Lecture 17 10.01.24 Herbal Slides - Student Slides PDF

PHAR 721 Nutrition, Vitamins, Complementary and Alternative Medicine Dietary/Herbal Supplements: Female Health Ladan Panahi, PharmD, BCPS [email protected] 1 Dietary/Herbal Supplements:...

PHAR 721 Nutrition, Vitamins, Complementary and Alternative Medicine Dietary/Herbal Supplements: Female Health Ladan Panahi, PharmD, BCPS [email protected] 1 Dietary/Herbal Supplements: Female Health 2  Black Cohosh What is it? Plant that grows in open woods at the edges of dense forests from Ontario, Canada to Tennessee and west to Missouri in the United States. Root active What is it used for? Premenstrual syndrome (PMS), dysmenorrhea, menopause How does it work? Controversial; may have estrogenic activity although shown has no effect on vaginal epithelium, endometrium, or hormone concentrations. Might have selective estrogen receptor modulating (SERM) effects and therefore have estrogenic effects in some tissues and anti-estrogenic effects in other tissues 3 What is the evidence for efficacy for Black Cohosh? Mixed Results; lack standardized dosing and have poor methodologic quality Some studies suggest significant improvement of symptoms related to menopause Some studies showed no significant difference vs. placebo Dose: 40 mg po daily in divided doses The long-term effects on cardiovascular disease, osteoporosis, breast cancer, and gynecological cancers are unknown  What is the evidence for safety? Common side effects: low incidence of ADRs; dyspepsia (>10%), headache, and rash Serious but rare side effects: weight gain Black Cohosh and hepatotoxicity. What are the significant drug or disease interactions? Safety Fertility agents lack of data regarding maternal or fetal safety and efficacy Considerations Hepatotoxic agents Concurrent use of female hormonal regimens (estrogens or progestins) weightgain hepatotoxicity Disease interactions: caution with hormone- sensitive conditions for example breast cancer or gynecological cancers 5  Black Cohosh Safety Continued Who may or may NOT consider using this herbal? Avoid use in patients with aspirin sensitivity Contraindicated in pregnancy and lactation Complications in neonates and mothers have been reported Concern for birth defects in untested products Caution in those with thromboembolic/cardiovascular disease Caution in those with hepatic failure or hepatotoxic medications 6  How should we counsel our fu.es patients? Therapeutic effects generally Black begin after 2 weeks, with maximum effects usually observed within 8 weeks Cohosh Usage longer than 12 months is not recommended Safety Anyone who develops symptoms of liver failure, such Continued as abdominal swelling, dark urine, or jaundice, while taking black cohosh should stop using it and consult a health care provider 7  Fenugreek A spice and medicine in India, China, and Northern Africa. Used as a natural source of food flavoring, and may be found in products such as maple syrup or other foods What is it? and beverages What is it used for? Diabetes, dysmenorrhea, dyslipidemia, and stimulation of breast milk production How does it work? - Lactation: increased sweat production impacting the milk duct or by phytoestrogens and diosgenin found in fenugreek - Lower cholesterol: seeds are high in fiber and possibly delay glucose absorption or binding of cholesterol - Lower blood sugar: glucose-induced insulin release and reducing insulin resistance or high fiber delays glucose absorption 8 What is the evidence for efficacy for Fenugreek? Typical dose for increasing milk supply: 2-3 capsules (580-610 mg per capsule) can be administered 3-4 times per day Maximum recommended amount of fenugreek seed is 6 grams/day  Evidence limited A small studies have suggested that fenugreek may help lower blood What is the sugar levels in people with diabetes or prediabetes (max A1c 1%) , but most of these studies were not of evidence for high quality It’s uncertain whether fenugreek can increase milk supply in breastfeeding efficacy for women; studies have had mixed results Fenugreek? Fenugreek seems to help the most when it is started a day or two after giving birth not all research showed this The evidence on fenugreek for other health conditions is too limited for any conclusions to be reached 10  Fenugreek Safety Considerations What is the evidence for safety? Side effects: hypoglycemia , hypokalemia, urine, sweat, and breast milk have been noted to smell like maple syrup What are the significant drug interactions? High-fiber content can bind with drugs and decrease drug absorption May increase risk of bleeding in patients taking anticoagulants and antiplatelets Antihyperglycemic medications 11  Fenugreek Safety Considerations Who may or may NOT consider using this herbal? Avoid during pregnancy because of potential uterine stimulant effects and malformation in the baby Prior allergy to chickpeas and peanuts History of liver disorder How should we counsel our patients? Caution in patients with diabetes and are on antihyperglycemic medications Discontinue fenugreek at least 2 weeks before 12 elective surgical procedures.  Phytoestrogens What is it? Derived primarily from soy and red clover What is it used Symptoms associated with menopause , maintain bone for? health, and promote cardiovascular health How does it work? - Soy is a primary source of phytoestrogens called isoflavones, a class of compounds that are structurally similar to endogenous (natural) estrogen and synthetic estrogen. - All isoflavones are competitive ligands of in vitro estrogen receptor assays and appear to function as selective estrogen receptor modifiers (SERMs) 13  Menopausal Symptoms: Consuming soy protein 15-60 grams, providing 34-100 mg of isoflavones, daily seems to modestly decrease 14 the frequency and severity of hot flashes in some menopausal adults. Improvement seems to be greater in those with a higher frequency of hot flashes at baseline Breast Cancer Prevention: Observational studies indicate that among Asian women, higher dietary intakes of soy during childhood What is the and adolescence are associated with a lower risk evidence for of breast cancer later in life (~25% reduced risk) efficacy for Soy amount in Western diets too low for this association to be Phytoestrogen: observed genetic differences or Soy? differences in quantification of soy intake Soy products in supplement form have not been shown to reduce breast cancer risk Bone Health: Soy isoflavone mixtures probably may have a beneficial effect on bone health in postmenopausal women, but inconsistent evidence Clinical Evidence: Soy for Heart Health? The American Heart Association (AHA) initially recommended that >= 25 g/day PO of intact soy protein, as part of a diet low in saturated fat and cholesterol, may reduce LDL cholesterol by 4—8% and decrease the risk of coronary heart disease (CHD) US Food and Drug Administration (FDA) has proposed to revoke the heart health claim status for soy protein foods that it originally granted (Oct 2017) Jenkins, DJA et al. Cumulative Meta-Analysis of the Soy Effect Over Time Originally published 27 Jun 2019. Journal of the American Heart Association. 2019;8:e012458. Meta-analysis 46 soy trials  total cholesterol and low-density lipoprotein (LDL) cholesterol demonstrated small and statistically significant reductions due to soy Clinical trial data suggest ingestion of soy isoflavones alone may not be as effective as whole soybean 15  Intake of isoflavones and tofu was associated with a lower coronary heart disease risk in 3 large prospective cohorts of US men and women. 74 241 women and 42 226 men who were free of cardiovascular disease and cancer at baseline comparing ≥1 serving/week soy with