Care needed in selecting dietary and herbal supplements for patients with kidney disease


Disclosures:
Wetherington reports no relevant disclosures.


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Complementary and alternative medicine is a multibillion-dollar industry made popular by people looking for improved well-being. This effort can be done with or without guidance from a health care provider.

Many people look to dietary and herbal supplements for a healthier lifestyle. There is a perception that herbals, vitamins and minerals are harmless or safer than pharmaceuticals because these are “natural.”

Amanda C. Wetherington

The recent recall by TruVision Health LLC of various nutritional supplements brings into question the safety of these products for patients with kidney disease. The supplements contained unapproved ingredients hordenine and/or octodrine dimethylhexylamine, which behave as stimulants, and are possibly unsafe and are not permitted to be sold.

Unseen harm

Patients with kidney disease are more vulnerable to the unseen harm of supplements, which can contribute to kidney damage (see Table 1). A published review by Gabardi and colleagues examined reported cases of dietary supplement-induced renal dysfunction in humans. They found 17 dietary supplements associated with complementary and alternative medicine (CAM)-induced immune-mediated nephrotoxicity, nephrolithiasis, rhabdomyolysis with AKI and hepatorenal syndrome. In some cases, the renal dysfunction was diagnosed either through renal biopsy or clinical observation.

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Creatine may be the most controversial of these offenders as there are several small-scale trials that argue against nephrotoxicity of creatine supplementation. However, there have been at least two reported cases in which the consumer acquired renal dysfunction from acute focal interstitial nephritis and tubular injury with a 2 g to 5 g per day dose of creatine. One patient had a previous existing condition of focal segmental glomerulosclerosis. It is important to assess for CAM in patients at higher risk for renal injury from common supplements used for exercise performance.

Vitamins

There have been cases in which chromium picolinate supplementation dosing and product purity may have played a role in kidney injury.

Renal dysfunction has been reported due to kidney stones/oxalate formation with ascorbic acid (vitamin C) and vaccinium macrocarpon (cranberry). Vitamin C supplementation is commonly used to enhance wound healing or iron absorption and for benefiting immune system resiliency. Cranberry tablets are commonly used to prevent or treat bladder and urinary tract infections. A 450 mg concentrated cranberry tablet contains approximately 180 mg of oxalate.

In a study by Terris and colleagues, an analysis of urine samples saw an increase of oxalate excretion by 43.3% after cranberry tablet ingestion. Cranberry and vitamin C supplements may increase risk for calcium-oxalate stone formation.

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Supplements like licorice, that have diuretic properties, have been associated with severe hypokalemia. Others include kava, aloe vera, creatine, ephedra,

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United States & Canada Healthcare Professionals Who Utilize Dietary Supplements Market Landscape Report 2023

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Dublin, March 27, 2023 (GLOBE NEWSWIRE) — The “US & Canada Market Landscape of Healthcare Professionals Who Utilize Dietary Supplements 2023” report has been added to ResearchAndMarkets.com’s offering.

Understanding Healthcare Practitioners Can Transform Your Supplement Business

Whether you are a supplement brand that sells directly through healthcare professionals (HCPs) or a brand that sells directly to consumers, you need to know what influences healthcare practitioners’ supplement decisions and recommendations.

Why?

  • Interest and engagement in integrative health and medicine is expanding rapidly. 49% of adults believe in many or some alternative medicines and therapies.

  • The practitioner channel represents 10% of all U.S. supplement sales but its influence on the overall sale of supplements is far greater. What HCPs recommend translates into consumer sales.

When It Comes to Supplement Brand Evaluation, Not All HCPs Are Alike

Most complementary and integrative HCPs consider their philosophy of health and wellness to be holistic. However, the term “holistic” has a broad definition, and within the spectrum of this definition some HCPs take more of a “vitalistic” approach, while others align more closely with a “pragmatic” approach.

This 83-page written report and 21-pages of market sizing charts provide a comprehensive overview of each of the health professional credentials that are most likely to influence the use of dietary supplements and other integrative products and services among their patient groups:

  • Integrative MDs/DOs

  • Licensed Naturopathic Doctors

  • Dietitians and Nutritionists

  • Doctors of Chiropractic

  • Licensed Acupuncturists

  • Independent Pharmacists

  • Nurses (RNs and APRNs)

  • Physician Assistants

  • Unlicensed Naturopaths, Health Coaches, and Herbalists

  • Massage Therapists

  • Holistic and Biological Dentists

  • Veterinary Clinics

While these HCPs share criteria for evaluating supplement brands, each of these professional credentials are different enough to warrant careful consideration before educating, marketing or selling to them.

Within each of the 14 HCP credential chapters you’ll learn:

In addition, you’ll find a resource guide with major organizations, educational institutions and associations that serve each credential.

What companies will benefit from this report?

  • Professional supplement brands

  • Consumer supplement brands

  • Medical foods companies

  • Testing & diagnostic labs

  • Medical device companies

  • Diagnostic & therapeutic device companies

  • Health technology companies

  • Genomic research and product companies

  • Health systems

  • Health centers & clinics

  • Research centers

  • Recruiters

  • Academics/universities

  • Insurance providers

  • Think tanks

Who will benefit?

  • CEOs

  • COOs

  • CMOs

  • Marketing directors

  • Category managers

  • Innovation managers

  • M&A groups

  • New ventures

  • Entrepreneurs

Companies Mentioned

  • Academy for Five Element Acupuncture

  • Academy of Chinese Culture and Health Sciences

  • Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) .

  • Acupuncture and Integrative Medicine College, Berkeley

  • Acupuncture and Massage College

  • Acupuncture and Oriental Medicine National Coalition

  • Alhambra Medical University

  • American Academy of Acupuncture and Oriental Medicine

  • American Academy of Medical Acupuncture (AAMA)

  • American Academy of Veterinary Acupuncture

  • American Association of Acupuncture and Oriental Medicine (AAAOM)

  • American College of Acupuncture and Oriental Medicine

  • American College of Traditional Chinese Medicine at CIIS

  • American Institute of Alternative Medicine

  • American Organization for the Bodywork Therapies of Asia (AOBTA)

  • AOM Program, College of Health and Wellness, Northwestern Health Sciences University

  • AOMA Graduate School of Integrative Medicine

  • Arizona

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Vitamin D supplements linked to 40% lower incidence

Three capsules if vitamin D laying outside of a red plastic pill box that has one compartment openShare on Pinterest
Scientists say there may be an interesting link between vitamin D supplements and dementia. Anastasiia Stiahailo/Getty Images
  • Researchers assessed the association between vitamin D supplementation and the incidence of dementia.
  • They found that vitamin D supplementation was linked to a lower dementia incidence.
  • Further studies are needed to certify the results.

Over 55 million people live with dementia worldwide, which is expected to rise to 139 million by 2050. There are currently no medications that can stop or reverse the condition.

Interventions that can affect dementia risk factors are being explored to slow disease progression. One such risk factor is vitamin D deficiency.

Some studies have found that vitamin D may aid the clearance of amyloid beta aggregates—one of the hallmarks of Alzheimer’s disease (AD). However, studies have produced conflicting results on whether vitamin D improves cognitive function.

Other studies show that low vitamin D levels are linked to a greater risk of dementia and AD.

Further studying the link between vitamin D supplementation and cognitive decline could help develop preventative strategies for dementia.

Recently, researchers assessed the link between vitamin D supplementation and incident dementia. They found that vitamin D supplementation is linked to lower incidence of dementia.

The study was published in Alzheimer’s and Dementia: Diagnosis, Assessment & Disease Monitoring.

For the study, the researchers analyzed data from 12,388 people from the National Alzheimer’s Coordinating Center, who were dementia-free at the start of the study. Their average age was 71 years old.

Altogether, 37% of the cohort took at least one of three vitamin D supplements: calcium-vitamin D, cholecalciferol, and ergocalciferol.

In their analyses, the researchers also accounted for demographic, clinical, and genetic variables, such as depression and APOE ε4 status—a gene variant linked to a higher risk of dementia.

After five years, the researchers found that 83.6% of those exposed to vitamin D supplements were alive and dementia-free. The same was true for 68.4% of those not exposed to vitamin D.

Within 10 years, the researchers found that 22% of participants developed dementia, of which 74.8% were not exposed to vitamin D supplements.

Whereas 14.6% of those with vitamin D exposure progressed to dementia, the same was true for 26% of those with no vitamin D exposure.

After adjusting for factors including cognitive diagnosis, depression, and APOE ε4 status, they found that vitamin D exposure was linked to a 40% lower incidence of dementia compared to no exposure.

Women see more benefit

The effects were strongest among women: women exposed to vitamin D were 49% less likely to develop dementia than those without exposure. Vitamin D-exposed men were 26% less likely to develop dementia than non-exposed men.

The researchers also found that depression was linked to a 35% higher incidence of dementia.

While findings were consistent for each vitamin D formulation, they noted that vitamin D supplements had the greatest effects on individuals with normal cognition as opposed to mild cognitive impairment and APOE ε4 non-carriers versus carriers.

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Tap Into Health and fitness: Being familiar with supplements and protein for physical fitness

No exercise session is complete with no a complimentary restoration protein shake, according to Matt Hammett, the visitor solutions director at Outdated Town Hot Springs. Hammett has been a lifelong fitness center user.

“I’ve most likely hardly ever not had a gym membership,” Hammett explained.

Most persons exercise session in the gym for cardio activity, which is the place excess fat is getting burned for strength, or to develop muscle mass, which is exactly where protein and dietary supplements come into participate in. “A good deal of men and women have a misunderstanding that you create muscle mass mass in the gymnasium, but what you’re really executing is tearing your muscular tissues apart with the use of weights,” Hammett stated. “Where you in fact make mass is when you are recovering from your exercise and not at the health club.”



Protein synthesis window informs recovery

Restoration from a exercise routine essentially occurs through the protein synthesis window. This is anywhere from immediately post workout to 1 hour and 15 minutes post work out. All through the protein synthesis window, muscles are in a key condition to take up protein. This is the procedure that truly builds muscle.

“Your overall body doesn’t go into maintenance manner right up until you go to rest. If you have not absorbed the appropriate proteins and macro vitamins right before you go to rest, your human body is not healing itself. This can exhibit as muscle mass strains, tightness, soreness, and so on.” Hammett explained. “When the muscle mass does not heal correctly calcium is despatched to that place, which is what we come to feel as set off points, tightness, scar tissue.”



Varieties of proteins and exercise routine recovery

Just one crucial difference for conditioning oriented people is the difference involving whey protein and casein protein. Whey protein is milk centered and is rapidly digesting for quick energy alternative. Casein protein is a gradual digesting protein that will enable restore vitality about a more time interval of time.

“If you are only consuming whey protein, you’re obtaining that immediate electrical power improve, but just after 1-2 several hours it is entirely digested and long gone,” Hammett explained. “That’s where by casein protein comes in. It gets digested immediately after 2-5 several hours, dissolving a lot more slowly so your system can consistently use it to fix your muscles through the day.”

Greatest Muscle Protein provides whey and casein

Old City Hot Springs offers fitness fanatics Supreme Muscle Protein (UMP) solutions out there for retail sale or mixed into smoothies and shakes in their cafe.

UMP brings together whey and casein protein to facilitate utmost restoration soon after a training. UMP is offered in a range of flavors which includes vanilla, chocolate, strawberry, angel food cake, rocky road.

“A lot of people today who have experienced protein shakes in the previous and didn’t take pleasure in them, that was 100% whey protein,” Hammett claimed. “When you make a shake out of whey protein it’s thinner,

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Do vitamin D supplements reduce cancer, cardiovascular risk?

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A new study searches for links between vitamin D supplements, cancer, and heart disease. Raymond Forbes LLC/Stocksy
  • Initial research has suggested that vitamin D may reduce the risk of developing cardiovascular disease and cancer.
  • However, there have been few large, higher-quality randomized controlled trials (RCTs) to corroborate this.
  • A recent RCT examined the effects of vitamin D supplementation in Finland.
  • It found no association between vitamin D supplementation and reduced risk of cardiovascular disease or cancer.

Vitamin D helps the body absorb calcium, which improves bone strength. Among other roles, it also contributes to the functioning of muscles, nerves, and the immune system.

Many scientists have set out to understand how vitamin D deficiency and supplementation may influence disease. According to the World Health Organization (WHO), there is some evidence that vitamin D may help protect against respiratory tract infections, for example.

Over the past 2 years, researchers have also explored whether vitamin D reduces the risks associated with COVID-19. Although investigations are ongoing, there seems to be some evidence that these supplements might improve intensive care unit admission rates.

Two other areas of particular interest are vitamin D’s potential effects on cardiovascular disease and cancer risk. However, few RCTs have looked into this. These types of studies are the gold standard for identifying causal relationships in scientific research.

A recent study, which appears in The American Journal of Clinical Nutrition, goes some way toward addressing this knowledge gap.

Speaking with Medical News Today, Vimal Karani, a professor of nutrigenetics and nutrigenomics at the University of Reading, in the United Kingdom, confirmed that there has been a gap between the initial research and findings from clinical trials.

Prof. Karani was not involved in the recent study but has worked with some of its authors.

He explained that past large epidemiological studies “have established a link between vitamin D deficiency and the risk of [cardiovascular disease] traits in various ethnic groups.” This, he said, suggests that vitamin D supplements might lower cardiovascular risk.

“However,” he continued, “clinical trials have not provided convincing evidence of the blood pressure-lowering effect of vitamin D supplementation.”

Prof. Karani said that there could be a wide range of reasons for this, including “differences in the sample size, duration of supplementation, dose of the supplementation, age of the participants, geographical location, sun exposure, and the outcome measures. Further research is required to replicate the findings in multiple ethnic groups.”

To provide further evidence of the relationship between vitamin D, cardiovascular disease, and cancer, the researchers behind the present study conducted the Finnish Vitamin D Trial.

This took place between 2012 and 2018, and it was double-blind, randomized, and placebo-controlled.

“When we started to plan the trial, there was a lot of evidence from observational studies that vitamin D deficiency would be associated with nearly all major chronic diseases, such as [cardiovascular disease], cancer, type 2 diabetes, and also mortality,” said Dr. Jyrki Virtanen in an interview with Medical

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