NR 228 Week 7 Discussion Question: Supplementing Your Diet.
It has become common practice for people to supplement their diets with pills, smoothies,
... [Show More] teas, herbals, and other complementary practices. Select 2 from the list below and locate an evidence-based article for each. Summarize the intended use, recommended dosage, and side effects and known interactions with over the counter and prescription medications. What if any contraindications are identified for a patient with liver and/or kidney disease?
Answer
I am interested to summarize probiotics and garlic because they are mostly used in my day to day life.
Probiotics
People talk all the time about probiotics and its uses. The FDA has not approved probiotics for medical uses so far, but if we visit doctors’ offices with digestive issues, they recommend us to use it as a complimentary treatment. It is not approved by the FDA, but it helps for treatment and prevention of diarrhea and irritable bowel syndrome. It may play a role in aiding digestion for patients suffering from some digestive diseases, including irritable bowel syndrome, inflammatory bowel disease, antibiotic-associated diarrhea, and Clostridium difficile-associated diarrhea (Stevens, 2016). The recommended dosage is 250 mg – 500 mg two to four times a day. The properties of probiotics may help strengthen homeostasis and thus reduce side effects associated with cancer and other disease treatments (Mego, Holec, Drgona, & Hainova, 2013). Probiotics alters the properties of gut microorganisms, which range from their growth to their metabolism and use of nutrients. These alterations appear to influence glucose and fat metabolism in the host (Arora, Singh, & Sharma, 2013). Side effects are bloating, constipation, and flatulence. Antifungal medications may decrease effectiveness of probiotics, but there is limited data to support contraindications of this supplement. Since, this is not approved by the FDA, we as nurses should advise our patients and other groups to read package labels carefully to ensure safe and efficacious use.
Garlic
Garlic is also considered as complimentary or alternative medicines as a lipid lowering agents, but medical use of this product has not been approved by FDA. Garlic has so many health benefits for treatment and prevention of various diseases; keeps away unwanted and harmful viruses, bacteria, fungi, reduces heart disease, prevent infection of wounds, and may improve individual’s blood sugar levels by reducing insulin resistance (Tweed, 2017). There are multipurpose benefits from garlic supplements. Garlic contains numerous sulfide compounds, which have anticarcinogenic properties (Kodali & Eslick, 2015). The dosage of garlic supplement is 200 to 400 mg three times a day, which is available over the counter (OTC) as well as in the grocery markets in raw forms. It is contraindicated for the people who have bleeding disorders. Use of garlic with anticoagulants, thrombolytics, antiplatelet agents may increase risk of bleeding (Tweed, 2017). We as educators need to educate our patients not to take herbal remedies without consulting with their providers because of drug interactions and other side effects.
References:
Arora, T., Singh, S., & Sharma, R. K. (2013). Probiotics: Interaction with gut microbiome and
antiobesity potential. Nutrition, 29(4), 591-596. doi:10.1016/j.nut.2012.07.017
Kodali, R. T., & Eslick, G. D. (2015). Meta-Analysis: Does Garlic Intake Reduce Risk of Gastric
Cancer?. Nutrition & Cancer, 67(1), 1-11. doi:10.1080/01635581.2015.967873
Mego, M., Holec, V., Drgona, L., & Hainova, K. (2013). Probiotic bacteria in cancer patients undergoing chemotherapy and radiation therapy. Complementary Therapies In
Medicine, 21(6), 712-723. doi:10.1016/j.ctim.2013.08.018
Stevens, G. A. (2016). Probiotics for Digestive Health: A Review of Information Resources.
Journal Of Consumer Health On The Internet, 20(4), 167-172.
doi:10.1080/15398285.2016.1202019
TWEED, V. (2017). Put More Garlic in Your Life. Better Nutrition, 79(1), 24-25.
Response:
I really enjoyed reading your summary. I also summarized garlic and probiotics in the discussion because these supplements are considered as vitals in our cultural diets. Garlic is one of the important supplements that has been used everywhere in the world. Studies has shown that in people with high blood pressure, garlic intake help decrease the blood pressure, and works as an anticoagulants, thrombolytics, and antiplatelet (Tweed, 2017). Just like prescribed medicines, many people use it by adding during meals preparations. Garlic supplements can interact with different drugs, including warfarin (Rahman, 2007). In our culture, we believe that garlic with green tea helps our immune system to fight from disease processes. Without garlic, we never cook vegetables or meat, so it is considered as one of the main ingredients/supplements in cooking. In our culture, both probiotics and garlic are used for immune system enhancement, lowering the risk of different allergies, and reducing high cholesterol. Since, this is not approved by the FDA, we as nurses should advise our patients and other groups to read package labels carefully to ensure safe and efficacious use. Anything in moderation is good, but consuming excess than that of body’s requirement causes serious effects in our health.
Reference
Rahman, M. S. (2007). Allicin and Other Functional Active Components in Garlic: Health
Benefits and Bioavailability. International Journal Of Food Properties, 10(2), 245-268.
doi:10.1080/10942910601113327
TWEED, V. (2017). Put More Garlic in Your Life. Better Nutrition, 79(1), 24-25.
Melatonin, in its oral form, has many uses, the most common being insomnia and jet lag. It is also used for heart disease, symptoms of menopause, benzodiazepine withdrawal in the elderly, breast and prostate cancer prevention and treatment, fibromyalgia, IBS, epilepsy, pulmonary sarcoidosis, and to increase chances of pregnancy in women with polycystic ovarian syndrome. Topical melatonin is used to prevent and treat sunburn.
In a study done by the National Natural Science Foundation of China, melatonin was given to severely burnt rats with less than 60% kidney function. After administration, glomerular filtration rate was drastically improved and creatinine and BUN levels dropped. It also reduced inflammatory response by inhibiting inflammatory cytokines and increasing the action of inflammation reducing cytokines. In their study they concluded that melatonin activates sirtuin 1, a nicotinamide adenosine dinucleotide dependent deacetylase that regulates hepatic lipid homeostasis, which has a protective and therapeutic effect on the kidneys. They believe this serves as evidence that melatonin has the potential to improve renal function and prevent acute kidney injury in burn victims (Bai et al., 2016).
For insomnia and jet lag, 0.5-5 mg 1 hour prior to bedtime is the recommended dose. For other indications, there are no widespread recommended dosage amounts for melatonin. The doctor decides on the dosage based on the individual needs of the patient, usually as a part of multimodal treatment.
Side effects of melatonin may include vivid dreams or nightmares and a hangover effect. A lower dose can prevent this.
Melatonin is contraindicated in pregnant women. It should be used only under physician supervision in those with hormonal issues, a history of depression, and those over the age of 65.
Melatonin can interact with many medications. It decreases the effects of desipramine, fluoxetine, clonidine, methoxamine, steroids, and immunosuppressants so they are less effective. Calcium channel blockers, beta blockers, NSAIDs, caffeine, tobacco, and alcohol lower melatonin levels, making melatonin less effective. Birth control pills may increase the amount of melatonin that your body naturally makes, so taking a melatonin supplement may cause unhealthy levels in the system. Melanin increases the bleeding risk in people who are on anticoagulant therapy. Melatonin may also improve patient response to tamoxifen, interleukin-2, and triazolam.
Probiotics have not been approved by the FDA for any medical use; however, their usage is common. People usually use it for vaginal infections and bowel issues like diarrhea, constipation, IBS, Crohn’s disease, and ulcerative colitis. It can also be used immune system enhancement, lowering the risk of pollen allergies, reducing the risk of childhood eczema, and high cholesterol.
A recent study done in China has shown that probiotics can reverse Langerhans cell histiocytosis and alcoholic hepatic stenosis and injury in rats. Previous studies have shown that alcoholic liver disease is closely related to the alterations that alcohol induce in the microbial flora of the gut. Using this knowledge, the researchers investigated the use of probiotics to provide a more favorable environment is the gut and they were successful in find a link. The improvement seems to be related to a reduction in circulating lipopolysaccharide and improvement of the intestinal barrier function. This study also showed that probiotics had a beneficial role in regulating hypoxia-inducible-factor, a gene that, when overexpressed and dysregulated, is strongly linked to cancer of the colon, breast, pancreas, prostate, kidneys, stomach, brain, and bladder. This seems to point to the use of probiotics for cancer prevention; however, this study was done on rats and human trials have not been done. On the other hand, the cancer prevention potential is exciting(Li, Duan, Wang, McClain, & Feng, 2016).
It is generally recommended that probiotics are ingested through natural means like yogurt with live cultures, but it can be taken as a supplement or vaginal suppository. Some supplements require refrigeration; others do not. Probiotics feed on the prebiotics, carbohydrates that the body cannot break down, which provides them with the nutrients that the bacteria need to establish a firm colony in the body; therefore, t is recommended that prebiotics are ingested concurrently. Sources of prebiotics include breast milk, onions, tomatoes, honey, garlic, wheat, and barley.
Under the age of one, babies get probiotics from breast milk. For formula fed infants of this age, it is recommended that a pediatrician be consulted concerning route and dose. In adult, doses are different depending on the health goal. Additionally, dose ranges drastically depending on the source. Anywhere from 1-15 billion colony forming units (CFUs) per day is appropriate. The accepted supplement dose is 250-500 mg orally 2-4 times daily. Each person’s flora is different, hence the ideal dose can vary drastically from person to person. Diarrhea or bloating are the only established side effect in those with normally functioning immune systems. If this occurs, you do not need to stop taking them and this is not a sign of intolerance, but the dose is too high.
Contraindications may exist for people with immune deficiencies so, for them, probiotics should only be taken under physician supervision.
Probiotics interact with sulfasalazine by increasing its metabolism. Probiotics also interfere with antibiotics, which kill probiotics. Antibiotics should be taken at least 2 hours from probiotics, before or after.
Melatonin, in its oral form, has many uses, the most common being insomnia and jet lag. It is also used for heart disease, symptoms of menopause, benzodiazepine withdrawal in the elderly, breast and prostate cancer prevention and treatment, fibromyalgia, IBS, epilepsy, pulmonary sarcoidosis, and to increase chances of pregnancy in women with polycystic ovarian syndrome. Topical melatonin is used to prevent and treat sunburn.
In a study done by the National Natural Science Foundation of China, melatonin was given to severely burnt rats with less than 60% kidney function. After administration, glomerular filtration rate was drastically improved and creatinine and BUN levels dropped. It also reduced inflammatory response by inhibiting inflammatory cytokines and increasing the action of inflammation reducing cytokines. In their study they concluded that melatonin activates sirtuin 1, a nicotinamide adenosine dinucleotide dependent deacetylase that regulates hepatic lipid homeostasis, which has a protective and therapeutic effect on the kidneys. They believe this serves as evidence that melatonin has the potential to improve renal function and prevent acute kidney injury in burn victims (Bai et al., 2016).
For insomnia and jet lag, 0.5-5 mg 1 hour prior to bedtime is the recommended dose. For other indications, there are no widespread recommended dosage amounts for melatonin. The doctor decides on the dosage based on the individual needs of the patient, usually as a part of multimodal treatment.
Side effects of melatonin may include vivid dreams or nightmares and a hangover effect. A lower dose can prevent this.
Melatonin is contraindicated in pregnant women. It should be used only under physician supervision in those with hormonal issues, a history of depression, and those over the age of 65.
Melatonin can interact with many medications. It decreases the effects of desipramine, fluoxetine, clonidine, methoxamine, steroids, and immunosuppressants so they are less effective. Calcium channel blockers, beta blockers, NSAIDs, caffeine, tobacco, and alcohol lower melatonin levels, making melatonin less effective. Birth control pills may increase the amount of melatonin that your body naturally makes, so taking a melatonin supplement may cause unhealthy levels in the system. Melanin increases the bleeding risk in people who are on anticoagulant therapy. Melatonin may also improve patient response to tamoxifen, interleukin-2, and triazolam.
References
Bai, X., He, T., Gao, J., Liu, Y., Liu, J., Han, S., … Hu, D. (2016). Melatonin prevents acute kidney injury in severely burned rats via the activation of SIRT1. Scientific Reports, 6, 32199. doi:10.1038/srep32199
Ehrlich, S. (2015, August 6). Lactobacillus acidophilus | University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/lactobacillus-acidophilus
Ehrlich, S. (2016, February 3). Melatonin | University of Maryland Medical Center. Retrieved from http://umm.edu/health/medical/altmed/supplement/melatonin
Grodner, M., Roth, S. L., Walkingshaw, B. C., &Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (2nd ed.). St. Louis, MO: Mosby/Elsevier.
Li, F., Duan, K., Wang, C., McClain, C., & Feng, W. (2016). Probiotics and alcoholic liver disease: Treatment and potential mechanisms. Gastroenterology Research and Practice, 2016(5491465), 11. doi:10.1155/2016/5491465
Vallerand, A. H., Sanoski, C. A., &Deglin, J. H. (2014). Davis's drug guide for nurses (14th ed.). Salt Lake City, UT: F.A. Davis Company.
Discuss the psychological, sociological, economical, and cultural implications of food on nutritional status.
I decided to look at the countries with the highest rates of fish consumption, since that is a major source of Omega-3 fatty acids, and compare it to heart disease rates. It is true that the countries with the highest fish intake in the world also have the lowest rates of heart disease in the world. This means that the cultural implications of being raised in a culture with high fish consumption can be nutritionally beneficial for those people.
For instance, South Korea is the 6th highest consumer of fish in the world, and they have the lowest rate of heart disease in the world. Other countries, like Spain, Italy, and Japan, also rank in the 10 highest consumers of fish and the 10 lowest rates of heart disease. This would serve as evidence that Omega-3 fatty acids are very beneficial for the heart.
However, there are also countries, like France and Luxembourg,that do not have extremely high levels of fish intake that are also among the lowest rates of heart disease in the world. In fact, France is the lowest, second to South Korea. Dr. Peter Attia believes that this is because having very low intake of Omega-6 (mostly from plant oils), low amounts of artificial sugar, and lower consumption of carbohydrates can be just as beneficial as Omega-3 fatty acids. But if you do consume high levels of Omega-6, high amounts of Omega-3 will combat the negative effects.
References
Attia, P. (2016, April 18). How do some cultures stay lean while still consuming high amounts of carbohydrates? - The Eating Academy | Peter Attia, M.D. The Eating Academy | Peter Attia, M.D. Retrieved from http://eatingacademy.com/nutrition/how-do-some-cultures-stay-lean-while-still-consuming-high-amounts-of-carbohydrates
Grodner, M., Roth, S. L., Walkingshaw, B. C., &Grodner, M. (2012). Nutritional foundations and clinical applications: A nursing approach (2nd ed.). St. Louis, MO: Mosby/Elsevier.
Kvrgic, D. (2015, May 29). 11 Countries That Consume the Most Fish. Retrieved from http://www.insidermonkey.com/blog/11-countries-that-consume-the-most-fish-350130/
World Health Organization. (2014). CORONARY HEART DISEASE DEATH RATE BY COUNTRY. Retrieved from http://www.worldlifeexpectancy.com/cause-of-death/coronary-heart-disease/by-country/ [Show Less]