Reviewing Supplements with Proven Health Benefits

Americans—millions of them—use complementary and alternative medications, and for good reason. Accumulating evidence indicates that several common primary care problems respond to complementary and alternative treatment approaches. For example, patients who have chronic low back pain are often surprised and delighted when they try acupuncture and find relief.

Interventions that address the mind while soothing the body can also help; for example, cognitive behavior therapy, yoga, tai chi, and music therapy can improve the quantity and quality of sleep. Exercise is a well-proven intervention for many maladies, and especially as an adjuvant treatment for anxiety.

Pharmacies carry a wide range of herbal and nutritional supplements, but many retail health clinicians have only a passing familiarity with these products. Which are the most useful? That question is answered by the authors of a continuing education unit published in the September 2016 issue ofAmerican Family Physician.

The authors cover 5 herbal and nutritional supplements of great interest to retail health clinicians:

• Fish oilfor hypertriglyceridemia: Although its ability to reduce cardiovascular events is still being investigated, fish oil (4 g of combined eicosapentaenoic acid/docosahexaenoic acid per day) has been proven to lower triglyceride levels 25% to 30%. Some patients report minor gastrointestinal adverse effects, but fish oil at this dose has no significant drug interactions.
• St. John’s wortfor depression: Effective in mild to moderate depression at doses of 300 mg to 1200 mg daily, St. John's wort has some drug interactions that can be significant. Warn patients that it has drug interactions. Occasional gastrointestinal adverse effects have been reported.
• Ginkgo bilobaextract for treatment (but not prevention) of dementia: At doses of 240 mg per day, this supplement seems to preserve mitochondrial function, promote hippocampal neurogenesis and neuroplasticity, and enhance cerebral blood flow.
• Coenzyme Q10(ubiquinone) as adjunctive therapy for heart failure: Given in doses of 100 mg 3 times daily, this supplement works at the mitochondrial level to increase myocardial energy.
• Probiotic supplementationfor antibiotic-associated diarrhea: Patients should start probiotics within 3 days of initiating antibiotics, and continue for the duration of antibiotic treatment and 1 week after stopping. The dose differs by age, with children needing 5 to 10 billion colony-forming units per day and adults needing 10 to 20 billion colony-forming units per day.

The article provides pointers that are important in the counseling booth. For example, patients cannot self-treat heart failure with coenzyme Q10 alone—it is adjunctive therapy only. Ginkgo's rare adverse effects include headache and dizziness. St. John's wort is recommended at 300 mg 3 times a day; this can be an adherence challenge, and patients who take oral contraceptives, some antibiotics, protease inhibitors, certain immunosuppressive medications, and digoxin should avoid this cytochrome P450 enzyme inducer. With the use of probiotics, patients rarely experience and adverse effects.