Tell Your Doctor What Dietary Supplements You Are Taking
In a recently published article using survey data from the 2005-2008 National Health and Nutrition Examination Survey (NHANES) researchers found that 1 in 3 Americans taking prescription drugs were also taking dietary supplements. This was certainly not an unexpected finding. People with a medical condition often proactively work to improve their health and nutrition in order to help overcome their condition. Exercise, stress reduction, weight control and proper nutrition are all health pillars used overcome and prevent disease whether you have a medical condition or not.
Women with anemia often take multivitamins with iron and those with osteoporosis may start taking vitamin D, calcium and other important bone health minerals and vitamins. Men who have an overall higher risk of cardiovascular disease may take fish oil to reduce vascular inflammation or cholesterol lowering fiber as dietary supplement for better heart health. Despite the study authors comments and media coverage that there is something “wrong” with taking both medications and dietary supplements I believe this is a very positive finding. Americans want to take control of their lives and do those things necessary to enjoy a better life. This survey also tells healthcare professionals we need to begin to address our patient’s desire to integrate dietary supplements into a wellness lifestyle.
As mentioned in the article, and what I also advocate in my own practice, is that those who take dietary supplements should inform their healthcare provider about the type and the dose of the supplements they take. The easiest and least confusing way to do this is to bring the actual supplement bottle(s) with you to your doctor so they can be recorded and to determine any potential interaction with medications or medical conditions.
There are three main categories of supplements that have greater potential to interact with either a prescription drug or an existing medical condition. Certain herbal preparations, weight loss supplements and supplements known to interact with the ability of blood to clot are often singled out due to various factors that may result in adverse or undesired effects.
St. John’s Wort (Hypericum perforatum): Used as an anti-depressant, it is a herb that can interact with liver function and reduce the concentration of some medications in the blood. Common interactions include: Lanoxin, the cholesterol-lowering drugs Mevacor and Altocor (lovastatin), and the erectile dysfunction drug Viagra (sildenafil).
Vitamin E: Taken with blood-thinning medication such as Coumadin (warfarin) can increase increased risk of bleeding.
Ginseng: (Herb) Can interfere with the bleeding effects of Coumadin (warfarin), heparin, aspirin, and non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, and ketoprofen. Combining ginseng with MAO inhibitors such as Nardil or Parnate may cause headache, trouble sleeping, nervousness, and hyperactivity.
Ginkgo Biloba: (Herb) High doses could decrease the effectiveness of anticonvulsant medications to control seizures: Tegretol, Equetro or Carbatrol (carbamazepine), and Depakote (valproic acid).
Other supplements found in certain weight loss products and most energy drinks can cause in some people excessive elevations in heart rate and blood pressure along with symptoms of insomnia and anxiety which is generally unhealthy over time. Caffeine, itself or caffeine found in kola nut, yerba mate and guarana should be not be used by those with cardiovascular conditions or on medications to treat this condition. In 2011 published articles on energy drinks showed that most energy drinks contain 70-80 mg (though some contain as much as 400mg.) of caffeine per 8 oz. serving, about 3 times the concentration in cola drinks.
Summary: The fact is Americans are and will continue to use dietary supplements to help support their nutrition and health. The key to safe supplement used with prescription medication is communication. Patients who take supplements and prescriptions medications must discuss what they take and why with their physicians and physicians must become knowledgeable about potential supplement –drug interactions. The response should not be you can’t take one while on the other but to use both safely to the greater benefit to the patient and the condition they have.
Emily K. Farina, Concomitant Dietary Supplement and Prescription Medication Use Is Prevalent among US Adults with Doctor-Informed Medical Conditions, JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS, April 2014
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