What NPs Need to Know About Dietary Supplements for Improved Health Function

By MidlevelU Contributor and Nurse Practitioner Student Justin Groce

As people seek alternative methods for improving their health, the implementation of dietary supplements into daily regimens becomes more commonplace. However, many supplements are bogus and are merely supported by the "Oz effect" (which is a legitimate phenomenon, by the way). 

So, which supplements actually have science to back up their efficacy? Which supplements deserve to be taken and which should be left on the shelf? Some supplements serve only to create expensive urine while others can have positive health effects. Let's take a look at a few common supplements and the science backing their claims. 

Fish Oils

What's so great about fish oils? For one, you don't have to eat an entire fish to get it's health benefits which for many is a positive (unless you're a sushi lover...pass the spicy tuna roll, please!). Fish oils are packed with healthy fats, namely EPA, DHA, and omega-3. The American Heart Association recommends 1g/day of fish oil, however literature supports supplementing anywhere from 2 to 4g/day. Remember, these dosages reflect the combined oils (DHA+EPA), not each individual ingredient unless otherwise specified. 

Fish oils have been shown to reduce salivary cortisol levels, inhibit thromboxane, promote lipolysis and reduce markers of inflammation (Noreen et al, 2010; Van Schoonbeek, de Matt & Heemserk, 2003). In other words, they reduce stress levels and improve body composition. Furthermore, literature supports that fish oils reduce triglycerides while simultaneously increasing HDL levels (Wei & Jacobson, 2011). Not bad considering you won't actually have to eat fish! If you're worried about those nasty "fish burps", simply freeze your pills before ingesting (you're welcome). 

Considerations: Since fish oils reduce platelet aggregation, caution should be used in those on blood-thinning therapies. Fish oils take days to weeks to confer measurable health benefits. 

CoQ-10

In recent years Co-Q10 (co-enzyme Q10) has received much praise...and for good reason. I recall first hearing about Co-Q10 about 5 years ago from a sports nutritionist/physician who recommended that his patients with vascular disease take the supplement (Gao et al, 2012). Since then, I've recommended that many of my clients take it as well. Anecdotally, my clients who have taken the supplement have demonstrated improvements in cardiovascular health and have reported positive improvements from their primary care provider. 

So, what is Co-Q10? Co-Q10 is a molecule found within mitochondria that aids in energy metabolism (Antonio, 2008). Additionally, it works as an antioxidant and exerts it's mechanism of action by preserving nitric oxide levels. A study by Mabichi et al (2007) compared two groups to evaluate the supplements effects. One group of participants consumed 100mg of Co-Q10 while concurrently on atorvastatin therapy while one group took atorvastatin alone. The results? The group taking both Co-Q10 and atorvastatin had an 11.1% HDL improvement over the atorvastatin only group. Statin medications deplete exogenous Co-Q10, thus the rationale for supplementing (Ghirlanda et al, 1993). 

People who benefit most from Co-Q10 are those who have suffered a myocardial infarction (Singh et al, 1998). Dosing is typically 70 to 90mg/day taken along with a meal containing fats. Higher dosing has not been shown to confer additional benefits. 

Considerations: Grapefruit juice increases Co-Q10 levels. Co-Q10 is structurally similar to vitamin K2 and may antagonize the effects of warfarin. 

Spirulina

Spirulina certainly doesn't sound very appetizing. After all, it is algae. Blue. Green. Algae. However, spirulina has been dubbed the new "superfood" by various nutritional experts. Many vegans tout spirulina as an excellent source of antioxidants and proteins, for good reason. 

Althouth literature supporting spirulina is in its early stages, that which has been published suggests that spirulina can be beneficial to people with non-alcoholic fatty liver disease (NAFLD) and to diabetics. In a study by Lee et al (2008), 8g of spirulina supplementation/day improved lipid metabolism and lipid peroxidation in type 2 diabetics without influencing body weight. Similarly, Parikh, Mani, and Iver (2001) noted an HbA1c reduction of one point after two months of 2g/day spirulina supplementation in type 2 diabetics. 

Spirulina can be taken with food or on an empty stomach. The typical dose is 5 to 10g/day. Spirulina comes in powdered form and may be added to protein shakes or taken alone. 

Consideration: There is one documented case of an allergic reaction after consuming spirulina (Petrus et al, 2010). 

Cinnamon

Personally, I prefer cinnamon when it comes in the form of an Altoid, but for the purpose of health promotion, I will disregard my preferences. Cinnamon has been demonstrated to improve blood glucose levels. Peruse the ingredients of most "fat burners" on the market and you will find one form of cinnamon or another on the list of ingredients. Cinnamon exerts its anti-diabetic effects by inhibiting alpha-glucosidase and by acting as an insulin mimetic (Mohamed et al, 2011; Kirkham et al, 2009). These actions aid in breaking down carbohydrates and incorporating them into cells for fuel thus improving blood glucose clearance. Furthermore, Khan et al (2003) has noted improvements in fasting triglycerides, LDL, and total cholesterol with cinnamon supplementation. Cinnamon is dosed at 1 to 6g daily with a carbohydrate containing meal. 

As an aside, cinnamon has also been shown to aid in smoking cessation (Wittman, 2011). Simply hold a cinnamon stick as one would a cigarette in place of lighting up. 

Considerations: Cinnamon does contain a compound called camourin, which is hepatotoxic and should be avoided in high doses. To minimize camourin exposure, opt for Ceylon cinnamon instead of Cassia cinnamon. Ceylon is more expensive, has a tan-brown color (rather than red), sweeter taste, and is more fragile. 

Garlic

Best known as a close-proximity repellant, garlic isn't widely recognized for its purported health benefits. However, literature supports the food as a cardiovascular and immune health booster. Whether eaten whole, crushed, or taken in a supplementary capsule, garlic uses can reap health benefits. 

Kojuri, Vosoughi, and Akrami (2007) found that twice daily supplementation of 400mg of garlic capsules in hyperlipidemic patients reduced total and LDL cholesterol by 12.1% and 17.3% respectively, Furthermore, HDL cholesterol increased by 15.7%. In a double-blind crossover study conducted by Steiner, Khan, Holbert, and Lin (1996), 7.2g of garlic daily for six months reduced total cholesterol by 7%, LDL by 4.6%, and blood pressure by 5.5% in hypercholesterolemic men. Garlic dosing is 600mg/day taken at mealtime. 

Considerations: Garlic has mild anti-platelet effects, so caution should be taken in patients receiving blood thinning therapies (Rahman & Billington, 2000). 

Hopefully theses simple, cost-effective therapies can help benefit you and your patients!

 

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