Dietary Supplements

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					Dietary Supplements

   Dr Claire Shields
      May 2008
    Tayside GPR
•   Lethargy
•   Paronychia
•   Susceptibility to infections
•   Impaired taste and smell
               Zinc Deficiency
• Anorexia, lethargy,     • Immune disorders and
  diarrhoea                 susceptibility to infections
• Alopecia, dermatitis,   • iron deficiency anaemia
  paronychia              • macular degeneration,
• mental retardation        night blindness
• impaired nerve          • Impared taste and smell
  conduction and nerve    • impaired wound healing
  damage                  • Growth retardation,
• hepatomegaly              delayed sexual
                            maturation, hypospermia
    Risk factors for Zinc deficiency:
•   Burns/trauma
•   liver disease
•   Inadequate diet/malabsorption
•   Prolonged parenteral nutrition

Ix – difficult to confirm diagnosis
Mx – tx underlying cause + zinc supp
• Dermatitis
• Diarrhoea
• Dementia
                    Pellagra
• Vit B3/niacin
  deficiency
• Dermatitis
  (dermnetnz.org)
                 Pellagra
• Diarrhoea 50% of cases, abd pain,
  nausea, vomiting, poor appetite
• Neuro features – initially apathy and slight
  depression, confusion, psychosis,
  comatose

Tx – Vitamin B, tx underlying cause
• Gingivitis
• Fatigue and
  weakness
• Aching imbs
• Anaemia
• Rash on shins
  (perifollicular
  hyperkeratotic
  papules)
                 Scurvy
• Vit C/ascorbic acid deficiency
• Vulnerable groups – alcoholics, elderly,
  fad dieters, dialysis patient’s,
  IBD/malabsorption disorders, severe
  dyspepsia
• Tx: Vit C supplements
• Echinacea – prevention and tx of common cold
• Garlic – red cholesterol, antithrombotic
  /fibrinolytic effects
• Ginger – reduces nausea
• Soya – reduces menopausal symptoms
• St John’S Wort – depressive illness
• Glucosamine – reduce pain and sx of OA
• VitC/Zinc – reduce duration of cold
• Vit E – to prevent cardiovascular disease
• 10-20% of UK population take some sort
  of supplement
• Antioxidants marketed as healthy anti-
  aging products, but what is the evidence
  for this?
     “Mortality in Randomized Trials of
  Antioxidant Supplements of Primary and
Secondary Prevention” – Systematic Review
   and Metanalysis by G. Bjelakovic et al.
          JAMA 2007;297:842-857
•   815 clinical trial identified, 47 included
•   Adults
•   Vitamin A,C,E, betacarotene or selenium
•   Vitamin A increased risk of mortality by
    16%, betacarotene by 7%, Vitamin E by
    4%.
      Cochrane Review, 2008
• 67 studies (>230,000 participants) from Europe,
  N America, S America, Asia, Australia
• Adults, mean age: 62yrs
• 21 studies – healthy participants
• 46 studies – pre-existing disease
• Vit A,C,E, betacarotene and selenium alone or in
  combination (all doses and all durations of tx)
  versus placebo or no intervention
• Sole outcome measure was all cause mortality
             Conclusions
• No evidence that antioxidants reduce
  mortality
• Vitamins A, E and betacarotene
  significantly increase mortality
• No evidence Vit C increases longevity
            Further studies
• Selenium and Vit C
• Look at “natural” antioxidants
• Tertiary prevention in specific diseases
Mother in law = very nice lady!

				
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