Dangerous dietary supplements: Garcinia cambogia-associated hepatic failure requiring transplantation.

Commercial dietary supplements are marketed as a panacea for the morbidly obese seeking sustainable weight-loss. Unfortunately, many claims cited by supplements are unsupported and inadequately regulated. Most concerning, however, are the associated harmful side effects, often unrecognized by consumers. Garcinia cambogia extract and Garcinia cambogia containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we report the first known case of fulminant hepatic failure associated with this dietary supplement. One active ingredient in this supplement is hydroxycitric acid, an active ingredient also found in weight-loss supplements banned by the Food and Drug Administration in 2009 for hepatotoxicity. Heightened awareness of the dangers of dietary supplements such as Garcinia cambogia is imperative to prevent hepatoxicity and potential fulminant hepatic failure in additional patients

Prevalence of drug-herb and drug-supplement interactions in older adults : A cross-sectional survey

© British Journal of General PracticeBackground Polypharmacy is common among older adults, with increasing numbers also using prescription drugs with herbal medicinal products (HMPs) and dietary supplements. There is no reliable evidence from the UK on concurrent use of HMPs and dietary supplements with prescription drugs in older adults. Aim To establish prevalence of concurrent prescription drugs, HMPs, and dietary supplements among UK community-dwelling older adults and identify potential interactions. Design and setting Cross-sectional survey of older adults registered at two general practices in South East England. Method A questionnaire asking about prescription medications, HMPs, and sociodemographic information was posted to 400 older adults aged ≥65 years, identified as taking ≥1 prescription drug. Results In total 155 questionnaires were returned (response rate = 38.8%) and the prevalence of concurrent HMPs and dietary supplements with prescriptions was 33.6%. Females were more likely than males to be concurrent users (43.4% versus 22.5%; P = 0.009). The number of HMPs and dietary supplements ranged from 1 to 8, (mean = 3, median = 1; standard deviation = 1.65). The majority of concurrent users (78.0%) used dietary supplements with prescription drugs. The most commonly used dietary supplements were cod liver oil, glucosamine, multivitamins, and Vitamin D. Others (20.0%) used only HMPs with prescription drugs. Common HMPs were evening primrose oil, valerian, and Nytol Herbal® (a combination of hops, gentian, and passion flower). Sixteen participants (32.6%) were at risk of potential adverse drug interactions. Conclusion GPs should routinely ask questions regarding herbal and supplement use, to identify and manage older adults at potential risk of adverse drug interactions.Peer reviewe

Characteristics of drug and dietary supplement inquiries by college athletes.

BackgroundIn the United States, the National Center for Drug Free Sport manages the drug-testing programs for athletes of the National Collegiate Athletic Association (NCAA). Through its Resource Exchange Center (REC), Drug Free Sport supports athletic staff and athletes with information regarding drugs and dietary supplements.PurposeTo characterize the types of drug-related and dietary supplement-related inquiries submitted to Drug Free Sport through the REC.Study designCross-sectional study.MethodsAll inquiries submitted to the REC for the period of September 1, 2005, through June 30, 2006, were reviewed. The data were categorized by the method of inquiry submission; the name of the substance in question; the sex, sport, and NCAA division of the athlete involved; the nature of the inquiry; and the response provided by the REC regarding the NCAA's status of the substance in question.ResultsPseudoephedrine, acetaminophen/hydrocodone, and albuterol were the most commonly self-searched medications; stimulants accounted for the majority of banned medications. Dietary supplements accounted for 80% of all inquiries submitted to the REC via the Banned Drug Inquiry Form. Among all dietary supplements, creatine was the most commonly inquired. Banned substances accounted for 29% of all inquiries.ConclusionsThere were more than 10 000 inquiries regarding the status of medications, dietary supplements, and other substances for NCAA athletes during the 2005-2006 academic year. It is helpful for athletes to have resources that help them navigate banned-substance lists and so avoid the inadvertent use of banned substances.Clinical relevanceEducating athletes regarding the stimulant content of various dietary supplements and addressing the lack of clinical trials to support stated claims and safety appear critical

Sports foods and dietary supplements for optimal function and performance enhancement in track and field athletes

Numerous nutritional products are marketed with claims of optimizing athlete health and function and/or enhancing performance. Products that fall under the banner of “Sports Foods” or “Dietary Supplements,” may be used to support performance during training and competition or for enhancing aspects of training adaptation, recovery, immune function, and/or overall athlete health. Effective marketing campaigns and athlete endorsements may convince us that certain sports foods and supplements are fundamental in allowing athletes to reach their sporting goals. However, this approach is naive in understanding the true foundations of athlete success, such as the inherent genetic predisposition for athletic characteristics, the many hours of well-structured/periodized training, appropriate underlying nutrition, adequate sleep and recovery, and of course, good overall physical and mental health. Nevertheless, if these variables are all accounted for, there may be a role for sports foods and dietary supplements in an athlete’s training and competition routine, particularly within elite sport where marginal performance gains are pursued. The following review presents general considerations for track-and-field athletes using sports foods and dietary supplements to enhance performance, in addition to exploring the potential therapeutic/prophylactic use of these nutritional aids

FDA vs. Ephedra: Dietary Supplement Regulation Under DSHEA

The Dietary Supplement Health and Education Act of 1994 (DSHEA) dramatically changed the way dietary supplements are regulated in the United States. DSHEA created a new category of products defined as “dietary supplements,†and altered the way in which these products are regulated in an attempt to promote consumer access to dietary supplements. By weakening the FDA’s regulatory control of dietary supplements, DSHEA made it impossible for the FDA to insure the safety of dietary supplements sold in the United States. DSHEA allows most supplements to enter the market without first being tested for safety, and once on the market, DSHEA makes it very difficult for the FDA to remove potentially dangerous dietary supplements. The FDA’s inability to insure the safety of dietary supplements under DSHEA is exemplified by its failed efforts to place tighter restrictions on the sale of dietary supplements containing ephedra alkaloids (ephedra or ephedrine). Despite mounting evidence that supplements containing ephedra alkaloids may be responsible for serious injury and death, the well-funded and politically-connected ephedra industry has successfully fought off all FDA efforts aimed at imposing tighter regulations on ephedra supplements. Changes to existing law, including pre-market testing, mandatory reporting of adverse events, and accurate content labels are necessary if the FDA is to fulfill its goal of policing consumer safety

Dietary supplement use among health care professionals enrolled in an online curriculum on herbs and dietary supplements

BACKGROUND: Although many health care professionals (HCPs) in the United States have been educated about and recommend dietary supplements, little is known about their personal use of dietary supplements and factors associated with their use. METHODS: We surveyed HCPs at the point of their enrollment in an on-line course about dietary supplements between September, 2004 and May, 2005. We used multivariable logistic regression to analyze demographic and practice factors associated with use of dietary supplements. RESULTS: Of the 1249 health care professionals surveyed, 81 % reported having used a vitamin, mineral, or other non-herbal dietary supplements in the last week. Use varied by profession with highest rates among nurses (88%), physician assistants or nurse practitioners (84 %) and the lowest rates among pharmacists (66%) and trainees (72%). The most frequently used supplements were multivitamins (60%), calcium (40%), vitamin B (31%), vitamin C (30%), and fish oil (24%). Factors associated with higher supplement use were older age, female, high knowledge of dietary supplements, and discussing dietary supplements with patients. In our adjusted model, nurses were more likely than other professionals to use a multivitamin and students were more likely to use calcium. CONCLUSION: Among HCPs enrolled in an on-line course about dietary supplements, women, older clinicians, those with higher knowledge and those who talk with patients about dietary supplements had higher use of dietary supplements. Additional research is necessary to understand the impact of professionals' personal use of dietary supplements on communication with patients about them

Dietary supplement use among dietetics students at the University of KwaZulu-Natal.

Master of Science in Dietetics and Human Nutrition. University of KwaZulu-Natal, Pietermaritzburg 2017.Introduction: A dietary supplement is a product, which aims to add nutritional value to the diet. The use of dietary supplements is favoured among many countries, with a steady increase in use. There are many groups that are known to make use of dietary supplements such as females, the elderly, health professionals, gym goers, pregnant women, children under the age of 18 years and university students. University students are a group that are known to make use of dietary supplements in order to improve their academic performance, increase energy and promote overall general health. It is assumed that students studying towards a nutrition-related degree such as dietetics would be more likely to use dietary supplements, due to their interest in and exposure to nutrition. However, there is a lack of published data investigating the prevalence of dietary supplement use, factors associated with use and reasons for use among South African university students, studying towards a nutrition-related degree. Therefore, this study aimed to assess the use of dietary supplements by dietetics students at the University of KwaZulu-Natal (UKZN). Aim: The aim of the study was to assess the use of dietary supplements by students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. Objectives: a) To determine the prevalence of dietary supplement use among dietetics students at UKZN. b) To determine the factors associated with dietary supplement use among dietetics students at UKZN. c) To determine the reasons for use of dietary supplements among dietetics students at UKZN. Methods: A cross-sectional, descriptive study was conducted using students registered for a Bachelor of Science or a Post Graduate Diploma in Dietetics, at UKZN. A self-administered questionnaire consisting of both open and close-ended questions was developed to collect data. The sample comprised of 139 dietetics students. Results: The use of dietary supplements was reported by 23% of the dietetic students. The most commonly used supplement among the students was Centrum (multivitamin) (21.9%, n=7), followed by calcium supplements (15.6%, n=5). There was a significant relationship between use of dietary supplements and gender and race. White and Indian students used dietary supplements more than the other race groups (p<0.05). Females (p=0.018) and students who lived at home were more likely to consume dietary supplements (46.9%; n=15) (p=0.008). Fourth year students (34%) used dietary supplements the most. There was no relationship between dietary supplements and physical activity, eating habits or ability to meet dietary requirements. Common reasons for using dietary supplements were to strengthen the immune system, improve energy levels and enhance health. Expense (32.7%; n=35), adequate diet (22.4%; n=24), deem it unnecessary/waste of money (15.0%; n=16) and unsure about supplements (14.0%; n=15), were statistically significant reasons for not using a dietary supplement (p<0.05). A significant proportion of the sample (72.2%) indicated that their source of information on dietary supplements was the internet (p=0.011), followed by dietetics/nutrition lectures (41.7%). About 73.3% (n=22) of the students who used supplements indicated that they had experienced an overall improvement in physical health after use of dietary supplements (p=0.016). Other results achieved included: more energy (53%; n=16) and better memory/concentration (53.3%; n=16). Furthermore, half of the sample that used supplements (50%; n=15) reported an improved resistance to illness/ability to fight illnesses earlier. Just over half the sample (51.4%) indicated that they planned to use a dietary supplement in the future. Conclusion: There was a low prevalence of use of dietary supplements among dietetics students at UKZN. Factors such as race, gender, residence and year of study influenced the use of dietary supplements. Use of dietary supplements was more common among white and Indian students, females and those in the fourth year of study. Dietary supplements were used to strengthen the immune system, improve energy levels and enhance health. The high cost of supplements was the main deterrent to use of dietary supplements

Mississippi Pharmacists’ Perceptions of Dietary Supplements

Dietary supplements are often a controversial topic among healthcare professionals. Many view supplements positively and appreciate the health benefits they can provide. Others are wary of the decreased regulation dietary supplements are subject to and believe that the benefits of supplements do not outweigh the risks. Dietary supplements are of particular interest to pharmacists, as they are often sold at their place of work, and pharmacists have to consolidate their patients’ supplement use with their medication use. The purpose of this thesis is to evaluate the viewpoints of Mississippi pharmacists in relation to dietary supplements. A survey was sent to members of the MPhA (Mississippi Pharmacists Association) to gather information on demographics, perceptions of specific supplements, and perceptions of supplements in general. We found that specific supplements are recommended at a much higher rate than others, with a general trend of vitamins and minerals being recommended more often than herbal and other supplements. Mississippi pharmacists reported that there should be more research into dietary supplements and that their dietary supplement education is not as adequate as it should be. Younger pharmacists also tended to be more skeptical towards dietary supplements. Respondents are extremely interested in continuing education related to dietary supplements, especially as it relates to COVID-19, allowing for an important opportunity for continuing education providers

Re-Regulating Dietary Supplements

In 1994, Congress introduced the Dietary Supplement Health and Education Act (DSHEA) to create a regulatory framework for the dietary supplement industry. Since the passage of DSHEA nearly thirty years ago, U.S. adults have steadily increased their annual consumption of dietary supplements. The once $4 billion industry comprising approximately 4,000 products has swelled to a$40 billion trade with anywhere from 50,000 to 80,000 dietary supplements available over-the-counter. Despite the increased market size of dietary supplements, the Food and Drug Administration’s (FDA) pre-market authority to regulate the introduction of dietary supplements into the stream of commerce has remained subdued. Under DSHEA, the FDA has limited authority to review dietary supplements before entering the market. Unlike pharmaceuticals, which must be shown to be safe and effective prior to approval and marketing, dietary supplements can be sold to consumers without such reassurances. Instead, the FDA’s authority is generally limited to post-market enforcement under DSHEA. In fact, the FDA lacks the express authority to remove dietary supplements from the market unless it can establish that the products are unsafe, adulterated, mislabeled or misbranded. Given the morbidity and mortality associated with adulterated dietary supplements and the challenges in addressing the latest fads before they cause harm, Congress must give the FDA the power it needs to be proactive. The FDA desperately needs the tools to regulate the dietary supplement industry and remove harmful dietary supplements from the market. We call on Congress to amend DSHEA to grant the FDA the express statutory authority to (1) regulate dietary supplements prior to entering the market; (2) require manufacturers to submit Supplement Labels to the FDA for pre-market review; (3) require that supplements undergo both pre-market composition testing and post-market randomized composition testing; (4) strengthen agency authority to remove adulterated dietary supplements from the market; and (5) establish an excise tax on dietary supplements

Understanding The Behavior And Attitude Of Professional Athletes In Saudi Arabia Toward Dietary Supplements

A dietary supplement is defined as a product taken orally that contains a dietary ingredient (vitamins, minerals, herbs, amino acids, enzymes, etc.), and is intended to supplement one\u27s diet. Dietary supplements include plant extracts and concentrates from foods. Supplements help provide required nutrients to fulfill nutritional levels for daily training or competitive performance, and can help remedy nutritional deficiencies. Therefore, it is important that sports professionals have a thorough knowledge of these supplement products. However, athletes need to be informed about the use and possible benefits, side effects, and risks associated with the use of dietary supplements. Four objectives guided this study: (a) assess the use and attitudes of professional athletes in Saudi Arabia toward dietary supplements, (b) determine the availability of dietary supplements in Saudi Arabian markets, (c) identify the microbiological quality and safety of dietary supplements in Saudi Arabia, and (d) evaluate the impact of educational program on the knowledge and attitude of professional athletes in Saudi Arabia toward dietary supplements. In order to achieve the first objective, approximately 105 professional athletes were recruited as subjects from three different Saudi Arabian sports clubs. A questionnaire was designed to determine factors that influence professional athletes\u27 choices and use of dietary supplements. To achieve the second objective, twelve stores from each region of Riyadh were selected to assess the availability of dietary supplements on the market. In the third objective, approximately 80 different supplements from Riyadh were analyzed for microbial quality and product safety. The aim of the fourth objective was to develop a program to educate professional athletes in Saudi Arabia about the benefits of dietary supplements. Both pre- and post assessments were used. The majority of athletes indicated that their use of supplements was for the purpose of improving health and performance. The availability of different supplements ranged from approximately 23 to 97% according to the demand. In addition, of 80 most popular supplements selected for microbiology analysis, nine were shown to have contamination. Thus, this study provides a better understanding of factors that influence the attitudes of professional athletes with regard to the use of dietary supplements. The study identifies dietary supplements available in the Saudi Arabian market, and more importantly provides analyses to differentiate the quality among these products. The overall effect of this research is that professional athletes in Saudi Arabia and athletes worldwide will be able to make informed decisions about their choices and use of dietary supplements