Cholestasis Linked to Bodybuilding Supplements: Exploring the Risks of Contamination.

Dietary herbal products taken together with prescription medicines may have harmful effects. In this study, we evaluated the use of dietary herbal supplements and identified factors that predict the concomitant use of these supplements in patients taking drugs prescribed for chronic cardiovascular diseases. We performed a cross-sectional study with 343 patients with cardiovascular diseases. Data regarding the sociodemographic status, medical condition, number of prescription drugs, and use of herbal supplements were collected using a self-administered questionnaire. Regular use of dietary herbal supplements was reported by 82.5% of patients. The most commonly consumed herbal supplement was garlic (71.2%), followed by onion (67.1%), and walnut (63.6%). Consumption of herbal supplements was commonly observed in patients with hypertension (53.6%). Among the patients in the study, 21.3% patients reported consumption of herbal supplements to the physician. Results of multivariable analysis showed that body mass index (odds ratio [OR] = 0.890, 95% confidence interval [CI] = 0.826-0.960), heart failure (OR = 0.325, 95% CI = 0.142-0.742), coronary artery disease (OR = 0.162, 95% CI = 0.069-0.379), smoking (OR = 3.852, 95% CI = 1.194-12.433), hypertension (OR = 10.584, 95% CI = 4.648-24.103), and dysrhythmia (OR = 9.339, 95% CI = 2.035-42.853) were associated with the use of dietary herbal supplements. Our results showed that dietary herbal supplements were commonly used by patients with chronic cardiovascular diseases. Therefore, understanding the interactions between the herbal supplements and drugs is necessary for minimizing adverse reactions.

Complementary and alternative medicine are treatments administered alone or in combination with conventional medical treatments. Data on complementary and alternative medicine use in children with kidney and urinary tract diseases are limited. In this cross-sectional study, the frequency and preferred methods of complementary and alternative medicine use and factors associated with their use were evaluated in 201 patients (48% female; median age, 11years; median disease duration, 5.1years) with kidney and urinary tract diseases and 260 healthy (without chronic disease) controls. Data were collected through a questionnaire-based interview and patients' medical records. Herbal and dietary supplements, including fish oil, were the most commonly used complementary and alternative medicine agents in both groups. There was no difference in herbal and dietary supplement use between the groups when fish oil was excluded (29% vs. 28%; p = 0.88). Herbal and dietary supplements were mainly used to improve/mitigate renal disease (52%). Logistic regression analysis revealed that disease duration > 7years (odds ratio (OR), 3.70; 95% confidence interval (CI), 1.48-9.20), current use of six or more drugs (OR, 5.6; 95% CI, 1.28-24.41), and recurrent urinary tract infection or nephrolithiasis (OR, 3.92; 95% CI, 1.02-15.09) were the independent risk factors for herbal and dietary supplement use, except fish oil. Middle socioeconomic status was associated with decreased herbal and dietary supplement use, except fish oil, compared with low socioeconomic status (OR, 0.30; 95% CI, 0.11-0.81). Herbal and dietary supplements were used by 78% patients, despite knowing that these products could have side effects; only 42% of the patients shared the information about herbal and dietary supplement use with their doctors.Conclusion: Herbal and dietary supplement use is frequent in children with kidney and urinary tract diseases. Educating health professionals regarding such use is mandatory for developing strategies to prevent critical consequences. What is Known: • Complementary and alternative medicine (CAM) practices are therapeutic approaches that do not have sufficient efficacy and safety evidence. • CAM is widely used in healthy children and in certain chronic diseases. What is New: • Herbal and dietary supplements (HDSs) were the most commonly used method in kidney and urinary tract diseases. • Duration of disease, number of drugs, and socioeconomic status are determinants of HDS use except fish oil.

Very little is known about herbal and dietary supplement disclosure in adults with chronic medical conditions, especially on a national level. To examine herbal and dietary supplement disclosure to conventional health care providers by adults with chronic medical conditions. Data on herbal and dietary supplement use (N = 5456 users) in the previous year were used from the 2002 National Health Interview Survey. Bi-variable analyses compared characteristics between herbal and dietary supplement disclosers and nondisclosers. Multivariable logistic regression identified independent correlates of herbal and dietary supplement disclosure. Overall, only 33% of herbal and dietary supplement users reported disclosing use of herbal and dietary supplements to their conventional health care provider. Among herbal and dietary supplement users with chronic conditions, less than 51% disclosed use to their conventional health care provider. Hispanic (adjusted odds ratio and 95% confidence interval = 0.70 [0.52, 0.94]) and Asian American (adjusted odds ratio and 95% confidence interval = 0.54 [0.33, 0.89]) adults were much less likely than non-Hispanic white Americans to disclose herbal and dietary supplement use. Having less than a high school education (adjusted odds ratio and 95% confidence interval = 0.61 [0.45, 0.82]) and not having insurance (adjusted odds ratio and 95% confidence interval = 0.77 [0.59, 1.00]) were associated with being less likely to disclose herbal and dietary supplement use. Herbal and dietary supplement disclosure rates are low, even among adults with chronic conditions. These findings raise concerns about the safety of herbal and dietary supplements in combination with allopathic care. Future studies should focus on educating physicians about crosscultural care as well as eliciting information about herbal and dietary supplement use.

To assess the patterns of dietary (DS) and herbal supplement (HS) use in MS patients, compare use between MS patients and healthy controls and to identify potential interactions with drugs used to treat MS. This study included 279 MS subjects and 161 controls from a study of risk factors in MS. All patients received a neurological examination. All subjects provided responses to a standardized questionnaire administered during an in-person interview. A larger proportion of MS patients (82.1%) compared to controls (60.1%) used one or more DS regularly for at least 3months (p<0.001). There was a trend toward a higher proportion of MS patients (26.6%) versus controls (17.8%) who used HSs for more than 1month (p=0.038). The most common DS used after MS onset was a multivitamin (78.1%), followed by vitamin D (65.8%). Use of the majority of specific DSs increased significantly after MS onset compared to before. The proportion of controls and MS patients after MS onset who reported using an individual HS was generally similar. The most commonly used HS in patients after MS was evening primrose oil (40.4%) followed by cranberry fruit extract (35.2%). There was no evidence for associations with progressive disease course or with choice of disease-modifying treatment. Dietary supplements are used more frequently by MS patients than controls. Use tends to increase after MS onset compared to before, especially for DS. The use of HS by MS patients is only modestly greater than by controls.

Introduction: Medication nonadherence contributes to poor blood pressure control and increases cardiovascular disease risk in patients with hypertension. Identifying modifiable risk factors for low or nonadherence to antihypertensive medication is needed. Studies that have examined the relationship between herbal or dietary supplement (HDS) use and antihypertensive medication nonadherence provide inconsistent findings. Data from the National Health and Nutrition Examination Survey were used to examine the association between HDS use, current use of prescribed antihypertensive medication, and blood pressure status. Methods: The study sample included hypertensive adults (n = 5,478) who have been told by a health professional to take prescribed medication for their health condition. Respondents were classified as either HDS users or HDS nonusers. Depending on the kind of supplement used, HDS users were further divided into three mutually exclusive groups: hypertension HDS users, nonhypertension HDS users, and those who used both kinds of supplements. Supplements groupings were based on reports in the literature. Blood pressure status definition was based on Eighth Joint National Committee (JNC 8) recommendations. Adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) were obtained from logistic models. Results: Overall HDS use prevalence was 62%. Current medication use did not significantly differ between patients reporting no HDS use and those reporting HDS use (aOR: 1.45; 95% CI: 0.78-2.69). No observable differences were found in current medication use between patients reporting no HDS use and those taking nonhypertension HDS or both kinds of supplements. Use of hypertension HDS was associated with improved blood pressure (aOR: 1.90; 95% CI: 1.07-3.36) compared with no HDS use. Conclusion: In a nationally representative U.S. sample, HDS use did not compromise current use of prescribed medication and was associated with improved blood pressure control. More research is needed to better understand why HDS use is associated with better blood pressure control.

Dietary supplement use is common in the United States. Some herbal supplements may cause coagulopathy, hypertension, or dry eyes. The goal of this study is to reveal the incidence of herbal supplement use in the cosmetic surgery population. A retrospective chart review of 200 patients undergoing facial cosmetic surgery performed by a single surgeon was performed. Variables studied included patient age, sex, surgical procedure, herbal medication use, and intraoperative variables. Exclusion criteria were age younger than 15 years, noncosmetic procedures such as trauma, and incomplete preoperative medication form. Patients were subdivided into the supplement user group (herbal) and the supplement nonuser group (nonherbal). Statistical analysis included descriptive statistics, t test, and chi-square analysis. The incidence of supplement use was 49 percent in the 200 patients; 24.5 percent of patients used only vitamins or minerals, 2.5 percent of patients used only animal- and plant-based (nonvitamin/mineral) supplements, and 22 percent of patients used both types of supplements. In the herbal group, patients used an average of 2.8 supplements. The herbal and nonherbal groups differed significantly in sex (herbal, 89.8 percent female; nonherbal, 77.5 percent; p < 0.04) and age (herbal, 51.4 years; nonherbal, 38.5 years; p < 0.001). Herbal supplement use is prevalent in the facial cosmetic surgery population, especially in the older female population. Considering the potential ill effects of these products on surgery and recovery, awareness and careful documentation and prohibiting the patients from the consumption of these products will increase the safety and reduce the recovery following cosmetic procedures.

Underreporting the Use of Dietary Supplements and Nonprescription Medications Among Patients Undergoing a Periodic Health Examination

Drug-Induced Liver Injury: Icelandic Lessons

The use of dietary supplements has grown dramatically in the last decade. A large number of dietary and herbal supplements escape regulatory and quality control; components of these preparations are poisonous and may contain, among other toxins, heavy metals. Uncontrolled use of dietary and herbal supplements by special populations, such as the military, may therefore pose a health risk. Clinical symptoms are not always properly attributed to dietary supplements; patients often do not mention supplement use to their health care provider. Therefore, a health risk estimate is hard to make on either the individual or the population level. The literature on this issue was reviewed and discussed in the light of a representative clinical-chemical case study. This case study was performed on a host of preparations that were used by one single individual in the military. Both essential (chromium, copper, zinc, and iron) and poisonous (arsenic, lead, and nickel) trace elements were determined using inductively coupled plasma combined with optical emission spectrometry (ICP-OES) or with mass spectrometry (ICP-MS). Arsenic and lead were detected at exposure levels associated with health risks. These health risks were detected predominantly in hormone-containing supplements and the herbs and botanicals used for performance enhancement. To the extent that this is a representative sample, there is an underestimation of supplement use and supplement risk in the US military, if not in the general population. Since clinical symptoms may be attributed to other causes and, unless patients are specifically asked, health care providers may not be aware of their patients' use of dietary supplements, a strong support of laboratory diagnostics, such as a toxicological screening of blood or urine, is required. In addition, screening of the preparations themselves may be advised.

Dietary supplements are products containing dietary elements including vitamins, minerals, amino acids, herbs, or botanicals. They can aid consumers with low dietary intake and quality, as well as those with high demands, by boosting nutritious value. A cross-sectional study was conducted among adults living in Saudi Arabia aged between 18–60 years old using online self-administered questionnaire. Information regarding sociodemographic characteristics, use and type of dietary supplements, and attitude toward and patterns of dietary supplement use was collected. The chi-square test, Pearson correlations, and the independent t-test were used. In total, 531 participants (115 men and 416 women) were included. Approximately half of the participants (51.8%, n = 275) used dietary supplements. Participants who were using dietary supplements were significantly younger (29.16 ± 9.32 years), more highly educated (85.5%, n = 235), and worked in the health sector (63.7%, n = 100). Herbal supplement use was associated with older age and female sex. Single mineral supplements were used more frequently by married, female, pregnant, or breastfeeding participants and those not working in the health sector. Fatty supplements were used more frequently by participants with a higher level of education. Regarding the attitude toward dietary supplement use, women, single participants, and health care workers showed a significant positive attitude. In-depth investigation into the amount of and reasons for dietary supplement use in the health sector is required. Additionally, educating pregnant and breastfeeding women on the importance of dietary supplements is necessary.

Consumption and reasons for use of dietary supplements in an Australian university population

Patients’ use of herbal and other dietary supplements and poor reporting of this to medical practitioners is widely documented in the literature. Many herbal supplements have potent pharmacological activity that can lead to potential adverse effects and drug interactions. The perioperative setting is a critical point in patient care for preventing these potential complications. A literature review was conducted regarding commonly used herbal and natural supplements and their potential for adverse effects in the surgical setting. Several herbal supplements or botanicals used by patients may, because of their chemical structure and pharmacokinetics, have adverse effects if used during the perioperative period. With the increasing use of herbal supplements by patients, it is critical for healthcare workers to screen patients pre-surgically for use of herbal and other natural supplements and to be knowledgeable about their potential adverse effects.

The use of dietary herbal supplements in patients taking prescribed or over-the-counter medications may not be appropriate due to potential herb-drug interactions. The case report of an 81-year-old Chinese American woman taking nonprescribed, over-the-counter, dietary herbal supplements is presented to demonstrate the risk of undisclosed use of supplements. This article emphasizes the need for registered dietitian nutritionists and other health care professionals to encourage patients disclose their use of dietary supplements and conduct evaluations on potential adverse herb-drug interactions. Recommendations should be provided to patients regarding the use of dietary supplements as part of the comprehensive patient care.

Prevalence, Adverse Events, and Factors Associated with Dietary Supplement and Nutritional Supplement Use by US Navy and Marine Corps Personnel

The nationwide concern over the escalating use of herbal and other alternative dietary supplements is prompting a call for action in health care organizations. Not only is there mounting evidence to support a strong concern for patient safety, but the use of these products by people participating in biomedical research protocols has an added impact on the integrity of the research design and data gathering. These issues are of increasing concern to the National Institutes of Health's hospital for biomedical research, the Warren Grant Magnuson Clinical Center. Surveys completed in 2000 showed that 25–45% of Clinical Center patients reported taking herbal and other alternative dietary supplements. In 2001, the Clinical Center moved forward to develop and implement a policy to guide hospital staff in the management of patient use of herbal and alternative supplements. The policy established the requirement for all patients to be screened for supplement use upon admission or outpatient visit. Continued use of supplement products during hospitalization and/or outpatient enrollment on protocol require a physician's authorizing order. The implementation of this policy has increased awareness and provided an important step forward in protecting patient safety and preserving the scientific integrity of the research at the NIH's Clinical Center.