Module2 Borkowska Macovei Polkowski Stavropoulos

CUNY School of Public Health
NUTR734 Clinical Nutrition I

Group Module 2
DUE 11.3.2015
Ewelina Borkowska, Paula Macovei, Margaret Polkowski, Maria Stavropoulos
I Definitions (1.0 point each 15 points)
Laparoscopic gastric band: Laparoscopic gastric banding is a weight loss surgery where a band
is placed around the upper portion of the stomach and it creates a small pouch to hold all
consumed food. The band it is placed around the upper part of the stomach limits the amount of
food one can eat by making one feel full after eating very small amounts of food. A person with a
BMI of 40 or more or a person with a BMI of 35 or more, with a serious medical condition is
recommended to have this type of weight loss procedure.1,2
Billroth I: Billroth I is a type of partial gastrectomy that removes up to 75% of the distal
stomach. Billroth I is a gastric surgical procedure where the remnant stomach may be reattached
to the duodenum.3
Billroth II: Billroth II is another type of partial gastrectomy where the remnant stomach may be
reattached to the side of the jejunum during surgery. In Billroth II, the duodenal stump is
preserved which allows bile and pancreatic enzymes to flow into the intestines.4
Roux-en-Y: The Roux-en-Y gastric bypass procedure is when a large portion of the stomach and
duodenum are bypassed. A small pouch is created out of a portion of the stomach and attached
directly to the small intestine. Patients who undergo this surgery are set up for digestion and
absorption complications. The pouch created during this surgery is extremely small and cannot
hold large amounts of food, and because the duodenum is bypassed, fat absorption is decreased.
Vitamin and mineral deficiencies can occur because of a decrease in absorption.5,6
Biliopancreatic diversion: Biliopancreatic diversion is a high-risk, malabsorptive procedure,
which restricts both food intake and absorption of calories and nutrients in the body. Portions of
the stomach are removed and what remains is attached to the lower part of the small intestine,
bypassing the upper part of the small intestine. This procedure helps weight loss to occur because
fewer calories are absorbed.7
Vertical banded gastroplasty: Vertical banded gastroplasty, also known as stomach stapling, is
a gastric procedure that restricts and decreases food intake but does not disrupt the process of
digestion. When undergoing vertical banded gastroplasty, a band and staples are used to create a
pouch along the inner portion of the stomach. The band slows the emptying process, causing one
to feel full for longer periods of time. Recently, this procedure has become unfavorable because
of an increased rate of complications seen in many patients.8,9
Osteoporosis: Osteoporosis is a medical condition in which bones become weak and brittle. The
WHO defines osteoporosis in terms of a decline in bone mineral density. Osteoporosis is a
multifactor disease that occurs when the bone mineral density becomes so low that the body is
unable to withstand ordinary strains done to the body. There are two types of primary
osteoporosis, distinguished by sex, the age at which fractures occur, and the kinds of bone that
are involved. Secondary osteoporosis occurs when an identifiable drug or disease process causes
bone tissue loss.10,11
Rickets: Rickets is a disease apparent in children, involving impaired mineralization of growing
bones. It is caused by deficiency in vitamin D, calcium, and phosphorus. Rickets is characterized
by structural abnormalities of the weight-bearing bones. Treatments for rickets disease include
oral preparations of the vitamin or intake of natural sources rich in the vitamin that is deficient.12
DEXA scan: or dual-energy x-ray absorptiometry scan assesses bone mineral density and it is
and enhanced form of X-ray technology used to measure mineral, fat and boneless lean tissue
compartments.13
Bone Densitometry: is a test similar to an X-ray, which uses tissue absorption of photons to
measure bone mass. It is primarily used to detect osteopenia and osteoporosis.14
Bone Mineral Density (BMD): is a medical term that refers to the amount of mineral matter in
the bones. In a clinical setting, BMD is used as an indicator of osteoporosis and fracture risk.15
Parathyroid Gland: small endocrine glands located in the neck that produces parathyroid
hormone (PTH). PTH regulates the concentrations of calcium in the blood.16
Anaphylaxis: is a severe allergy that may be life threatening, and it is characterized by a drop on
blood pressure and a narrowing of the airways, blocking normal breathing. Other signs and
symptoms may that indicate anaphylaxis are skin rashes, nausea and vomiting.17
Celiac Disease: autoimmune disorder in people genetically predisposed to gluten intolerance.
The disease is characterized by immune attacks to the small intestine that lead to damage on the
villi and intestinal lining causing malabsorption of nutrients. Celiac Disease can be treated by
adoption a gluten-free diet.18
Irritable Bowel Syndrome: a widespread condition that affects the large intestine and it is
characterized by chronically recurring abdominal discomfort and/or pain and altered bowel
habits such as constipation and diarrhea.19
II Dietary Supplements: In a table format, please include purported uses, mechanism of action, adverse reactions or
contraindications, and drug-supplement interaction
Supplement 2027
Aloe
Purported Use
Possibly effective for:
Constipation
Cold sores (HSV)
Itchy rash on skin or
mouth
Psoriasis
Insufficient evidence:
HIV
Sunburn, burns
Skin damage d/t
radiation
Cancer
DM
Dry skin, dandruff
Wound healing
Bitter melon
Diabetes (DM)
Adverse Reactions /
Contraindications
Contains gel that may GI Aloe latex may cause stomach
cause positive changes pain, cramps, diarrhea
in skin condition
Life Stage Avoid in children,
pregnancy and lactation
Contains latex that has Conditions Use with caution in:
laxative effects
DM may cause hypoglycemia,
inflammatory bowel disease aloe
latex acts as irritant
Avoid in: hemorrhoids-exacerbates
condition, pre/post surgery
Other Long term use of aloe latex
may cause kidney problems, blood
in urine, low potassium, muscle
weakness, weight loss, and heart
disturbances
High dose of aloe latex are linked
to kidney failure and may be fatal
(>1g/day)
Mechanism of Action
Drug-Supplement
Interactions
Digoxin: laxative effects of aloe
latex can potassium levels
which side effects of digoxin
Antidiabetes drugs may cause
hypoglycemia
Medications taken by mouth
laxative effects can amount of
medicine absorbed by body
Diuretics laxative effects of
aloe latex can potassium
levels too much
Laxatives can laxative
effects and cause
dehydration/low minerals in
body
Warfarin (Coumadin) laxative
effects of aloe latex can
diarrhea, which can effects of
warfarin and risk of bleeding
Sevoflurane (used during
surgery) may bleeding
during surgical procedures
Contains chemical that Life Stage Avoid in pregnancy and Antidiabetes drugs may cause
acts like insulin to help lactation may cause menstrual
hypoglycemia
reduce blood glucose

levels
Black Cohosh
Carnitine
PMS and painful
menstruation
Breast cancer
Infertility
Labor induction
Osteoporosis
Acne
bleeding
Conditions Use caution with: DM
may cause hypoglycemia
Avoid in: glucose-6-phosphate
dehydrogenase (G6PD) deficiency
may cause anemia, headache,
fever, and coma; pre/post surgery
Other Safety of long-term use (>3
months) is unknown
Contains chemicals
GI Stomach upset, cramping
that may reduce
Life Stage Avoid in: pregnancy and
inflammation and may lactation may risk of
work similar to
miscarriage
serotonin
Conditions Avoid in: breast cancer
and hormone-sensitive conditions
May or effects of
that could be affected by estrogen;
estrogen depending on liver disease; protein S deficiency
which part of the body risk of blood clots
Other Headache, rash, vaginal
spotting/bleeding, weight gain,
may be associated with liver
damage
Effective for:
Kidney disease
L-carnitine is an amino GI N/V/D, stomach upset,

acid naturally
heartburn

Menopausal
symptoms
Atorvastatin (Lipitor) may

harm liver
Cisplatin may effects of
drug
Hepatotoxic drugs (eg Tylenol,
isoniazid, phenytoin, statins)
may harm liver
Medications changed by the
liver (eg Elavil, Prozac,
Aricept) may rate of
metabolism in liver which can
effects/side effects of drugs
Anticoagulants (Sintrom,
Coumadin) may effects of
L-carnitine deficiency produced in the body.

Angina, heart failure
Hyperthyroidism
Male infertility
Myocarditis
Preventing side
effects from valproic
acid
Cartilage
Bovine (BC)
and Shark
(SC)
Chamomile
It helps the body

produce energy by
playing role in lipid
oxidation and
translocating LCFAs
into mitochondria.
Life Stage Avoid in pregnancy

(unknown effects. Use caution in
lactation.
Conditions Avoid in:
hypothyroidism may exacerbate
symptoms; seizure disorders
Other Seizures, fishy smelling
urine/breath/sweat
It is important in heart
and brain function,
muscle movement and
Insufficient evidence for: other processes.
High cholesterol
Muscle disorders
Retts syndrome,
ADHD
Lyme disease
Improving athletic
performance/enduran
ce
Shark cartilage may
Life Stage: Avoid in pregnancy and
help prevent tumor
lactation (unknown effects)
Cancer
growth by blocking
Osteoarthritis
blood vessel growth
Shark: bad taste, N/V/C, stomach
Psoriasis
upset, low BP, dizziness, high
Hemorhoids (BC)
Bovine cartilage may blood glucose, high Ca levels,
Poison ivy (BC)
provide chemicals
fatigue
Acne (BC)
needed to rebuild
Rectal Itching (BC) cartilage, may reduce Bovine: N/D, swelling, local
swelling, and may help redness, tiching
RA (BC)
with wound healing
Wound healing
Possibly effective:
Contains chemicals
Life Stage: Avoid in pregnancy and
slowing blood clotting

Thyroid hormones may
effectiveness of hormones
Shark cartilage avoid in

individuals whose calcium
levels are too high
Birth control pills may

5
(German)
Anxiety
Colic
Diarrhea
Upset stomach
(dyspepsia)
Oral mucositis
Dermatitis, eczema
Gingivitis
Insomnia
Common cold
Hemorrhoids
Vaginitis
Wound healing
Cranberry

Preventing UTIs
T2DM
Chronic fatigue
syndrome
Pleurisy
Scurvy
Cancer
Reduce urine odor
Chromium
Likely effective for:
that may promote

relaxation (mechanism Conditions: Hormone-sensitive
unknown)
conditions (breast, uterine, ovarian
cancer) estrogenic properties
It may reduce swelling Other: allergic reactions, pre/post
by slowing production surgery
of pro-inflammatory
prostaglandins,
leukotrienes, and
histamines
effectiveness of drugs
liver (eg Mecavor, Allegra)
may effects/side effects of
drugs
Sedatives (benzodiazepines,
CNS depressants) may
sleepiness and drowsiness
Tamoxifen may
effectiveness of drug
Anticoagulants (warfarin)
may effects and slow blood
clotting
Contain chemicals that Life Stage Food is safe to consume Anticoagulants/Antiplatelet
prevent bacteria from but avoid supplements in
drugs (Coumadin) effects of
sticking to cells lining pregnancy and lactation
the urinary tract
Conditions Use caution in:
atrophic gastritis and
Contains salicylic acid hypochlorydia may affect B12
hnliver (eg Elavil, Valium,
which can reduce
absorption, DM sugar sweetened Glucotrol) may rate of
swelling, prevent blood cranberry juice may blood
metabolism in liver and may
clots
glucose
effects/side effects (minor
Other: Avoid if you have allergy to interaction)
salicylic acid
Avoid if you have kidney stones
oxalates in cranberry extracts may
risk of stones
Chromium is an
GI Nausea
Insulin: may cause
Chromium deficiency essential trace element

needed for health.
It may help keep blood
T2DM
glucose levels normal
High cholesterol
by improving the way
the body uses insulin.
Chondroitin
Pre-diabetes
Depression
PCOS
Weight loss,
increasing muscle
Improving athletic
performance
Increasing energy
Osteoarthritis (OA)
Chondroitin is a
building block of
cartilage. It may slow
the breakdown of
cartilage in joints
(osteoarthritis) and
possibly restore lost
cartilage.
Life Stage Do not take amounts

exceeding AI levels in pregnancy
or lactation
Conditions Avoid in: kidney/liver
disease, Use caution in: DM may
cause hypoglycemia
Other Skin irritation, headaches,
dizziness, mood changes, impaired
thinking, judgment, coordination.
High doses may cause blood
disorders, liver/kidney damage.
Chromium may exacerbate
behavioral or psychiatric
conditions such as depression,
anxiety, or schizophrenia
hypoglycemia
Nutr Possible chelation reaction

when taken with chitosan
GI epigastric distress, nausea,
diarrhea, constipation
Other edema (eyelid or lower
limbs), extrasystole (extra beats
that interrupt normal rhythm of
heart)
Anticoagulants/antiplatelets
(Coumadin) taking
chondroitin with glucosamine
the effects of warfarin on blood
clotting
Levothyroxine (Synthroid)
may how much the body
absorbs, decreasing effects
(take drug 30 minutes before, or
3-4 hours after chromium)
NSAIDs - may chromium
levels in body and risk of
adverse effects
Coenzyme Q10 Likely effective for:

CoQ10 deficiency
Mitochondrial
disorders (that limit
energy production)
Cranberry
CoQ10 is required for

proper function of
many organs.
CoQ10 helps provide

energy to cells and
plays a role in ATP
CVD treatment (CHF, production.
angina, HTN)
CoQ10 seems to have
Parkinsons treatment
antioxidant activity.
HIV
Treat adverse effects
of statins (muscle
pain)
Contain chemicals that
prevent bacteria from
Preventing UTIs
sticking to cells lining
the urinary tract
T2DM
Contains salicylic acid
Chronic fatigue
which can reduce
syndrome
swelling, prevent blood
Pleurisy
clots
Scurvy
Cancer
Reduce urine odor
Nutr Can prolong antioxidant

effect of Vitamin E
GI gastritis, N/D, appetite
Life Stage Avoid in pregnancy and
Conditions May insulin
requirements in DM; Caution with
hepatic function which can
CoQ10 blood levels
Other Insomnia with doses
>100mg in evening
Chemotherapy: CoQ10
antioxidant activity may
effectiveness
Antihypertensives: taken with
CoQ10, may cause BP to drop
too low
Anticoagulants/Antiplatelets
(Coumadin): CoQ10 may
blood clotting, therefore the
effectiveness of warfarin
Life Stage Food is safe to consume

but avoid supplements in
Conditions Use caution in:
atrophic gastritis and
hypochlorydia may affect B12
absorption, DM sugar sweetened
cranberry juice may blood
glucose
Other: Avoid if you have allergy to
salicylic acid
Avoid if you have kidney stones
oxalates in cranberry extracts may
risk of stones
Anticoagulants/Antiplatelet
drugs (Coumadin) effects of
liver (eg Elavil, Valium,
Glucotrol) may rate of
metabolism in liver and may
effects/side effects (minor
interaction)
Fish
Oil/Omega3/DHA
Effective for:
High TG levels
Heart disease
Age-related macular
degeneration (AMD)
Atherosclerosis
ADHD
Asthma
Bipolar disorder,
psychosis,
developmental
coordination disorder,
Raynauds syndrome
HBP
RA
Stroke, angina, HBP,
heart failure, heart
transplant
GI Belching, heartburn, nausea,

-3 fatty acids are
essential and cannot be loose stools, diarrhea, taste
produced by the body. changes/after taste
Life Stage Caution with lactation
-3 fatty acids reduce Conditions Avoid in: liver disease
pain and swelling, may may bleeding or liver scarring;
HIV/AIDs and other conditions
prevent blood from
that suppress immune response;
clotting easily, and
Bipolar disorders/depression may
have anti symptoms; Implanted
hyperlipidemic and
defibrillator may risk of
anti-inflammatory
arrhythmia
effects
Other Bad breath, rash, nosebleeds
High doses (>3g/day) may slow
blood clotting and reduce immune
system activity and may make
controlling blood glucose in DM
more difficult
Avoid consuming large amounts
from fish high in mercury and
other chemicals (shark, king
mackerel, farm-raised salmon)
Avoid if you have fish/seafood
allergy
Orlistat may prevent

absorption of fish oil when
taken together
Antihypertensives may
effects of drug
drugs may effects of
Flaxseed
Oil/Pill
Garlic
High cholesterol
RA or OA
BPH
ADHD
Atherosclerosis
Heart disease, HBP
Dry eyes/skin
DM
Constipation
Atherosclerosis
Certain cancers
(colon, rectal,
stomach)
HBP
Ringworm
Jock itch
Athletes foot
CHD, MI
BPH
OA
Hayfever
Cold & flu
Low BP
Hemorrhoids
Asthma, bronchitis,
SOB
Flaxseed provides
PUFAs such as ALA
that have antiinflammatory
properties
GI High doses (>30g/d) may cause Anticoagulants/Antiplatelet

loose stools and diarrhea
Life Stage Avoid in pregnancy and slowing blood clotting
lactation may premature birth
Conditions Avoid in bleeding
disorders may severe bleeding;
pre/post surgery
Contains sulfurcontaining volatile

compounds that seem
to have antioxidant,
anti-inflammatory and
antiatherosclerotic
properties as well as
antibacterial, antiviral,
antifungal and
anticancer properties
GI Burning in mouth/stomach,
heartburn, gas, N/V/D
Life Stage Avoid in medicinal
amounts in children, pregnancy
and lactation (food amounts is ok)
Conditions Avoid in: bleeding
disorders, pre surgery; Use caution
in hypotension, GI problems
Other Bad breath, body odor, skin
burn when applied to skin, GIT
irritation
Isoniazid may how well

drug is absorbed
NNRTIs (HIV/AIDS) may
rate of metabolism in body and
effects of drugs
liver (eg cyclosporine, Allegra,
Forane) may rate of
metabolism in liver and ecrease
effect of drugs
Anticoagulant/Antiplatelet
Birth control pills may
effectiveness of drug
10

Ginkgo
Maintaining healthy
liver function
Anxiety
Mental function,
dementia,
schizophrenia,
Alzheimers disease
Vision problems
(glaucoma, in DM)
Peripheral vascular
disease
PMS
Tardive dyskeinesia
Vertigo, dizziness
Age related memory
loss
Lyme disease
Sexual dysfunction
Atherosclerosis,
Stroke, heart disease,
Raynauds syndrome
Chronic fatigue
syndrome (CFS)
Improves blood
circulation

lactation may cause early labor
or extra bleeding
May slow Alzheimers Conditions May interfere with
disease by interfering management of blood glucose,
with changes in brain may cause seizures or bleeding
that interfere with
disorder symptoms; Avoid pre/post
thinking
surgery
Other Infertility
Contains antibacterial Avoid consuming roasted seed or
and antifungal
crude ginkgo plant which can
properties
cause difficulty breathing, weak
pulse, loss of consciousness, and
shock
liver (eg Celexa, Valium,
Elavil, Flexeril) may rate of
metabolism in liver and effect
of drugs
Antidiabetes drugs may or
insulin and blood glucose levels
in T2DM
Anticonvulsants may effects
of drugs
Xanax effects of drug
Trazodone (Desyrel) may
cause serious side effects in
brain and coma
HCTZ may BP when taken
with ginkgo
11
Glucosamine
Goldenseal
Likely effective:
Osteoarthritis
Glucosamine sulfate is
naturally found in the
body and used in
producing tendons,
Temporo-mandibular ligaments, cartilage
and thick fluid
joint arthritis
surrounding joints
Knee pain
Multiple sclerosis
Interstitial cystitis
Glaucoma
Weight loss
Contains berberine
which can have
UTIs
antibacterial and
Digestive disorders
antifungal properties
such as stomach
upset, ulcers, colitis, and may prevent e.coli
from attaching to
gastritis,
urinary tract walls
hemorrhoids,
constipation
Berberine may lower
Anorexia
BP and improve
Menstrual
arrhythmia and lower
irregularities
blood glucose and
CFS
LDL
Conjunctivitis
Common cold
Hay fever
GI N/D/C, heartburn
Conditions Use caution in T2DM
may blood glucose; High
cholesterol may cholesterol
levels; HBP may BP; Avoid
pre/post surgery
Other Drowsiness, skin reactions,
headache
Use with caution if you have
shellfish allergy
Antimitotic chemotherapy
may rate that tumor cells can
copy and drug effectiveness
Acetaminophen may interfere
with how well each works
Antidiabetes drugs may
effects of drug on controlling
blood glucose levels
Life Stage Avoid in newborn

babies, young children, pregnancy
and lactation may cause brain
damage
Medications changed by liver

(eg Elavil, Prozac, metoprolol,
Allegra) may rate of
metabolism and effects/side
effects of drug
Medications moved by Pglycoprotein substrates (eg
Imodium, verapamil,
cyclosporine) may amounts
of drug in body which could
side effects
12
Grape Seed
Extract

Chronic venous
insufficiency
Eye stress from glare
Hay fever
N/V from
chemotherapy
Athletic performance
Heart disease, HBP,
atherosclerosis, MI,
stroke
High cholesterol
Metabolic syndrome
Nonalcoholic fatty
liver disease
Poor night vision,
diabetic retinopathy,
AMD
Contains flavonoids
which have antioxidant
effects, lower LDL
levels, relax blood
vessels, prevent heart
disease
GI N/V/D, stomach upset,

indigestion
Conditions Use caution in bleeding
conditions and pre/post surgery
slows blood clotting
Other Cough, dry mouth, sore
throat, infections, headache,
muscular problems
Phenacetin may
effectiveness of drug when
taken together
liver (eg Clozaril,
Flexeril,Zyprexa) may rate
of metabolism in liver and
13
Echinacea

Common cold
symptoms
Vaginal yeast
infections
May activate antiinflammatory

chemicals in the body
Nutr Avoid taking with caffeine

can caffeine levels and cause
jitteriness, headache, tachycardia
GI N/V/D, unpleasant taste,
May stimulate immune stomach pain
system
Life Stage Avoid in children under
12 years of age, pregnancy and
Seems
to
have
Anxiety
chemicals that attack
Conditions Avoid in auto-immune
Exercise performance
yeast and fungi
disorders (MS, RA, systemic lupus
HSV, HPV
erythematous) may affect
Influenza
immune system and exacerbate
Leukopenia
symptoms
Other Fever, sore throat, dry
Warts, eczema,
mouth, headache, tongue
psoriasis
numbness, dizziness, insomnia,
UTI
disorientation, joint/muscle aches,
CFS
allergic reactions in children
ADHD
Avoid if you have an inherited
tendency toward allergies (atopy)
Immunosuppresants may
body (eg cyclosporine,
Cardizem, estrogens) or liver
(eg Clozaril, Flexeril, Zyprexa)
may effects/side effects of
drugs
14
Ginseng
(American)
Possibly effective:
DM
Respiratory Tract
infections
Contains ginsenosides
that seem to affect
insulin levels in the
body and lower blood
glucose

lactation
Conditions Use caution in DM
may cause hypoglycemia;
insomnia; schizophrenia; hormonesensitive conditions (breast,
uterine, ovarian cancer) may
Athletic performance, Contains
polysaccharides
that
exacerbate symptoms
mental performance
may affect the immune Other Itching, insomnia, headache,
ADHD
system
nervousness, tachycardia, HBP or
Cancer-related fatigue
low BP, breast tenderness, vaginal
Menopausal
bleeding; Avoid pre/post surgery
symptoms
HBP
Schizophrenia
Insulin resistance d/t
HIV treatment
hypoglycemia
MAOIs may cause too much
stimulation and lead to anxiety,
headache, restlessness, and
insomnia
15
Hawthorn

Heart failure
Insufficient evidence to
rate effectiveness:
Angina, HBP, Low
BP, arrhythmias,
blood circulation
problems, d heart
function
Anxiety
High cholesterol
Hawthorn can improve

the amount of blood
pumped out of the
heart during
contractions, widen the
blood vessels, and
nerve signal
transmission
GI Nausea, stomach upset

Conditions May interact with
medications used to treat heart
disease
Other Fatigue, sweating, headache,
dizziness, palpitations, nosebleeds,
insomnia, agitation
Seems to relax blood Long-term effects (>16 weeks) are
vessels farther from the unknown
heart which can reduce
BP
Antihypertensives (Beta
blockers, Ca-channel blockers)
may effects of rugs
Digoxin may effects and
side effects of drug
Sexual dysfunction drugs (eg
Viagra, Cialis, Levitra) may
cause hypotension
Medications that blood flow
(eg nitroglycerin, isosorbide)
may effects and cause
dizziness/lightheadedness
Seems to have
antioxidant activity
and may
accumulation of fats in
liver and aorta by
excretion of bile,
cholesterol formation,
and enhancing LDL
receptors
16
Horse
Chestnut

Varicose veins and
other circulatory
problems such as
poor blood
circulation, leg
swelling, edema
Contains aescin which

thins blood and makes
it more difficult for
fluid to leak out of
veins and capillaries,
and weakly promotes
fluid loss through urine
to help prevent edema
Nutr Avoid with supplements that

slow blood clotting (eg garlic,
ginger, ginseng)
GI Stomach upset
Life Stage Avoid in pregnancy or
Conditions Avoid in: liver/kidney
disease, pre/post surgery
Use caution in: bleeding disorders
may slow blood clotting; DM
may cause hypoglycemia; bowel or
stomach disorders can irritate
GIT
Other Dizziness, headache, itching
Do not ingest raw horse chestnut
seed, bark, flower, and leaf which
may cause death
Avoid if you have latex allergies

hypoglycemia
Lithium how well body gets
rid of drug through diuretic
effects
17
Melatonin

Sleep disorders in the
blind
Trouble falling asleep
Sleeping problems
due to sleep-wake
cycle disturbances
Withdrawal from
benzodiazepines
HBP
Insomnia
Jet lag
Reducing anxiety
before surgery
Tumors
Sunburn
Thrombocytopenia
Melatonin is naturally
found in the body and
regulates night and day
cycles or sleep-wake
cycles. melatonin
signals the body to
prepare for sleep, and
levels prepare the body
to awake.
Nutr Caffeine and St. Johns work

melatonin blood levels, B12 may
blood levels
GI Stomach cramps, N/V
pregnancy and lactation may
interfere with ovulation and
development during adolescence
Conditions Avoid in: bleeding
disorders; Use caution in: HTN,
seizures, depression, d hepatic
function or DM
Other Headache, short-term
feelings of depression, daytime
sleepiness, dizziness, irritability,
hypotension, hypothermia
Do not drive or use machinery for
4-5 hours after taking melatonin
Birth control pills melatonin

in body
Antidiabetes drugs may
blood glucose
Antihypertensive drugs: may
BP with medication
Nifedipine GITS (Procardia
XL) may effectiveness of
drug
Immunosuppressants:
Anticonvulsants may
seizure frequency
Sedatives may cause too
much sleepiness
Verapamil may metabolism
of melatonin and its effects
Medications changed by liver
(eg Tylenol, Valium, Dilantin,
warfarin) rate of
metabolism which can
effects/side effects of drugs
18
Milk Thistle

Seasonal allergies
DM
Heartburn
(dyspepsia)
Menopausal
symptoms
Skin damage from
radiation
Liver disease or
damage
Peppermint
Oil
May protect liver cells

from toxic chemicals
and drugs and has
antioxidant effects by
possibly increasing
glutathione and
superoxide dismutase
in the liver
Seems to have antiinflammatory effects
by inhibiting the
synthesis of proinflammatory
leukotrienes
GI Laxative effect, N/D,

indigestion, gas, bloating, loss of
appetite
lactation (effects unknown)
Conditions:Use caution in: DM
may cause hypoglycemia;
hormone-sensitive conditions
(breast, uterine, ovarian cancer,
endometriosis) may have
estrogenic effects
Sylmarian may help

body break down
estrogen
Peppermint oil seems Nutr Avoid taking with iron or
to reduce spasms in the quercetin reduces iron and
IBS
GI tract.
quercetin absorption
GI: Heartburn (in achlorydia or
Peppermint
can
relieve
when taken with antacids)
Relaxing colon
during medical exams pain beneath the skin Life Stage Avoid medicinal doses
by causing surface
in pregnancy and lactation (effects
Breastfeeding
warmth when applied unknown)
discomfort
to skin
Other Flushing, headache, mouth
Spasms caused by
sores
endoscopy
Migraine or tension

liver (eg Coreg, Allegra,
Celebrex, tamoxifen) alters
rate of metabolism in liver
which can or effects/side
effects
hypoglycemia
Estrogens may effects of
drugs

liver (eg cyclosporine, Elavil,
Zofran) rate of metabolism
in liver which can effects/side
effects
Antacids (eg Rolaids), PPIs (eg
Prilosec, Prevacid, Nexium)
and H2-Blockers (eg Zantac,
Pepcid) d pH can cause
enteric peppermint products to
dissolve to quickly, which can
19
headache
SAMe (SAdenosyl-LMethionine)

Depression
Osteoarthritis
Liver disorders in
pregnancy
Saw Palmetto

Prostate surgery
recovery
Symptoms of benign
prostatic hyperplasia
(BPH enlarged
prostate)
Prostate cancer
cause heartburn and nausea

The body uses SAMe
to make certain
chemicals that play a
role in pain,
depression, liver
disease, and other
conditions.
GI V/D/C
Conditions Avoid in: bipolar
disorder may induce mania;
Parkinsons disease may
exacerbate symptoms; pre/post
surgery may affect CNS
Other dry mouth, headache, mild
insomnia, anorexia, sweating,
dizziness, nervousness
Poorly understood:
Nutr Avoid with supplements that
Saw palmetto seems to slow blood clotting (eg garlic,
shrink the inner lining ginger, ginseng)
that puts pressure on
GI N/V/D/C
the tubes that carry
urine and possibly acts lactation
as an inhibitor of 5- Conditions Avoid in pre/post
surgeries may slow blood
reductase which
clotting
converts testosterone
Other Dizziness, headache
into
dihydrotestosterone
(DHT) which may
encourage prostate
enlargement
MAOIs and Antidepressants (eg

Prozac, Paxil, Zoloft, Elavil)
and other drugs that
serotonin: effects, may cause
serotonin syndrome
Levodopa (Parkinsons)
effect of drug
Birth control pills and estrogens

effects of estrogen in body
drugs: effects by slowing
blood clotting
20
St. Johns
Wort

Depression (mild to
moderate)
Contains hyperforin
and hypericin that act
on chemical
messengers in the
nervous system that
regulate mood

Skin redness and
irritation
Somatization disorder Contains compounds
that may production
Wound healing
of fibroblast cells that
play a role in wound
healing
Nutr May iron absorption, may

cause serotonin syndrome when
taken with tryptophan,
GI dry mouth, GI upset, abdominal
pain, constipation
lactation
Conditions Avoid in: Alzheimers
or schizophrenia may induce
psychosis; bipolar disorder and
major depression may induce
mania
Other Insomnia, restlessness, vivid
dreams, headache, fatigue,
sedation, anxiety, agitation,
irritability, paresthesias (pins &
needles), dizziness, tremor,
photosensitivity at high doses
Caution with all drugs

effectiveness of drugs by
increasing the metabolism of
the drugs and decreasing serum
drug levels some major drug
interactions include Xanax,
birth control pills, cyclosporine,
digoxin
Antidepressants and other drugs
that serotonin (eg
fenfluramine, Zoloft, Prozac,
Demerol) effects, may
cause serotonin syndrome
Photosensitizing drugs (eg
Elavil, Cipro, Levaquin):
effect and sensitivity to sunlight
21
Turmeric

Osteoarthritis
Contains curcumin that

may inflammation
and treat inflammatory
diseases, possibly by
Alzheimers disease down regulating
cytokines, transcription
Inflammatory
diseases such as DM, factors, redox status,
protein kinases, and
Crohns disease,
enzymes that all
Ulcerative Collitis
promote inflammation
(UC), arthritis,
Colorectal cancer
Curcumin may be
GI problems such as chemo-protective and
stomach pain,
inhibit progression of
diarrhea, bloating,
cancer via cellular
dyspepsia, stomach
signal transduction
ulcers, IBS
Nutr Medicinal amounts may

iron absorption
GI Stomach upset, N/D, dizziness
Life Stage Avoid medicinal
amounts in pregnancy and
lactation (food amounts ok)
Conditions:Avoid in: gallbladder
problems may exacerbate
gallstones; bleeding disorders and
pre/post surgery may slow
clotting; Use with caution in: DM,
GERD, hormone sensitive
conditions (Breast, ovarian, uterine
cancer, endometriosis) may
estrogen effects, iron deficiency
Drugs (eg aspirin, warfarin,
ibuprofen, Plavix): effects of
Antidiabetes Drugs (eg
glimepiride, glyburide,
glipizide): effects may
cause hypoglycemia
Azulfidine EN-Tabs
(Sulfasalazine) (for UC)
absorption and effects/side
effects of drug
Talinolol (p-glycoprotein
inhibitor) absorption and
effects/side effects of drug
22
Yohimbe
Erectile dysfunction
General sexual
problems and sexual
problems caused by
SSRIs
(antidepressants)
Aphrodisiac
Orthostatic
hypotension
Contains yohimibine,
an alpha-2-blocker that
BP and blood flow
and nerve impulses to
the genitals
Nutr: Avoid taking with foods

containing caffeine and tyramine
(eg aged cheese, fermented meat,
red wine) which can lead to
dangerous HBP; Avoid with
supplements that slow blood
clotting (eg garlic, ginger, ginseng)
GI upset stomach, polyuria, N/V,
bloating
pregnancy, and lactation
Conditions Avoid in bleeding
disorders, pre/post surgery,
schizophrenia, prostate conditions,
PTSD, liver/kidney disease, HBP,
angina, heart disease,
anxiety/depression, DM
Other Arrhythmia, tachycardia,
kidney failure, seizure, HBP, heart
attack, tremor, anxiety, irritability,
insomnia, dizziness, headache
Antihypertensives (eg
clonidine, enalapril, losartan,
HCTZ, effects of drugs
MAOIs effects and side
effects of yohimbe/drugs
Tricyclic antidepressants (eg
Elavil, Tofranil) may lead to
heart problems
Phenothiazines effects and
side effects of yohimbe
Stimulants (eg epinephrine,
phentermine) effects, may
cause tachycardia and HBP
23
III Medications: In a table format, please include classification, indication, mode of action, and drug-nutrient interaction (1.5 point
each 30 points)
Medication 27, 41-43 Classification
Alendronate
Bisphosphonate
(Fosmax)
Risedronate
(Actonel)
Ibandronate
(Boniva)
Bisphosphonate
Bisphosphonate
Indication
Osteoporosis,
Pagets disease,
heterotopic ossification
treatment
Osteoporosis,
Pagets disease,
treatment
Osteoporosis,
Pagets disease,
treatment
Osteoporosis,
Pagets disease,
hypercalcemia or
malignancy therapy &
bone metastases
treatment
Zoledronic acid
(Reclast)
Bisphosphonates
(Parenteral)
Calcitonin
(Fortical)
Polypeptide Hormone Osteoporosis

(postmenopausal
especially), Pagets
disease, hypercalcemia
treatment
Mode of action
Strengthens bones by
inhibiting bone removal
(resorption) by osteoclasts
& increases bone density
(resorption) by
osteoclasts, increases
bone density & lowers
blood calcium release
from bones
Increases bone density &
strength
Inhibits bone removal by
osteoclasts & promotes
bone formation by
Drug nutrient interaction

Avoid water with high mineral
content
Avoid alcohol

content
Avoid alcohol

content
Avoid alcohol
Avoid alcohol
Decrease Ca and Vit D in diet

(in hypercalcemia parenteral
treatment)
Avoid Ca and Vit D suppl.
24
Denosumab
(Prolia)
Monoclonal antibody Osteoporosis

(postmenopausal)
non-metastatic prostate
cancer, breast cancer,
bone metastases
Raloxifene
Selective estrogen
Osteoporosis treatment
(Evista)
receptor modulator
& prevention, breast
(SERM).
cancer prevention ( in
postmenopausal women)
Teriparatide
Parathyroid hormone Osteoporosis treatment
Parathyroid
analog
(postmenopausal
Hormone (Forteo)
women),
glucocorticoid induced
osteoporosis
Estrogen Therapy Hormone,
Menopausal symptom
Contraceptive
treatment, Osteoporosis
prevention,
birth control
Orlistat
Belviq
Antiobesity
Overweight/ obesity
Weight control agent, treatment
Lipase inhibitor
weight management
treatment
Antiobesity
Overweight/ obesity
osteoblasts.
Inhibits osteoclasts from
breaking down bone,
RANK ligand inhibitor
N/A
Decreases bone
resorption, increases bone

density, blocks estrogen
Limit alcohol
Increases bone formation

and density, stimulates
growth of new bone
N/A
Reduces symptoms of
menopause i.e. hot
flashes, vaginal dryness,
caused by decreased
estrogen, reduces bone
resorption & increases
bone formation, as a
contraceptive (in
combination) prevents
ovulation
Blocks enzyme that
breaks down the fat
(lipase) & decreases
absorption of dietary fat
(30%)
Reduces weight and helps
in maintaining weight loss
Acts on serotonin
Caution with grapefruits juice

and related citrus
Limit caffeine
Limit alcohol
Avoid SJW
Affects Fol, Pyr, Rib, Vit A, Fe,
Cu, Mg, Zn, Ca & possibly B12
abs.
Avoid olestra fat substitute
Decreases fat & fat soluble vits
& Beta-carotene abs.
May prevent absorption of fish
oil when taken together
Avoid SJW
25
Serotonin 5-HT2CReceptor Agonists
treatment
weight management
treatment
Overweight/ Obesity
treatment
Weight management
treatment
Contrave
Antiobesity
(with opioid
antagonist,
aminoketone
antidepressant)
Phentermine
Appetite suppressant, Overweight/ obesity

antiobesity
treatment
weight management
treatment
Qsymia
phentermine/
topiramate
Antiobesity
appetite suppressant
Orabase
Local Anesthetic
Pilocarpine
(Salagen)
Anti-Xerostomia
Tetracyline
Antibiotic,
antiarthritic,
anti-acne
receptors to suppress
appetite and hunger
Decreases appetite, curbs
hunger and food cravings
Avoid SJW
Avoid alcohol
Avoid alcohol
Avoid caffeine
Suppresses appetite by
affecting the CNS
Releases catecholamine in Avoid alcohol

the hypothalamus,
resulting in reduced
appetite and decreased
food consumption.
Treatment mouth, gum& Inhibits neurons action
N/A
throat pain/
potential from reaching
inflammation r/t i.e.
the CNS, which is
denture irritations,
interpreted as pain
mouth ulcers etc.
Dry mouth treatment
Increases salivation by
N/A
(from radiation)
affecting the nervous
Sjorgens syndrome
system (stimulating
treatment
acetylcholine)
Bacterial infection
Inhibits growth of
Avoid SJW
treatment (i.e. peptic
bacteria
Avoid taking with food
ulcer due to Bacteria H.
(especially mineral fortified foods)
pylori, inflammation of
Decreases absorption of Ca, Fe,
the stomach lining (H.
Mg, Zn
Overweight/ obesity
treatment, chronic
weight management
treatment
26
Pylori), infection in the

abdomen, biliary tract
infections, acne, UTI,
STD infections etc.)
Fluconazole
Antifungal,
anticryptococal
meningitis
anticandidiasis
Acyclovir
Antiviral
Famciclovir
Antiviral
Possibly decreases vit K & B12

Take Ca, Fe, Mg, Zn or MVI
minerals & mineral fortified
food separately (3hrs before)
Caution with vit A suppl.
Avoid alcohol
Fungal and yeast

Inhibits growth of fungus
infection treatment (in
by inhibiting the
mouth, throat,
cytochrome P450
esophagus, lungs,
dependent enzyme
bladder, genital area,
lanosterol 14-cancer related infections demethylase.
etc.)
Treatment of viral
It slows the growth and
N/A
infections (i.e. herpes,
spread of the herpes
chickenpox, Shingles)
viruses
Treatment of herpes
It slows the growth and
N/A
Zoster-Shingles, herpes spread of the herpes
simplex, labialis cold
viruses
sores
27
IV Questions
1. Describe how the following nutrient and/or factor may affect rickets and/or osteoporosis risk?
Both osteoporosis and rickets are diseases characterized by a decrease in bone mineral density and a weakening of the bones. Rickets
is more prevalent in children and it stems from a Vitamin D deficiency. In adults it manifests as osteomalacia. Osteoporosis is
commonly seen in adults and older individuals. Since vitamin D helps absorb calcium from the stomach, a deficiency in either of these
two nutrients may increase the risk for rickets and osteoporosis.
a. Alcohol
Excessive alcohol consumption causes bone loss and increases the risk of osteoporosis. More than 2 to 3 ounces of alcohol daily
interferes with adequate calcium absorption by the stomach and pancreas. Alcohol also, has a toxic effect and kills the bone-making
cells, osteoblasts. Alcohol also has a detrimental effect on bone health by affecting the levels of cortisol and parathyroid hormone
(PTH). High levels of cortisol induce osteoporosis by increasing bone breakdown and decreasing bone formation. Increased PTH,
another bone-damaging hormone leaches calcium from the bones.
Drinking too much alcohol can also cause Vitamin D deficiency and lead to the onset of rickets. Vitamin D deficiency can lead to bone
demineralization.
Thus, excessive alcohol consumption can impair both the status of calcium and vitamin D and lead to the development of bone disease
such as osteoporosis and rickets.28-30
b. Long-term Steroid use
Glucocorticoid administration has been purported as the most common cause of secondary osteoporosis. In patients with long-term use
of these anti-inflammatory steroid hormones, there was noted an increased risk for bone fractures. Rapid reduction in bone mineral
density has been detected in patients taking glucocorticoids with a relative risk for fractures of 75% in the first three months after
steroid therapy was initiated. Immediate discontinuation of glucocorticoids showed immediate improvement. Glucocorticoids induce
osteoporosis by decreasing the production of new osteoblast precursors and causing premature apoptosis of the mature osteoblasts.
Thus, it is suggested that long-term steroid use causes osteoporosis.31
c. Calcium Deficiency
Adequate calcium in the diet during childhood and adolescence is crucial in maximizing calcium retention in the bones and increased
bone density. A diet low in calcium that lacks milk and dairy products is often adopted during adolescence, especially in girls and this
may have detrimental effects on bone health later on in life leading to osteoporosis. Studies show that getting enough calcium early on
in life when programmed mesenchymal stem cells replicate to provide all the bone-forming cells for an entire life is key for optimal
bone health throughout life.
28
Severe calcium deficiency in growing children can also cause rickets. Calcium deficiency rickets causes hyperparathyroidism and
increases FGF23 levels, which decrease absorption and increase excretion of phosphate and also increases 1,25(OH)2D concentration
which increases the release of calcium from the bones into the blood. Both, FGF23 and 1,25(OH)2D inhibits bone mineralization.32-33
d. Vitamin Deficiency
Vitamin D maintains calcium levels by promoting calcium absorption from the gastrointestinal tract. Vitamin D deficiency makes it
difficult to maintain proper calcium balance and leads to the development of rickets. Children in industrialized countries and colder
climates are especially prone to development of rickets where exposure to sunlight is limited. Severe vitamin D deficiency is also seen
in children with dark skin due to a low endogenous vitamin D synthesis. To prevent rickets it is generally recommended administration
of 400 IU/day of vitamin D3 supplementation.10, 34
e. Malnutrition
Malnutrition is characterized by an inability to provide sufficient nutrients in the body. The lack of adequate nutrient may stem from a
reduced intake of food, intake of food that lacks nutritive value or the bodys inability to uptake the nutrients provided by the food in
the body. Other social and environmental factors may put children and adults at risk for malnutrition such as lack of access to fresh
fruits and vegetable and/or low income. As children shift into adolescence, frequently there is change in the diet from milk and milk
products that contain calcium and Vitamin D to sodas and snacks. Girls especially will tend to adopt a diet that lacks adequate
macronutrients from a body image concern. This may significantly reduce the nutrition value of the ingested foods and thus lead to
diseases such as rickets and osteoporosis later on in life.
Adults may also suffer from malnutrition for several reasons mentioned above. As the age progresses, missing on foods that are high
in calcium and avoiding sun exposure may lead to the onset of osteoporosis.35
29
2. In a table format, define the following terms and describe their symptoms. Also discuss nutritional recommendation
(diet modifications and/or restrictions) that would help to alleviate these conditions and their symptoms:
Condition36-40
Odynophagia
Definition
Painful swallowing
Symptoms
1. Burning sensation when swallowing
2. Squeezing sensation around throat when
swallowing drinking or eating
Mucositis
Inflammation of the
mucous membrane
lining the oropharynx
and esophagus
1. Common side effect of some types of

chemotherapy
Oral
Candidiasis
Infection caused by
fungi or yeast
1. Oral sores in mouth

2. Difficulty chewing and swallowing
3. Change in taste
Xerostomia
Dry mouth
Nutritional Recommendation(s)
1. May interfere with nutritional intake in some
patients with oral or esophageal cancers
2. Avoid caffeinated drinks, mint, and alcohol
(can aid in giving acid reflux)
1. Daily oral care
2. Avoid tobacco, alcohol and irritating foods
3. Use bland rinses (bland liquids and soft solids
are usually better tolerated in individuals with
oral esophageal mucositis)
4. Avoid strong- flavored, acidic, or spicy foods
5. Commercially prepared liquid medical food
supplements can be useful.
1. Increase kilocalorie and protein intake;
2. Administer oral supplements
3. Provide caries risk reduction education
Effects: pain, infection, lesions, altered ability to

eat, dysgeusia
1. Seen in poorly controlled diabetes mellitus,
1. Moist, soft, non-spicy foods; smooth cool or
Sjogrens syndrome, and other autoimmune
warm foods and fluids
diseases, and consequence of radiation therapy and 2. Provide caries risk reduction education
30
certain medications
Effect: increased caries risk, pain, no moistening
power, tendency of food to stick, dysgeusia
Esophagitis
Inflammation of the
esophagus
1. Reflux
2. Ingestion of a corrosive agent
3. Viral or bacterial infection, intubation, radiation,
or eosinophilic infiltration
*Symptoms may impair the ability to consume a
sufficient diet, interfere with sleep, work, and
overall quality of life.
1. Avoid large, high fat meals

2. Avoid eating at least 3. 3-4 hours before lying
down
4.Avoid smoking
5. Avoid alcohol & caffeine-containing
beverages
6. Stay upright and avoid vigorous activity soon
after eating
7. Consume a nutritionally balanced diet with
adequate fiber
8. Avoid acidic and highly spiced foods
9. Lose weight if overweight
31
References:
1. MedlinePlus. Laparoscopic gastric banding. Version current October 14, 2014.
2. Internet:https://www.nlm.nih.gov/medlineplus/ency/article/007388.htm (accessed October 30 2015).
3. Mahan KL, Escott-Stump S, Raymond JL. Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders. Krause's
Food and the Nutrition Care Process, 13th Edition. Missouri: Elsevier, 2012:605.
5. MedlinePlus. Roux-en-Y stomach surgery for weight loss. Version current May 8, 2014.Internet:
https://www.nlm.nih.gov/medlineplus/ency/imagepages/19268.htm (accessed October 30 2015).
7. MedlinePlus. Biliopancreatic diversion (BPD). Version current April 23, 2013.
Internet:https://www.nlm.nih.gov/medlineplus/ency/imagepages/19499.htm (accessed October 30 2015).
8. MedlinePlus. Vertical banded gastroplasty. Version current April 23, 2013. Internet:
https://www.nlm.nih.gov/medlineplus/ency/imagepages/19498.htm (accessed October 30 2015).
9. Tevis S, Garren MJ, Gould JC. Revisional surgery for failed vertical-banded gastroplasty. Obesity Surg 2011;21:1220-4.
10. Mahan KL, Escott-Stump S, Raymond JL. Intake: The Nutrients and Their Metabolism. Krause's Food and the Nutrition Care
Process, 13th Edition. Missouri: Elsevier, 2012:70.
11. Mahan KL, Escott-Stump S, Raymond JL. Nutrition and Bone Health. Krause's Food and the Nutrition Care Process, 13th
Edition. Missouri: Elsevier, 2012:541.
12. Mahan KL, Escott-Stump S, Raymond JL. Intake: The Nutrients and Their Metabolism. Krause's Food and the Nutrition Care
Process, 13th Edition. Missouri: Elsevier, 2012:69.
32
13. Mahan KL, Escott-Stump S, Raymond JL. Clinical: Inflammation, Physical, and Functional Assessments. Krause's Food and
the Nutrition Care Process, 13th Edition. Missouri: Elsevier, 2012:170-1.
14. Mahan KL, Escott-Stump S, Raymond JL. Nutrition and Bone Health. Krause's Food and the Nutrition Care Process, 13th
Edition. Missouri: Elsevier, 2012:537.
15. WebMD. Osteoporosis Health Center. Version current 2015. Internet: http://www.webmd.com/osteoporosis/bone-mineraldensity-test (accessed 10/28 2015).
16. Food and the Nutrition Care Process, 13th Edition. Missouri: Elsevier, 2012:535.
17. Mayo Clinic. Diseases and Conditions: Anaphylaxis. Version current 2013. Internet: http://www.mayoclinic.org/diseasesconditions/anaphylaxis/basics/definition/con-20014324 (accessed 10/28 2015).
18. Celiac.org. WHAT IS CELIAC DISEASE?. Version current 2013. Internet: https://celiac.org/celiac-disease/what-is-celiacdisease/ (accessed 10/28 2015).
19. Mahan KL, Escott-Stump S, Raymond JL. Medical Nutrition Therapy for Lower Gastrointestinal Tract Disorders. Krause's
Food and the Nutrition Care Process, 13th Edition. Missouri: Elsevier, 2012:633-5.
20. Fagelman E, Lowe FC. Saw palmetto berry as a treatment for BPH. Reviews in Urology 2001;3:134-8.
21. Mikaili P, Maadirad S, Moloudizargari M, Aghajanshakeri S, Sarahroodi S. Therapeutic uses and pharmacological properties
of garlic, shallot, and their biologically active compounds. Iran J Basic Med Sci 2013;16:1031-48.
22. Ozturk N, Korkmaz S, Ozturk Y. Wound-healing activity of St. John's Wort (Hypericum perforatum L.) on chicken embryonic
fibroblasts. J Ethnopharmacol 2007;111:33-9.
23. Shehzad A, Lee YS. Molecular mechanisms of curcumin action: Signal transduction. Biofactors 2013;39:27-36.
24. Shehzad A, Rehman G, Lee YS. Curcumin in inflammatory diseases. Biofactors 2013;39:69-77.
25. MedlinePlus. Drugs, Herbs and Supplements. Version current 2015.
Internet: https://www.nlm.nih.gov/medlineplus/druginformation.html. Accessed October 31, 2015.
26. WebMD. Vitamins and Supplements. Version current 2015. Internet: http://www.webmd.com/vitaminssupplements/default.aspx. Accessed October 31, 2015.
27. Pronsky ZN, Elbe D, Ayoob K. Food Medication Interactions. 18th Edition. Birchrunville: 2015.
28. Maurel D, Boisseau N, Benhamou C, Jaffre C. Alcohol and bone: review of dose effects and mechanisms. Osteoporosis Int
2012;23:1-16.
29. Davis JL. Drink Less for Strong Bones Tips to avoid getting tipsy. Version current 2015. Internet:
http://www.webmd.com/osteoporosis/features/alcohol (accessed 10/28 2015).
30. Thacher TD, Clarke BL. Vitamin D insufficiency. 2011;86:50-60.
31. Weinstein RS. Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinol Metab Clin North Am 2012;41:595-611.
32. Burckhardt P. Calcium revisited, part III: effect of dietary calcium on BMD and fracture risk. BoneKEy reports 2015;4:
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33. Mahan KL, Escott-Stump S, Raymond JL. Nutrition in Childhood. Krause's Food and the Nutrition Care Process, 13th Edition.
Missouri: Elsevier, 2012:405.
34. Carmeliet G, Dermauw V, Bouillon R. Vitamin D signaling in calcium and bone homeostasis: a delicate balance. Best Practice
& Research Clinical Endocrinology & Metabolism 2015;29:621-31.
35. Medline Plus. Malnutrition. Version current 2013. Internet: https://www.nlm.nih.gov/medlineplus/ency/article/000404.htm
(accessed 11/01 2015).
37. Mahan KL, Escott-Stump S, Raymond JL. Medical Nutrition Therapy for Cancer Prevention, Treatment, and Recovery.
Krause's Food and the Nutrition Care Process, 13th Edition. Missouri: Elsevier, 2012:848.
38. Mahan KL, Escott-Stump S, Raymond JL. Medical Nutrition Therapy for HIV and AIDS. Krause's Food and the Nutrition
Care Process, 13th Edition. Missouri: Elsevier, 2012:876.
39. Mahan KL, Escott-Stump S, Raymond JL. Nutrition for Oral and Dental Health. Krause's Food and the Nutrition Care Process,
13th Edition. Missouri: Elsevier, 2012:556-557.
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2015).
34

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CUNY School of Public Health

NUTR734 Clinical Nutrition I

reduce blood glucose

L-carnitine is an amino GI N/V/D, stomach upset,

Possibly effective for:

Atorvastatin (Lipitor) may

L-carnitine deficiency produced in the body.

Possibly effective for:

It helps the body

Life Stage Avoid in pregnancy

slowing blood clotting

Shark cartilage avoid in

Birth control pills may

Possibly effective for:

Likely effective for:

that may promote

Insulin: may cause

Chromium deficiency essential trace element

Life Stage Do not take amounts

Nutr Possible chelation reaction

Coenzyme Q10 Likely effective for:

CoQ10 is required for

CoQ10 helps provide

Nutr Can prolong antioxidant

Life Stage Food is safe to consume

GI Belching, heartburn, nausea,

Orlistat may prevent

GI High doses (>30g/d) may cause Anticoagulants/Antiplatelet

Contains sulfurcontaining volatile

Isoniazid may how well

Life Stage Avoid in pregnancy and

Life Stage Avoid in newborn

Medications changed by liver

Possibly effective for:

GI N/V/D, stomach upset,

Possibly effective for:

May activate antiinflammatory

Nutr Avoid taking with caffeine

Life Stage Avoid in pregnancy and

Possibly effective for:

Hawthorn can improve

GI Nausea, stomach upset

Likely effective for:

Contains aescin which

Nutr Avoid with supplements that

Antidiabetes drugs may cause

Likely effective for:

Nutr Caffeine and St. Johns work

Birth control pills melatonin

Possibly effective for:

May protect liver cells

GI Laxative effect, N/D,

Sylmarian may help

Medications changed by the

Medications changed by the

Likely effective for:

Possibly effective for:

cause heartburn and nausea

MAOIs and Antidepressants (eg

Birth control pills and estrogens

Likely effective for:

Possibly effective for: