Jessica A. Krenkel

Nutritional management of HIV/AIDS in the era of highly active antiretroviral therapy: a review

Stumm R, Thomas M, Coombes J, Greenhill J, Hay J. 2001; 58(3); 181–185. The laxative requirement and bowel function of 89 elderly orthopaedic subjects were compared for intake of 150 mL of pear juice twice daily (n=32); intake of a bran, prune, oat, and apple fiberball (n=24); or controls (n=33). Opiate use, low fluid intake <1500 cc, and average fiber intake < 20 g/d were similar in all groups. Laxative use was not reduced by either treatment, but the rate of bowel opening was significantly greater for the pear juice treatment for lengths of stay greater than six days (P=0.045). Pear juice does not contain fiber but the result was attributed to the cumulative effect of 6 g of sorbitol and 19 g of fructose in 300 mL. For patients desiring a natural strategy for improving bowel elimination, the positive response to pear juice (52%) versus fiber (13%) supported pear juice as an acceptable alternative. The author’s discussion of data collection problems would be useful for planning this type of study.

54 DEVELOPMENT OF RECOMMENDATIONS BASED ON MECHANISMS AND EVIDENCE OF INTERACTION BETWEEN HERBAL SUPPLEMENTS AND CARDIOVASCULAR DRUGS

There are 23 million people in the United States diagnosed with heart disease and the majority of these patients rely on prescription medication as part of their treatment regimen. With the high rates of herbal supplement use, there are certain to be drug interactions that occur without physician awareness. Therefore, physicians need to be aware of potential drug interactions that may result from their concomitant use with prescription medications. By understanding and appreciating important mechanisms, physicians can better screen for and avoid adverse events. This report offers the results of a systematic review of the literature regarding interactions between cardiovascular (CV) drugs and top-selling herbal supplements: echinacea, garlic, ginkgo biloba, ginseng, kava, saw palmetto, St. Johns wort, and valerian root. The PubMed literature search included CV drug herbal interactions, CV drug metabolizing pathways, and incidences of adverse events that were attributed to drug-herbal interactions. All primary literature was cross-referenced with the Herbal PDR and the Comprehensive Medicines Natural Database. The strength of evidence for each herbal interaction was rated with commonly used scales based on study design, validity, population size, and bias. This three point scale was weighted against the severity of potential interactions for the herbal and CV drugs. The severity of the interaction was scored based on the consequence or outcome: 1-documented hospitalization, emergency care or intervention required due to interactions; 2-proposed serious potential for interaction involving hospitalization, emergency care or intervention; and 3-non-emergent intervention required to treat or reduce effects of interaction. Based on this procedure, recommendations were color coded. Red indicates a strong potential for interaction with dangerous consequences that should be avoided. Orange indicates a strong potential for interaction with dangerous consequences that should be avoided, which is based on theoretical evidence only. Yellow indicates less potential for interaction with a lesser degree of consequence should interactions occur. Physicians should note caution regarding these interactions. For the supplements studied, 1 scored red (kava), 3 scored orange (echinacea, ginkgo biloba, and St. Johns wort), 3 scored yellow (garlic, ginseng, and saw palmetto), and valerian root had no known CV drug interactions. These scores along with known interactions serve as a tool to guide physicians when screening for interactions between herbal supplements and CV medications.

Carbohydrate advantage—Going the distance in weight management. Dietary strategies for weight management—The importance of carbohydrates

ple linear regression to determine the association of these factors and serum ferritin showed that current oral contraceptive pill use and alcohol intake were associated positively and phytate intake was associated negatively. Total iron, hemoglobin, and bioavailable dietary iron were not associated with serum ferritin. Because the three bioavailable dietary iron algorithms of Monsen and Tseng were not associated positively with iron status, the authors concluded that further studies are needed to validate dietary factors and revise algorithms that explain variations in iron status.

Nutritional assessment and intervention in patients admitted with a femoral neck fracture: A chronicle of missed opportunities

Miller M, Crotty M, Whitehead C, Daniels L, Finucane P. 2001;58(2 pl):S3–36. The objective of this study was to document current nutritional clinical practice for 183 elderly patients (> 60 years, mean 82.5 ± 7.6, female = 120, male = 63) with a femoral neck fracture admitted during a year to an Australian teaching hospital. Preoperative undernutrition, a risk factor for osteoporosis and further femoral neck fracture, was identified by a low serum albumin (38%, n = 111) and low total lymphocytes (72%, n = 180). Vitamin D status and bone density each were measured in one patient. Patients medicated for osteoporosis were given calcium supplements (4), Calcitrol Vitamin D (5), biphosphonate (1), and hormone replacement therapy (1). The study concluded that current nutritional practice missed the opportunity for detection and management of metabolic bone disease and secondary osteoporotic fracture prevention. The investigators recommended that evidence-based practice and clinical pathway protocols be implemented by a clinical team to increase awareness, address a lack of issue ownership, and diminish organizational barriers.