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Questions and Answers
What is a potential risk associated with the use of garlic supplements?
What is a potential risk associated with the use of garlic supplements?
Which of the following fatty acids is primarily derived from plant sources?
Which of the following fatty acids is primarily derived from plant sources?
How does fish oil primarily help to reduce triglyceride levels?
How does fish oil primarily help to reduce triglyceride levels?
Why should garlic be stopped 10–14 days prior to a surgical procedure?
Why should garlic be stopped 10–14 days prior to a surgical procedure?
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Which of the following foods is highest in EPA and DHA?
Which of the following foods is highest in EPA and DHA?
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What is the typical dosage range studied for Coenzyme Q10?
What is the typical dosage range studied for Coenzyme Q10?
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Which effect is NOT associated with Coenzyme Q10?
Which effect is NOT associated with Coenzyme Q10?
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What is a critical consideration for patients taking red yeast rice?
What is a critical consideration for patients taking red yeast rice?
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What is a reason for conflicting results regarding the efficacy of CoQ10?
What is a reason for conflicting results regarding the efficacy of CoQ10?
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Which of the following guidelines regarding CoQ10 supplementation is accurate?
Which of the following guidelines regarding CoQ10 supplementation is accurate?
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What is a function of Coenzyme Q10 in the body?
What is a function of Coenzyme Q10 in the body?
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What is a common adverse effect associated with statin medications that CoQ10 may address?
What is a common adverse effect associated with statin medications that CoQ10 may address?
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What type of compound is Coenzyme Q10 classified as?
What type of compound is Coenzyme Q10 classified as?
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What is the maximum percentage reduction in total cholesterol that can be achieved by taking certain red yeast rice products?
What is the maximum percentage reduction in total cholesterol that can be achieved by taking certain red yeast rice products?
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Why are some red yeast rice products in the United States considered illegal?
Why are some red yeast rice products in the United States considered illegal?
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What challenges do consumers face regarding the amount of monacolin K in red yeast rice products?
What challenges do consumers face regarding the amount of monacolin K in red yeast rice products?
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What does the FDA's stance on red yeast rice products indicate about their content?
What does the FDA's stance on red yeast rice products indicate about their content?
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What has been found regarding monacolin K content in red yeast rice supplements after analysis?
What has been found regarding monacolin K content in red yeast rice supplements after analysis?
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What is the typical dosing range for red yeast rice?
What is the typical dosing range for red yeast rice?
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What potential health condition might benefit from the use of red yeast rice products?
What potential health condition might benefit from the use of red yeast rice products?
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What is the main issue regarding the clarity of labeling for red yeast rice products?
What is the main issue regarding the clarity of labeling for red yeast rice products?
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What is the main pharmacologic component produced by garlic that is believed to contribute to its medicinal effects?
What is the main pharmacologic component produced by garlic that is believed to contribute to its medicinal effects?
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What potential side effect of garlic should patients be aware of before surgery?
What potential side effect of garlic should patients be aware of before surgery?
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Which statement about the efficacy of garlic in treating hyperlipidemia is accurate?
Which statement about the efficacy of garlic in treating hyperlipidemia is accurate?
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At what dosage of fresh garlic is it typically recommended for daily intake?
At what dosage of fresh garlic is it typically recommended for daily intake?
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Which conditions is garlic primarily used to treat?
Which conditions is garlic primarily used to treat?
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What should patients taking warfarin be aware of when considering garlic supplementation?
What should patients taking warfarin be aware of when considering garlic supplementation?
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What is the typical range of allicin provided by dried garlic powder supplements?
What is the typical range of allicin provided by dried garlic powder supplements?
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What is the recommended way to take CoQ10 for patients with heart failure?
What is the recommended way to take CoQ10 for patients with heart failure?
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What type of patients may consider taking fish oil supplements?
What type of patients may consider taking fish oil supplements?
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Why should patients avoid fish with high mercury content?
Why should patients avoid fish with high mercury content?
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What should be done with fish oil products that have a strong fishy or rancid smell?
What should be done with fish oil products that have a strong fishy or rancid smell?
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Which component found in fish oil supplements is primarily believed to have health benefits?
Which component found in fish oil supplements is primarily believed to have health benefits?
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What is advised to minimize fish burps when taking fish oil supplements?
What is advised to minimize fish burps when taking fish oil supplements?
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Study Notes
Red Yeast Rice
- Red yeast rice products can lower total cholesterol by up to 23% and LDL cholesterol by up to 34% when taken 1-5 grams daily for up to 24 weeks
- Red yeast rice products that contain statins are considered illegal, unapproved drugs by the FDA
- The amount of monacolin K (lovastatin) in red yeast rice products is not always clearly stated on the label
- Some red yeast rice products contain little or no statins, but many still contain significant concentrations
- Some products can contain up to 5 mg of statins per tablet
- It is not known whether red yeast rice products that contain a lower concentration of statins can significantly reduce cholesterol levels in patients with hyperlipidemia
Dosing
- Labels on red yeast rice supplements usually only state the amount of red yeast rice, not the amounts of monacolin K or other monacolins
- A study of 28 supplements found that monacolin K content ranged from 0.09–5.48 mg per 1200 mg of red yeast rice
- Typical dose of red yeast rice is 1.2.- 2.4 gram daily in 2 divided doses (600 mg po bid)
Coenzyme Q10
- Also referred to as ubiquinone
- Fat-soluble antioxidant and endogenously produced
- A rate-limiting cofactor in mitochondrial adenosine triphosphate (ATP) formation
- CoQ10 is involved in many energy production functions and regeneration of other antioxidants
- Stabilizes membranes and may have vasodilatory and inotropic effects
Coenzyme Q10 - Uses
- Statin-associated adverse effects
- General antioxidant in cardiovascular disease
- Many more…
Coenzyme Q10 - Dose Range
- 50-1200 mg/day
- Typical dosages studied have been 100 to 200 mg/day
Coenzyme Q10 - Evidence for Efficacy
- Statin Intolerance: statins decrease coenzyme Q10 production, possibly leading to muscle pain
- Randomized control trials: results conflicting
- Genetic differences may contribute to the variable responses to CoQ10 treatment
- In general, research is too limited for any conclusions to be drawn in research or conflicting results have been observed with CoQ10 use
Coenzyme Q10 - ACC/AHA Guidelines
- ACC/AHA guidelines currently do not recommend initiation of nutritional supplementation (including CoQ10) as treatment in patients with current or previous symptoms of heart failure
- Although results suggested an improvement in the primary MACE endpoint at 2 years, the small event numbers, difficulties in patient recruitment, and an unexpectedly large treatment effect with wide confidence intervals limit the interpretability of the results
- At this time point, CoQ10 initiation cannot be recommended to patients with heart failure
Coenzyme Q10 - Safety
- No serious side effects reported
- Possible side effects (100 mg) doses
- Take with food to aid absorption
Garlic
- The herb Allium sativum, best known for flavoring
Garlic - Uses
- Hyperlipidemia
- Hypertension
Garlic - How it Works
- Produces allicin, the main component of garlic’s odor, and may be responsible for pharmacologic effect
- Animal and in vitro studies: hypotensive, hypolipidemic, antiplatelet, antioxidant, and anti- infective properties
- Increases levels of the vasodilator hydrogen sulfide, enhances nitric oxide production, and may inhibit angiotensin-converting enzyme
Garlic - Dosing
- Fresh bulb : 1/2-1 raw clove daily (2 – 4 grams fresh garlic)
- Dried powder: 0.4-1.2 gram/daily (providing 3 to 5 mg allicin/day)
- Enteric-coated capsule: 600-900 mg/day to help with “garlic breath”
Garlic - Evidence for Efficacy
- Hyperlipidemia
- May reduce total cholesterol and LDL cholesterol levels in people with high levels of these blood lipids
- The effect is small, and it may take more than 8 weeks before noting any improvement
- No improvement in HDL levels or triglycerides
- Hypertension
- Garlic supplements may be helpful for high blood pressure, but the evidence is limited
Garlic - Safety
- May increase risk of bleeding
- Stop prior to surgery or procedures
- Common side effects: bad breath, body odor, heartburn/GI upset
Garlic - Drug Interactions
- Saquinavir
- Anticoagulants
- Antiplatelets
Garlic - Who May Consider This product
- Patients with mild hypertension
- Patients with mild hypercholesterolemia
Garlic - Patient Counseling
- Increased risk of bleeding
- Enteric-coated preparation may help decrease breath odor
- Odorless products may contain less allicin and may be less effective
- Garlic should be stopped 10–14 days prior to surgical procedures to avoid excess bleeding
Fish Oil
- Group of polyunsaturated fatty acids
- Omega 3
- Alpha-linolenic acid (ALA)
- Eicosapentaenoic acid (EPA)
- Docosahexaenoic acid (DHA)
- Omega 3
- The human body can convert small amounts of ALA into EPA and DHA, but the main way people increase levels is to consume foods and supplements that contain omega-3s
- ALA is found in walnuts and some plant oils, such as flaxseed, soybean, and canola.
- EPA and DHA are high in oysters and fatty fish such as salmon, sardines, mackerel, herring, lake trout, and albacore tuna.
Fish Oil - Uses
- Decrease triglycerides
- Decrease blood pressure
- Reduce cognitive decline in older patients
- Cardiac health??? Monitor patients taking fish oils and drugs that affect bleeding (e.g., anticoagulants, antiplatelets)
Fish Oil - Considerations
- Fish oil is not the same as fish (cod) liver oil
- Avoid eating fish with high mercury content
Fish Oil - Who May Consider This Product
- Patients with elevated triglycerides or mild hypertension (no cardiovascular disease history)
Fish Oil - Patient Counseling
- Discard products with a strong fishy or rancid smell or taste. This may be an indication of spoilage or poor product quality
- Take with meals, freezing, or enteric coated may reduce “fish burps”
- Take prescription product to minimize toxins
- Not all fish oil supplements are the same; must read label
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Description
This quiz explores the effects of red yeast rice on cholesterol levels, including its potential benefits and legal status concerning statins. Understand the dosing and concentration of monacolin K in various supplements to make informed health decisions.