1. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Robert Grimshaw, MD FACP A Lifetime of Quality Care That’s Convenient & Complete

2. Dietary Supplements (Part 2) Continuing our series on popular supplements, from the American College of Physicians meeting and other sources. Remember, purity and potency are not guaranteed under American law because these are considered foods. I don’t recommend any supplements without careful thought and consultation.

3. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Saw Palmetto: (Serenoa repens) The berry of the scrubby palm found from Texas to Florida. Its main use is for benign prostate enlargement, in a dose of 160 mg twice daily. Evidence of effectiveness is fair with open label (patients and doctors knew who was getting what) studies showing reduction in urinary symptoms for up to 3 years. Side effects include rare stomach upset and less impotence than finasteride (Proscar). It appears to work by much the same mechanism as that drug: inhibiting the conversion of testosterone to the 5-alpha dihydrotestosterone metabolite. Two cautions: 1) some people use it instead of thyroid hormone replacement (which can make them very sick if they’re hypothyroid); and 2) please get a prostate check (including PSA) BEFORE taking it (so we don’t miss a chance to catch early prostate cancer).

4. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Garlic: (Allium sativum)Garlic in doses of 600-900 mg extract (1800-2700 mg raw garlic) has been touted for blood pressure, clot inhibition and pain relief, and was even used as an antibiotic by the Soviet Army during WWII when penicillin ran out. However, the best evidence of effect is in reducing cholesterol (9-12% drop in total cholesterol in several studies). Side effects are few, but include possible bleeding.

5. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Ginger: (Zingiber officinale) Frequently used for nausea; it’s also used for motion sickness and flu symptoms. The dosage is 940 mg up to 3 times a day; studies have shown modest effects; drugs are more effective. Ginger, however, has few side effects, mostly stomach upset.

6. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Feverfew: (Tanacetum parthenium) Used for migraine. The usual dose is 1 dried leaf. It appears to inhibit the release of the neurotransmitter serotonin by platelets. A 1988 Lancet study showed a 24% reduction in migraines, when feverfew was used for prevention. Side effects are few, including mouth sores if the leaf is chewed. Locally, New York Medical College neuro-ophthalmologist Dr. Scott Forman has tried it for ophthalmic migraine (which affects vision, with no usual headache). And, he told me recently, it's good for many types of migraine. Caution: garlic, ginger and feverfew can all increase the effect of the blood thinner Coumadin and should be avoided by Coumadin patients. They also should not be used for 2 weeks before any elective surgery.

7. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Echinacea: (Echinacea purpurea, E. Pallida, E. angustifolia) Used for cold and flu symptoms. Dose is up to nine, 300-400 mg capsules a day. Evidence of effectiveness is weak, partially because of trouble making a reliable extract and the “bite” that it has, which makes placebo trials difficult. Side effects include allergic reactions (especially in those known to be allergic to ragweed or daisies), at least one death due to a lupus flare, and possible reactions in those with HIV, multiple sclerosis and tuberculosis.

8. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Goldenseal: (Hydrastis canadensis) Root and rhizome is used for diarrhea and upper respiratory infections. Dose is up to six 500-600 mg capsules. Large doses can cause skin ulceration, uterine contractions, stomach upset, hypertension and seizures. Clinical evidence of effect is scant.

9. A Lifetime of Quality Care That’s Convenient & Complete Dietary Supplements (Part 2) Dong Quai: (Angelica senensis) Used for sleep, a laxative and as an estrogen supplement. The dose is 1.5 grams 3 times a day. There are few adverse effects and little evidence of any beneficial effect.