascular disease risk and blood pressure
 2007 Nutrition Review & 2006 Journal of Cardiac Failure
Reduces statin-induced muscle myopathy
 2007 American Journal of Cardiology

53. Supplements for Special Situations
Vitamin B12 for people on stomach acid-blockers
Prilosec, Zantac, antacids, etc.
These medications deplete vitamin B12
Reduced stomach acid to absorb B12
Why is vitamin B12 important?
Help metabolize protein, fat, and carbohydrates
Low levels → fatigue, depression, neurological damage
Low concentrations associated with Alzheimer’s disease
 2010 Neurology
Supplementation lowers homocysteine
 2008 Proceedings of Nutrition Society
Supplementation reduces cognitive decline
 2012 American Journal of Clinical Nutrition

54. Supplements for Special Situations
B-vitamins and zinc for vegetarians
Especially B12 for vegans
Vegetarian diets typically low in these nutrients
2002 American Journal of Clinical Nutrition
Folic acid for pregnant women
Deficiency can cause neural tube defects
Supplementation prevents neural tube defects
2009 Annals of Internal Medicine
Can often be obtained in quality multivitamin

55. Evidence-Informed Supplementation
for Specific Health Concerns

56. Popular Supplements: Joint Health
Glucosamine & Chondroitin
2006 New England Journal of Medicine
Methylsulfuromethane (MSM)
2006 Osteoarthritis and Cartilage
Hyaluronic Acid
2008 Nutrition Journal
Turmeric
2006 Arthritis and Rheumatism
Ginger
2001 Arthritis and Rheumatism

57. Popular Supplements: Digestion
General Digestive Support
Digestive Enzymes
Broad-spectrum plant-based (preferable)
Animal-based
 Pancreatin
2009 Alimentary Pharmacology & Therapeutics
Acid-reflux… tapering off acid-blocking medications
Deglycyrrhizinated Licorice (DGL)
2001 Hospital Practice
Aloe Vera
Typically juice

58. Popular Supplements: Immune System
Echinacea
 2006 Cochrane Database Systematic Review
Vitamin C
 2010 Journal of International Medical Research
Vitamin D
 2010 Nutrition
Zinc
 2011 Cochrane Database Systematic Review
Probiotics
 2006 Journal of Clinical Gastroenterology
Mushroom extracts
 2012 Medicine and Sports Science

59. Popular Supplements: Heart Health
Red Yeast Rice
2010 American Journal of Cardiology
Fish Oil
2009 Annals of Internal Medicine
Coenzyme Q10
2007 European Heart Journal
Vitamin D
2009 Archives of Internal Medicine

60. Popular Supplements: Liver Health
Milk Thistle
2008 Annals of Hepatology
N-Acetyl Cysteine (NAC)
2005 Clinical Therapeutics
S-Adenosyl Methionine (SAM-e)
2007 Hepatology
Turmeric
2009 Liver International

61. Popular Supplements: Depression
St. John’s Wort
2008 Cochrane Database Systematic Review
Fish Oil
2010 Journal of Clinical Psychiatry
S-Adenosyl methionine (SAM-e)
2002 International Journal of Psychopharmacology

62. Popular Supplements: Sleep
Melatonin
2004 Journal of Clinical Endocrinology & Metabolism
Valerian Root
2006 American Journal of Medicine
5-Hydroxytryptophan (5-HTP)
2000 Alternative Medicine Review

63. Checklist: Informed Supplement Consumer
□ No interactions with other drugs/supplement
- Talk to healthcare professional and consult literature
□ No outrageous label claims
- Especially weight loss, sexual, bodybuilding products
□ Carefully read all ingredients on label
- Consider content, quality, source of ingredients
- Some forms of vitamins, minerals, etc. better than others
- Look for strains on probiotics

64. Checklist: Informed Supplement Consumer
□ Seek 3rd
party verification certificate
- Sign of commitment to product quality
- NSF “Gold Standard” of product quality
□ Choose brands supported by
peer-reviewed research
- Ultimate sign of commitment to product quality!
- Companies not required to conduct research…
provides consumers & healthcare professionals
with evidence the supplement works

65. Thank You! Questions?
Contact information: cdadamo@compmed.umm.edu