1. Jennifer Barrickman, PhD Student Walden University PUBH 8165-10 Instructor: Howard Rubin, PhD Winter, 2010

2. Definition Background Issues Tools Objectives

3. Background Miller, M.F., Bellizzi, K.M., Sufian, M., Ambs, A.H., Goldstein, M.S., &Ballard-Barbash, R. (2008). Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. Journal of the American Dietary Association, 108(3), 483-494.

4. Definition National Center for Complementary and Alternative Medicine [NCCAM]. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

5. Regulation FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what NCCAM. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD. Good Manufacturing Practices (FDA, 2009) CAC Draft Guidelines Adopted (FDA, 2009) Dietary Supplement Health and Education Act of 1994 (NCCAM, 2009) Codex Alimentarius Commission (CAC) (FDA, 2009) 1963199420052008-2010

6. The Market $23.7 billion industry (Gorski, 2008) Approximately 80% use supplements (Werneke et al., 2004) Consumer Healthcare Product Association. (2010). Dietary supplement facts and figures. Retrieved January 24, 2010, from http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx Gorski, D. (2008). The Dietary Supplement Safety Act of 2010: A long overdue correction to the DSHEA of 1994. Retrieved January 16, 2011, from http://www.sciencebasedmedicine.org/?p=3772http://www.sciencebasedmedicine.org/?p=3772 Werneke, U., Earl, J., Seydel, C., Horn, O., Crichton, P., & Fannon, D. (2004). Potential health risks of complementary alternative medicines in cancer patients. British Journal of Cancer, 90, 408-413.

7. Issues General Public Health Cancer Patients American Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdfhttp://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf

8. FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/ Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78. NCCAM. (2010). Herbs at a glance: Ephedra. Retrieved February 5, 2011, from http://nccam.nih.gov/health/ephedra/#cautions.http://nccam.nih.gov/health/ephedra/#cautions van der Voet, G. B., Sarafanov, A., Todorov, T. I., Centeno, J. A., Jonas, W. B., Ives, J. A., & Mullick, F. G. (2008). Clinical and analytical toxicology of dietary supplements: A case study and a review of the literature. Biology Trace Element Research. 125, 1-12. doi: 10.1007/s12011-008-8157-0 Increased Risk Contamination (van der Voet, 2008) Variable potency (Gardiner, 2008) Lack of regulation No pre-marketing approval required for dietary supplements Manufacturer self-monitoring (FDA, 2010) Impact of Weak Regulation

9. Risks Natural ≠ safe (NCCAM, 2009) Examples of interactions FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what National Library of Medicine. (2010). Dietary supplements labels database. Retrieved January 18, 2011, from http://dietarysupplements.nlm.nih.gov/dietary/

10. Potential Adverse Effects SupplementWarning St. John’s WortCan interfere with many medications GinkgoIncreased bleeding risk MistletoeSafety during cancer treatment unknown; should only be used in clinical trial Black CohoshHepatitis, liver failure, possibly contraindicated for hormone-sensitive conditions AstragalusMay interact with immune suppressors, affects blood sugar and blood pressure NCCAM. (2011). Herbs at a glance. Retrieved February 5, 2011, from http://nccam.nih.gov/health/herbsataglance.htm

11. False claims Office of Dietary Supplements. (n.d.). Dietary Supplements: Background information. Retrieved January 15, 2011, from http://ods.od.nih.gov/factsheets/dietarysupplements/ Oh, V. (1998). The powerful placebo: From ancient priest to modern physician/complementary medicine: A research perspective. British Medical Journal. 316, 1397.

12. Lack of Dialogue Awareness Embarrassment Reliable information Time Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78.

13. Progress American Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf U.S. Pharmacopeia. (2011). About USP. Retrieved January 17, 2011, from http://www.usp.org/aboutUSP/ Safer supplements National Formulary United States Pharmacopeia (USP, 2011) Dietary Supplement Safety Act (ACS, 2010)

14. Tools “Time to Talk” RSS feed Education Support groups Mentors Valid websites FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/ National Center for Complementary and Alternative Medicine. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD.

15. Call to Action Talk Listen Use tools

16. References American Cancer Society. (2010). Dietary supplements: How to know what is safe. Retrieved January 17, 2011, from http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf http://www.cancer.org/acs/groups/cid/documents/webcontent/002385-pdf.pdf Consumer Healthcare Product Association. (2010). Dietary supplement facts and figures. Retrieved January 24, 2010, from http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx http://www.chpa-info.org/pressroom/DS_ FactsFigures.aspx FDA. (2009). Overview of dietary supplements. Retrieved January 20, 2010, from http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ ucm110417.htm#what FDA. (2010). Dietary supplements. Retrieved January 15, 2010, from http://www.fda.gov/Food/DietarySupplements/ Gardiner, P., Phillips, R., & Shaughnessy, A. P. (2008). Herbal and dietary supplement-drug interactions in patients with chronic illness. American Family Physician, 77 (1), 73-78. Gorski, D. (2008). The Dietary Supplement Safety Act of 2010: A long overdue correction to the DSHEA of 1994. Retrieved January 16, 2011, from http://www.sciencebasedmedicine.org/?p=3772http://www.sciencebasedmedicine.org/?p=3772 Miejerman, I., Beijnan, J. H., Schellens, J. H. M. (2006). Herb-drug interactions in oncology: Focus on mechanisms of induction. The Oncologist, 11(7), 742-752.. Retrieved January 18, 2011, from http://theoncologist.alphamedpress.org/cgi/content/full/11/7/742 http://theoncologist.alphamedpress.org/cgi/content/full/11/7/742 Miller, M.F., Bellizzi, K.M., Sufian, M., Ambs, A.H., Goldstein, M.S., &Ballard-Barbash, R. (2008). Dietary supplement use in individuals living with cancer and other chronic conditions: a population-based study. Journal of the American Dietary Association, 108(3), 483-494.

17. National Center for Complementary and Alternative Medicine. (2009). Using dietary supplements wisely. (NCCAM Publication No. D426). Bethesda, MD. National Institutes of Health, Office of Dietary Supplements. (2010). About dietary supplements. Retrieved from http://dietary- supplements.info.nih.gov/pubs/ partnersbrochure.asp National Library of Medicine. (2010). Dietary supplements labels database. Retrieved January 18, 2011, from http://dietarysupplements.nlm.nih.gov/dietary/ http://dietarysupplements.nlm.nih.gov/dietary/ Office of Dietary Supplements. (n.d.). Dietary Supplements: Background information. Retrieved January 15, 2011, from http://ods.od.nih.gov/factsheets/dietarysupplements/ http://ods.od.nih.gov/factsheets/dietarysupplements/ Oh, V. (1998). The powerful placebo: From ancient priest to modern physician/complementary medicine: A research perspective. British Medical Journal. 316, 1397. U.S. Pharmacopeia. (2011). About USP. Retrieved January 17, 2011, from http://www.usp.org/aboutUSP/http://www.usp.org/aboutUSP/ van der Voet, G. B., Sarafanov, A., Todorov, T. I., Centeno, J. A., Jonas, W. B., Ives, J. A., & Mullick, F. G. (2008). Clinical and analytical toxicology of dietary supplements: A case study and a review of the literature. Biology Trace Element Research. 125, 1-12. doi: 10.1007/s12011-008-8157-0 Werneke, U., Earl, J., Seydel, C., Horn, O., Crichton, P., & Fannon, D. (2004). Potential health risks of complementary alternative medicines in cancer patients. British Journal of Cancer, 90, 408-413. References (cont.)

18. For Further Information… http://nccam.nih.gov/timetotalk/ http://www.fda.gov/food/dietarysupplements/default.htm http://www.cancer.gov/ncicancerbulletin/081109/page6 http://dietarysupplements.nlm.nih.gov/dietary/ http://www.fda.gov/Food/DietarySupplements/Alerts/default.htm www.nci.gov www.cancer.org www.asco.org http://www.fda.gov/AboutFDA/ContactFDA/StayInformed/RSSFeeds/TDS/rs s.xml