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TRANSCRIPT
Natural health products: The Good, The Bad & Maybe Helpful
October 17, 2013
Dragana Skokovic-Sunjic, RPh, NCMP
Clinical Pharmacist
Hamilton FHT
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
Natural, alternative, amazing, safe, organic cures…
• What is available?
• Where do we find it?
• Sources of information?
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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
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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”
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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 6 2003
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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)
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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
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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
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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.
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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.
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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."
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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
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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
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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
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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
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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
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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)
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Omega 3
o Benefits of consuming EPA, DHA:
–Lowers cholesterol
–Reduces risk of heart attack, strokes, death
–Slows development of plaque and blood clots
oHow much to take?
»Healthy adults: 300-500mg daily EPA + DHA
»High cholesterol: 2-3g daily
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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
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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): 100-125 nmol/L
most likely optimal
– SIGMA recommends : 2,000IU per day for
women in Canada
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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)
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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
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Calcium
• How much do we need to supplement?
• Assess the dietary intake first!
– Calcium carbonate
– Calcium citrate
– Coral calcium
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Magnesium
• Magnesium deficiency very common
• Magnesium supplementation beneficial:
- Muscle pain
- Muscle spasm (leg cramps, restless legs)
- Fibromyalgia
- Insomnia
- Migraines
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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 : 300-400 mg at bedtime
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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
Probiotics
Definition:
“live microorganisms which when administered in
adequate amounts confer a health benefit on the
host”
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• 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
Microbiota : What is going on in our gut ?
Dragana Skokovic-Sunjic RPh
Benefits of microbiota
• Immune function
• Direct action against pathogenic bacteria
• Barrier function
• Metabolic and anti-oxidative role
• Potential anti-carcinogenic action
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Not all probiotics are the same…
• For overall health:
- DanActive
- BioGaia
• For diarrhea:
- BioK+
- Florastor
• For irritable bowel syndrome:
- Tuzen
- Activia
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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
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Antioxidants?
• Cruciferous vegetables (cabbage, Savoy
cabbage, Brussels sprouts)
• Green, leafy vegetables (kale, Swiss chard)
• Cherries, dark skinned berries…
• Or tablets?
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