Physician Knowledge e-Newsletter - V 3(2) June 2006

Physician Knowledge e-Newsletter - V 3(2) June 2006

Below you will find information related to the Knowledge Based Systems at MGHS
(Please note you must be connected to the MGHS Network to gain access to these systems)

You can now get the newest Natural Medicines CE course Natural Medicines in the Clinical Management of Chronic Fatigue Syndrome.*
You can also use any of the many prior courses on many other conditions. All are accredited for physicians, pharmacists, NPs, PAs, CNMs, and RDs.

We continue to make updates to Natural Medicines Comprehensive Database every business day. Here are a few of special interest to you.

• Saw palmetto is now being questioned as an effective treatment for benign prostatic hyperplasia (BPH)...due to a surprising New England Journal of Medicine study that says saw palmetto is ineffective for moderate to severe symptoms. The study was high-quality and evaluated more patients than most previous studies. There are always questions about product quality. This study is no exception. But compared to older studies, this one appears to be more rigorous and the results seem to be valid. So why did this study have negative results and over 20 other studies were positive? Good question. No one knows for sure, but scenarios like this are common in clinical research. For now, advise patients that the evidence for saw palmetto is conflicting. Tell them that saw palmetto seems to produce modest symptom improvement for some patients.

• Soy is getting a negative review from the American Heart Association. They now say that soy protein and isoflavone extracts offer little to no benefit for preventing heart disease, osteoporosis, or menopausal symptoms. It's true that there has been some conflicting evidence about the effectiveness of soy for these conditions. But most evidence suggests that soy protein can modestly decrease total and low-density lipoprotein cholesterol. Most evidence also suggests that soy protein can modestly reduce menopausal hot flashes and slow bone mineral density loss in postmenopausal women. Take the American Heart Association findings with a grain of salt. The authors failed to describe how they selected trials for inclusion in their review...and as a result, several studies seem to have been left out. Explain to patients that soy isn't a miracle food. But it might help some patients if it replaces other protein sources in their diet.

• Fish oil was recently reviewed for its effect against cancer. This review was big in the news, but the findings aren't very reliable. The researchers tried to combine studies of omega-3 fatty acids from both plants and fish...and from both dietary and supplemental intake. This is a case of one study trying to do way too much. The study populations and treatments were so different in the different studies evaluated that it was impossible to pool the data for analysis. Explain to patients that there never was much evidence to support using fish oil supplements for preventing cancer. Tell patients that eating 1-2 servings of fatty fish per week is a good idea for most people...even if it doesn't reduce the risk of cancer.

• Activia is a new yogurt promoted for bowel regularity. The manufacturer, Dannon, says that it "...helps naturally regulate your digestive system." It contains a probiotic that the company calls "Bifidus regularis." But this is really a strain of "Bifidobacterium animalis." There is some evidence that this strain can survive passage through the GI tract...and this could be important to any potential beneficial effect. Some evidence also suggests that eating Activia can decrease colonic transit time. This suggests that it could be beneficial for reducing constipation. But so far, there is no reliable evidence that it works for preventing constipation...or that it is any more effective than other probiotic-containing yogurts. Tell patients that there isn't enough evidence to recommend Activia over other yogurts...but Activia is probably a good choice for patients who want a yogurt with live and active cultures

You can now get the newest Natural Medicines CE course Natural Medicines in the Clinical Management of Eye Disorders.*

• Black cohosh is under scrutiny due to several case reports of liver damage. In some cases, patients have required a liver transplant. The Australian Therapeutic Goods Administration now requires black cohosh products to carry a warning label that indicates the risk of liver damage. Some experts say Australia's action is an overreaction. In most reports, liver damage has been linked to products that contain black cohosh PLUS other ingredients. These products were not analyzed to determine if there was any contamination from adulterants. Based on the existing reports, it is not possible to determine if black cohosh is the actual cause of liver damage. For now, explain to patients that there have been some reports of liver damage. If they choose to take black cohosh, alert them to watch for symptoms of liver toxicity such as unexplained fatigue, abdominal pain, dark urine, or jaundice. Also encourage them to tell you or their primary physician so periodic liver tests might be monitored.

• Green tea extract is now also linked to at least seven cases of liver damage. It's too soon to know for sure if the green tea is the CAUSE of the liver damage. The problem could relate to the particular extraction method used, potential contaminants, or other unknown factors. Keep in mind that this does NOT pertain to green tea BEVERAGES...only the concentrated green tea extracts. For patients who want to take green tea, suggest that they drink green tea beverages rather than take a green tea extract supplement.

• Red Bull and similar energy drinks are immensely popular. Over 2 billion cans of Red Bull are consumed each year. The numbers are growing, especially in North America. But people often do not realize what they are ingesting. A can of Red Bull contains about 80 mg of caffeine along with taurine and other ingredients. Caffeine is thought to potentially exacerbate mania. In fact, a 36-year-old man with well-controlled bipolar disorder experienced mania after consuming multiple cans of Red Bull over 4 days. Advise patients with bipolar to consume heavily caffeinated beverages such as Red Bull only in moderation...or not at all.

Have you noticed the new look at naturaldatabase.com? It's more than a cosmetic makeover. You also get a new supercharged search feature. This means you get MORE answers...and you get them faster and easier.
Type in a natural product name - you get matching products PLUS quick links to conditions that the product is used for and potential interactions with drugs.
Type in a conventional drug name - you get quick links to natural products that might interact with the drug.
Type in a condition or disease name - you get products that are used for that condition PLUS our Effectiveness ratings.
You'll also get relevant links from any of the disease management series. Visit the site and you'll discover several other enticing enhancements. Let us know how you like them.
Best regards...
Jeff Jellin, Pharm.D., Editor-in-Chief

- ACP Medicine
- ACS Surgery: Principles & Practice
- AHFS Drug Information
- USP DI® Drug Information for the Health Care Professional
- USP DI® Advice for the Patient®
- Infectious Diseases: The Clinician's Guide to Diagnosis, Treatment, and Prevention
- The Review of Natural Products
- The Medical Letter® On Drugs and Therapeutics (1995-2006)

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