Natural health products - Juravinski Cancer Centre 2013 Dragana PDF Slides.pdf · Natural health...

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?


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


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”


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


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)


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


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


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.


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.


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."


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


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


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


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


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


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)


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


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


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


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)


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


Calcium

• How much do we need to supplement?

• Assess the dietary intake first!

– Calcium carbonate

– Calcium citrate

– Coral calcium


Magnesium

• Magnesium deficiency very common

• Magnesium supplementation beneficial:

- Muscle pain

- Muscle spasm (leg cramps, restless legs)

- Fibromyalgia

- Insomnia

- Migraines


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


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”

28 Dragana Skokovic-Sunjic RPh

29

• 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


Not all probiotics are the same…

• For overall health:

- DanActive

- BioGaia

• For diarrhea:

- BioK+

- Florastor

• For irritable bowel syndrome:

- Tuzen

- Activia


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


Dilution process in homeopathy


Antioxidants?

• Cruciferous vegetables (cabbage, Savoy

cabbage, Brussels sprouts)

• Green, leafy vegetables (kale, Swiss chard)

• Cherries, dark skinned berries…

• Or tablets?


Conclusion

Question the source of information Ask: Is it right for me? Do not accept the cookie cutter approach New evidence and data emerging daily

Not that long ago:


Natural health products - Juravinski Cancer Centre 2013 Dragana PDF Slides.pdf · Natural health...

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