[NPInfo] Re: "something natural"
Tracy Klein
whcnp at yahoo.com
Wed Aug 20 11:33:39 PDT 2008
I agree with Stephanie up to a point. A drug is a drug is a drug.
If patients want to do something "natural" for their cholesterol, I would advise
them to do diet, exercise, fiber, and fish oil.
Beyond that, I would consider referring to a naturopath if they want to clinically manage their health with supplements and herbs. I dont have the expertise to monitor things when I don't know what is in them.
As for reliable resources for vitamins etc. I like www.vitacost.com.
As a patient I will have the pleasure of exploring all these issues on a personal level once my HDL starts to fail me. Since my mother is permanently disabled from statin use due to rhabdomylosis I've been reading some pretty compelling evidence (genomics) why statins are not the best choice for everyone. I serve on the state's evidence based prescription drug plan committee and review all of the literature in depth in my role. The backing to now put patients on double and triple the recommended doses of statins and to start kids on statins has no support in long term clinical trials and uses surrogate markers for measurement of efficacy.
If that doesnt concern you, it should.
Tracy Klein, RN, FNP
Portland, Oregon
--- On Wed, 8/20/08, npinfo-request at nurse.net <npinfo-request at nurse.net> wrote:
From: npinfo-request at nurse.net <npinfo-request at nurse.net>
Subject: NPInfo Digest, Vol 29, Issue 44
To: npinfo at nurse.net
Date: Wednesday, August 20, 2008, 12:00 PM
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Today's Topics:
1. RE: Natural cholesterol lowering (Joseph Reis)
2. RE: Iron Deficiency Anemia (Smith, Melissa)
----------------------------------------------------------------------
Message: 1
Date: Wed, 20 Aug 2008 14:34:29 +0000
From: Joseph Reis <mastrlock at hotmail.com>
Subject: RE: [NPInfo] Natural cholesterol lowering
To: NP Info <npinfo at nurse.net>
Message-ID: <BAY109-W33ED80537957EE9E6C9F0FBD680 at phx.gbl>
Content-Type: text/plain; charset="iso-8859-1"
Well, this opened abit of a can of worms. Maybe one of our more homeopathic
NPS or PAs could provide a list of reliable sources for supplements they use?
Love the info on Red rice yeast. It has been very helpful!
Joe
> Date: Wed, 20 Aug 2008 10:28:26 -0400
> From: stephanie2u at optonline.net
> Subject: Re: [NPInfo] Natural cholesterol lowering
> To: npinfo at nurse.net
>
> Red yeast rice IS a drug. I think patients need to understand that.
> Even if they don't want to believe it the first time they're told,
I
> think repetition is worthwhile. If something has a pharmacologic
> effect in your body it is by definition a drug. And the reason people
> take stuff from the health food store is for its pharmacologic
> effect. Otherwise, why bother?
>
> I think people buy & use red yeast rice either in the mistaken belief
> that it is not a drug; or because they don't want to have to go to a
> licensed prescriber for a Rx and it's more convenient or they feel
> more independent of the prescriber if they can do as they please,
> when they want and at the dose and frequency they want--a control
> thing. The cost is certainly not a factor because all those
> supplements tend to be outrageously marked up.
>
> People may disagree with me, but I think as professionals, we know
> better and should be encouraging patients to use Rx statins which
> have had to satisfy FDA requirements for safety and efficacy.
>
> As for the supposed "multifacted properties" I would be able to
put
> some reliance in that theory if there were some scientific proof
> besides a idea expressed in a 20 year old publication I've never
> heard of. We have a responsibility to our patients to give them
> reliable information.
>
> Stephanie Walker, FNP
>
>
> On Aug 19, 2008, at 8:49 PM, ROBERT DOERFLER wrote:
>
> > Red rice yeast is Monascus purpureus, is a fungus that has been
> > used in
> > Chinese medicine for about 1000 years. It contains a number of
> > "monacolins",
> > including Monacolin K and others. Monacolin A has activity against
> > HMG CoA
> > after it is hydrolyzed to mevinic acid--registered with the FDA as
> > "lovastatin"--and was originally marketed as
"Mevacor" in the U.S.
> >
> > I located many warnings about potential side effects similar to the
> > statins,
> > but in my (very quick) survey only one RCT (n=446) which tested a
> > verified
> > RRY product against a "positive control" (standard of care)
in China
> > (another herbal preparation). The Positive control lowered
> > cholesterol by
> > 8%, TGs by 12%. RRY performed well: HDL up by 19%, LDL down by 31%,
> > TC by
> > 22%. The only side effects were flatulence, heratburn and dizziness
> > in some
> > participants. (Wang, et al. Curr Ther Res. 1997. 58;12: 964-978)
> >
> > There was one case of rhabdomyolysis, while a kidney transplant pt.
> > used RRY
> > while on cyclosporine. It is believed that, like the statins, the
> > RRY may
> > have been poorly metabolized by the CYP450 system, also a metabolic
> > substrate for cyclosporine. The pt. recovered when the RRY was
> > stopped.
> > (Ramesh Prasad, et al. Transplantation. 2002. 74;8:1200-1201. This
> > was the
> > only potential myositis-related reference to RRY use I located.
> >
> > Weil discusses the multifacted properties of herbs in Health &
> > Healing (Rev.
> > Ed. 1988) and offers that compound natural products may contain
> > principles
> > that balance out the negative aspects of other principles. It has
been
> > hypothesized that this is why St. John's wort doesn't cause
> > significant side
> > effects in most users, despite the fact that some of its components
> > act as
> > MAO inhibitors, for example. The 10 known monacolins, as well as
> > lignins,
> > and other substances in RRY may act the same way, as
"buffers" or
> > in ways
> > not yet known.
> >
> > That herbal/natural products are loosely regulated in the U.S. does
> > pose a
> > problem. Heber and colleages examined 9 commercially available
> > compounds.
> > Only 1 contained the full complement of 10 monacolins, and 7/9
> > contained
> > measureable concentrations of citrinin (an undesired product of the
> > frementation process). Monacolins varied from 0.0% to 0.58% w/w. (J
> > Alt.
> > Comp. Med. 2001. 7;2:133-139.) Cholestin3, the product used in the
> > study by
> > Wang's team above, contains 0.4% w/w and is standardized, which
> > prompted the
> > FDA in 1998 to declare Cholestin3 a drug and not a supplement. I
> > recall that
> > litigation related to this found in favor of the manufacturer--the
> > product
> > hadn't caused any known injuries or deaths. But I can't cite
that,
> > just
> > recall it from another short piece I read somewhere.
> >
> > I have used RRY in a significant number of patients; casual
> > observation
> > suggests that they do well without side effects and lipid lowering
> > is about
> > what I'd expect with a statin. In truth, most of my patients are
> > drug-averse, and so while I am confortable with statins, I also see
no
> > reason to be bugging them to "do it our way" as it were. I
have become
> > increasingly uncomfortable with the quality of products in health
food
> > stores, but am also averse to being in the supplement business,
> > mainly for
> > ethical reasons. For the moment, I am warning patients about
> > studies such as
> > the one by David Heber, and offering to get them professional-grade
> > supplements if they chose to spend the additional money (e.g.,
> > Integrative
> > Therapeutics, Douglas Labs, Thorne Research, Physiologics, etc.)
> > Supplements
> > are assayed and the assays are available for review for various
> > batches.
> >
> > Some spend the money, others don't. I haven't yet seen any
correlation
> > between who buys their stuff at the local store versus who buys
> > from a pro
> > outfit, but it's a small number of folks, since I practice 1 day
a
> > week now.
> > There are other references, including a trial that David Heber's
> > team did,
> > at Sloan-Kettering's site
(http://www.mskcc.org/mskcc/html/69352.cfm).
> >
> > Hope that's helpful.
> >
> > Eric
> >
> > R. Eric Doerfler, CRNP, PhD(c), CCH
> > Instructor Of Nursing
> > RN-BS Program Coordinator
> > Penn State University, Capital Campus
> > 777 W. Middletown Pike, Middletown PA 17057
> > 717-948-6513 red1012 at psu.edu
> >
> > Certified in Adult Primary Care & Classical Homeopathy
> > 1521 Cedar Cliff Drive, Suite 203
> > Camp Hill PA 17011
> > 717-761-6902
> > http://www.altmedresearch.us
> >
> >
> >
> > -----Original Message-----
> > From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
> > Behalf
> > Of Margienp at aol.com
> > Sent: Tuesday, August 19, 2008 10:07 AM
> > To: npinfo at nurse.net
> > Subject: Re: [NPInfo] Natural cholesterol lowering
> >
> >
> >
> > Yes but remember that red rice yeast can cause the same side
> > effects as,
> > the statins. Muscle aches etc.
> >
> >
> > In a message dated 8/18/2008 1:56:57 P.M. Eastern Daylight Time,
> > mastrlock at hotmail.com writes:
> >
> >
> > Can I get some natural remedies for lowering total cholesterol. I
> > work in
> > psych but have a pt that is into holistic medicine and wants info
> > on this
> > topic. Thanks in advance.
> >
> > Joe
> >
> > _________________________________________________________________
> > Talk to your Yahoo! Friends via Windows Live Messenger. Find out
> > how.
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> > ocid=TXT_TAGLM_WL_messenger_yah
> > oo
> > _082008_______________________________________________
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Message: 2
Date: Wed, 20 Aug 2008 11:46:19 -0500
From: "Smith, Melissa" <SmithMS at umkc.edu>
Subject: RE: [NPInfo] Iron Deficiency Anemia
To: "NP Info" <npinfo at nurse.net>
Message-ID:
<CAC3DE106D67B040951B7D273FA882010ACDF477 at KC-MSX4.kc.umkc.edu>
Content-Type: text/plain; charset="US-ASCII"
Thanks for the references. I was an ice craver until I was tested for
and found to be IDA. Once that corrected I no longer crave the ice.
Made my friends and family happy as they found the constant crunching
annoying.
Melissa
-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
Behalf Of Priscilla Merrill
Sent: Wednesday, August 20, 2008 4:28 AM
To: 'NP Info'
Subject: RE: [NPInfo] Iron Deficiency Anemia
You got my curiosity up so I googled it and here are some links.
Made me wonder if Vanilla Ice was anemic since he's so darn pale!
Bottom line, no one knows, just theories. I thoguth it might be the
iron in
the pipes but then water shoud also be a craving. The best answer I saw
was
that it has oxygen in it from the freezing process. Here are some
ideas.
http://www.mayoclinic.com/health/chewing-ice/AN01278
http://www.kevinmd.com/blog/2004/11/i-eat-lot-of-ice.html
http://answers.yahoo.com/question/index?qid=20060616173903AAE8Jhc
Priscilla Merrill FNP
-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On
Behalf
Of Kimberly Coleman
Sent: Tuesday, August 19, 2008 9:56 PM
To: NP Info
Subject: [NPInfo] Iron Deficiency Anemia
I was curious if anyone could tell me WHY? patients with iron deficiency
anemia crave ice. I know it's a form of PICA and can only find general
information. A pt. with low H&H (10, 30), low B12 (207), low ferritin
(7),
norm. TSH. The MD didn't want to do a TIBC (it wasn't needed right
now).
There is no hx. of abn. bleeding, had TAH >10yrs. C/O "eating a lot of
ice",
extreme fatigue/weakness and "a lot of joint pain and feels like muscles
are
drawing and stumbling". Going to be scheduling upper/lower scopes. Any
suggestions on the joint pain and stumbling, and what does ice have to
do
with it? As I said, I have heard of it, know it exists, but don't know
exactly why. Thanks. KC
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