Episode 67: Before You Buy that Supplement...

Another great conversation with Patricia Cantillo-Kodzis, APRN, Sub-Investigator / Nurse Practitioner for ClinCloud Research!

Mayo Clinic Guide to Supplements

The FTC vs. Manufacturer of Prevagen

USP Verified

Support the Alzheimer's & Dementia Resource Center 

Transcript

Supplements
 [00:00:00] Welcome to Informed Aging, a podcast about health, help, and hard decisions for older adults. I'm Robin Rountree, a former family caregiver. I've worked in the home care industry and now work for the Alzheimer's and Dementia Resource Center. With me. Hi, I'm Edith Gendron. I'm the Executive Director here at Alzheimer's and Dementia Resource Center.
I have about 40 years of experience working with aging adults. I'm a Positive Approach to Care Certified Trainer and Consultant. The thoughts and opinions expressed belong to Edith and I, not our wonderful employers and sponsors. This podcast is a service of the Alzheimer's and Dementia Resource Center.
We are not affiliated with the Alzheimer's Association. Before making any significant changes in your life or your person's life, please consult your own experts. Today, I'm very happy to tell you our guest is Nurse Practitioner Patti [00:01:00] Cantillo-Kodzis. Patti is often described as being with ClinCloud Research, but that's not full time, right?
You donate your time at some health areas or health entities? Yes, I do. I volunteer my time at Neighbors Network here in Winter Park and Maitland and also at Shepherd's Hope, which is free clinic for uninsured and underinsured.
That's awesome. Shepherd's Hope. Yeah. And we're going to talk about supplements today. So we'll be right back after this message. [00:02:00] We are back and Patti is here once again because she's so smart. We keep asking her questions and today we're asking about supplements.
My personal experience has been, I have a problem and I go to the internet instead of my doctor, right, which would be Dr. Google. And then you see somebody saying, Oh, this, this supplement changed my life. And maybe [00:03:00] 20 years ago I would buy the supplement. It wouldn't change my life. And, you know, I figured out.
You should just really go to your doctor, which is the smart thing to do, but there are so many supplements out there and they all promise, well, not all of them, but a lot of them promise to change your life, especially the ones you see on social media. That is true. But as you've said, they are probably not life altering.
Right. So exactly what is the definition of a supplement? So a supplement is something literally that you take to augment your dietary intake. Didn't use the word supplement in there. Nice. to use the word when you define something, but basically that's what it is. And it can be a vitamin, a mineral or some other substance.
But it is again, in addition to your dietary intake that you're trying to get more of a certain. Okay. So what's the difference between a supplement and something, a prescription the doctor would give you? Well, the [00:04:00] short answer is prescriptions have been studied and have to have evidence base behind them.
They would have had to gone through a clinical trial that they were studied in first animals and then humans, and have some proven efficacy, as well as, um, Documented side effects. A supplement does not have to have any of that, unfortunately. They can claim to have a study or two, and maybe they've done something, but it's not maybe as rigorous as the medical would be.
Yeah. Yeah, my favorite thing is when they tell you there's . Proof. Right. . We have proof that this good stuff will cure your brain. Yeah. But again, they don't have to. They might have proof. They might have fed it to their neighbors and asked their neighbor's opinion, , a month later and said, all right, there we go.
We did a study. It's proof, but it's not a full blown clinical trial and evidence. Before we get too far into supplements, because I know everybody's very [00:05:00] interested in it, I think we probably should spend just a little bit of time talking about how, even if it's a supplement, you can buy it from your friendly neighborhood drugstore, so to speak.
Um, you probably really do need to check with your doc because they can interact with what you're taking. I know like St. John's Wort or Kava Kava, if you're, you're on a medication for depression, those can cause problems. Yes? Absolutely. You really should have said, sometimes it's not as big a problem as others, but how do you know, as an individual consuming, if this is not problematic there is a website that I really like to go to.
And it actually very much will tell you about potential interactions and whether any evidence is there. is behind it. It's Mayo Clinic. Um, let me make sure I get it right. It is mayoclinic. org. org backslash drugs dash supplements. That's I go there a lot, , as a professional. And again, it will [00:06:00] say, Hey, even something like vitamin B, right?
We all take vitamin Bs, but it'll tell you, is it generally safe? If it does interact, what does it tend to interact with? Or as you said, some of those other supplements like Ginkgo Bilboa, St. John's Wort, which have now known to be, , dangerous. some , in some cases with certain drugs. Wow. Yeah. All right.
So we are going to have that website in the show notes in case you weren't writing in case you're driving right now, but that is great to know. So informed aging, what kind of supplements are aging people more gearing toward? Well, We do see a lot of older adults really grab anything that says it can benefit your memory.
Um, and I think the marketing folks out in the world absolutely know that. And they target that. And I will tell you right now, as of this moment, there is no clinical evidence behind any memory therapy. Supplement. Not a one. [00:07:00] Uh, say that again. No evidence. Can we name that one that you see on TV all the time that starts with a P.
Can we? I can. Am I allowed to? Sure. I would like to actually talk about Prevagen because I get asked about that all the time. And there, um, Advertising practices are deceptive, and I actually want to point out, if you look it up, you can find out in 2017, and it, the FTC, , Federal Trade Commission actually had a lawsuit against them that was settled in 2020 for false advertising practices.
 Basically it was kind of settled out of court where they are in court, but the settlement was that they had to reword their commercials. But it was so technical that most people don't even pay attention. It was something to the effect that it was proven in a subset of people who are cognitively normal, , unimpaired or mildly impaired.
And basically that subset is a very [00:08:00] small sample size. You notice I said cognitively normal. How do you tell if something is helping you if you do not have any impairment? And it was all opinion. It wasn't a clinical trial. It was not, uh, published in any medical journal, which clinical trials have to be published in peer reviewed journals and reviewed by the, you know, other medical professionals who aren't studying it.
None of that happened. You know, that being said, They're not the only ones, so I don't want you to, you know, you don't want to just pick on this one. And I have noticed their ads change to it's a very much, this is my story and this is what's happening to me. It's no longer so general. It's like, I've been taking this and I feel better.
Not guaranteeing that if you take it, you'll feel better. That, of course, is the implication. Yep. You're absolutely right. And very astute. And that's Let me say that that's what we have to be or do with supplements. We have to be [00:09:00] astute. They have their place actually I mean, I mentioned vitamin B on the Mayo website.
. Sometimes we need vitamin B And you know vitamin D D as in dog my gosh, it's become a very popular supplement It's got a lot of good benefits but you may not need mega doses of it. And certainly those can be checked at your physician's office as far as you have appropriate levels and would benefit from supplementation.
What about vitamin C, our old friend, vitamin C, the one that if you take too much of, you'll be sorry. Oh, really? Oh, yeah. You'll get often, often you'll get stomach cramps and other issues. Oh, from my friend vitamin C. Yeah. Apparently you've never overdosed on vitamin C. I'm proud of you. So, I mean, again, vitamin C has its place like anything else.
It will help you absorb iron better. If you're deficient, , vitamin C combined with zinc, there's been a little evidence. It's mostly the zinc that will help minimize the duration [00:10:00] of a cold.. It will not cure it. It will not stop it. It will only shave a little time off it if it even does that, So, there are some benefits, but don't, mega doses of anything is never a good thing.
You know, everything in moderation, and I mean that for everything. I'll tell you, you can have a little bit of wine and a little bit of coffee. I don't have any problem with that medically. There's been some studies that even benefit. to it. But no, you know, no one wants you to drink a pot of coffee or drink a bottle of wine.
No. Uh oh. I drink a lot of coffee in the morning. Well, little bit is fine. But it is hard. We like our substances, don't we? Yes. So a quart of cold coffee every morning doesn't qualify as a little bit? Probably not. A quart. Wow. Honestly, I'm serious. Okay. Okay. We'll work on that. Yeah. I guess it beats a quart of wine.
Right? Right. I know where you get all your energy. It's that caffeine. Caffeine. So if you've decided, I'm going to try [00:11:00] a supplement, maybe you've talked to your doctor, then you go to the drug store and holy moly, there's a lot to choose from different brands. Is there a way to know? If the store brand is the same as the national brand that I saw on TV or is it, I mean, how would you know?
That's an excellent question. And I will say that as part of the problem with supplements is they are not controlled like a prescription medications. There is one voluntary, Certification that the supplements can get and it's this little USP symbol. It's in a triangle typically 
but basically it's a voluntary certification. They go through that saying hey We're putting our lab where this supplement is manufactured up for voluntary inspection to show that we have clean and safe practices and we're putting in the bottle what we say is in the bottle. It's nothing against, it's nothing about evidence.
It's not going to say what we're putting in the bottle is going to fix you or help you [00:12:00] in any way, but at least you get that knowing what you're buying is what you're buying and that they are generally manufactured under clean and safe places. So look for that USP. symbol. That's a good start. Because there is so few regulation, I could see somebody not acting in our best interest going, Oh, let's make some money.
Say this cures all your diseases and put sawdust in capsules. Who would know unless you open that up? Like if you weren't under any kind of regulation? Yeah, well, and even you're not under any kind of regulation. More likely it's 98. That was a very vivid example. The sawdust. But they'll put something that is all filler and none of the substance.
, there was a study . It was in 2021. Um, and it was published in the Journal of American Medical Association. Glantamine, which is actually you can get that in prescription. . It is a valid prescription for Alzheimer's disease, Alzheimer's type dementia, where it can offer some benefit.
There's been [00:13:00] studies. It is also a supplement and they and I actually, um, it up right before I came in here. So they tested 10 over the counter brands of the galentamine. , and they found that within those tablets, there was actually anywhere between 2 and 110 percent of the galentamine
so some of the capsules and tablets only had 2 percent of what you thought you were buying. And some had too much. Oh. Uh, where they compared it to prescription. I mentioned this is a legitimate prescription because the FDA does monitor and control. They ran between 97. 5 and 104%. So a much tighter.
restriction. So yeah, if I'm paying for a thousand milligrams of vitamin C and I find out there's actually two milligrams in there, I'm not going to be very happy, but nobody's controlling it. It's the wild, wild west and the supplement world. It is. And you'll never know., So that's why we sometimes say supplements and [00:14:00] vitamins and minerals can just be expensive urine.
, and that's if, you know, if it is just a water soluble one that you urinate out. Which is another potential side effect of these supplements and vitamins. And you know, full disclosure, I take some myself. I do. . You know, there's a few that I like to just double check that I have enough in my body and diet.
 But, , If you spend a lot of money on supplements, 50, 60, 70 a bottle, some of these, you can spend hundreds of dollars monthly on a medication that A, may not be offering you benefit, and even B, more harmful if you're taking that in place of a prescription, if you are not taking that in place of a prescription.
going and seeking opinion from your physician, your healthcare practitioner. Is this right or is this wrong? What's best for me? Maybe you're not getting it because you think you watched the commercial and you say, well, why am I going to go to my doctor? I can just buy this and take it. Yeah. Yeah. Scary stuff.
And I'm with you. I [00:15:00] take, you know, my fish oil supplements and I take my probiotics and both have been recommended by doctors and I'm a big believer in them both. But yeah, there's so many to choose from when I am shopping. And then I shopped on price and I'm like, Oh, now I'm going back to the expensive one that worked better for me.
So it's just, it's so hard to tell. It is. And I wish I had an easy answer. I said, other than knowing the symbol, you mentioned something that I love, Rob, and you know what worked for you, you know, if you really had some benefit, you be in tune with yourself and your own body. And if you're getting some side effects.
So some common ones that turn out to be pretty good have some evidence behind them. I think fish oil. Has some good things. Fish oil does. Omega 3 fatty acids certainly know there's some benefit to cholesterol, which can also, as we're talking about older adults being concerned about, um, Different types of dementia, vascular dementia, that would definitely offer you some benefit.
, Coq 10, some [00:16:00] benefit for, again, if you're taking the, , the statins, it can help minimize the side effects. Also help with heart disease. I mentioned vitamin B12, particularly you can be diet deficient. If you've ever had, you can get a malabsorption problem. So taking supplemental B12, maybe even by injection, which would be a physician.
 Prescription vitamin D, which I'd invested in vitamin D 20 years ago. It's known to have a lot of benefits. Calcium to a certain degree. So yes, so those daily multivitamins, those would be considered a supplement as well? Correct. Okay. So you'd want to get your USP symbol at least and do that.
So now I do work closely with the physician, , who says her view on it is if they're not harmed, like she gets asked them and her view is if they're not harming the person, financially or some potential side effect that they're still talking with their doctor openly about them all. She say, [00:17:00] I don't never say never because I want someone if they really feel good about it and it's important to them and they are aware of the potential downfall as well as potential benefits and no, there's no guarantee.
She'll kind of say, knock yourself out. It's okay. Yeah. I think if you've heard what we've had to say, and then as we ask you to do, talk to your own expert, talk to your doctor about the supplements, I think, you know, you're going to be on the good path, but it's just knowing that there isn't a lot of regulation there that I think people do need to know that part of it.
Yes. Yes. And don't, just don't mix. You've got to talk to your doctor. You have to. We've seen some pretty unpleasant things happen when people take things without checking it out with their doc first. Yeah. You know? Absolutely. Absolutely. I think one of the things that was said, and I believe it was Dr. Ira Goodman that said it at a, um, workshop he was doing for us, was, and he was talking about CoQ10 and said [00:18:00] he takes it too, but he said you, you really, we don't know how much to take.
Because there's not a lot of evidence for how much really does work. So I thought that was pretty interesting. I think that might maybe tip people into taking, you know, 10, 000 micrograms of something when they really only need five. Right. Or whatever. Exactly. We don't know. And, you know, more studies need to be done.
There's just not enough time and money put into some of these. So I, I agree though, very much so. Talk to me about supplements and thyroid medication. Well, , I don't know which supplements you're thinking in particular, but , if you take metal based, supplements like calcium, magnesium, those interact with thyroid medication, they bind.
Um, so you cannot take those at the same time, which is something that's important. important for a lot of old adults knows that multivitamin. If you take a multivitamin for women over 50, there's calcium in there. I promise you that there's [00:19:00] magnesium in there. , and if you're taking that first thing in the morning on your empty stomach with your thyroid medicine, you're probably not getting the The full benefit of your thyroid medication, it's binding it up.
So, thank you. That was a very good question and point. A lot of people don't think about that. I take thyroid medicine, so I had to learn that because I was just dumping everything in my hand and going glop, and um, the labs got off. Okay. And the question was, aren't you taking your meds? It's like, yeah, I am.
Right. Tell me how you do that. Well, with that quart of cold coffee. So now I take it 30 minutes beforehand with water and then we start with the coffee and whatever else. And that's it. That's the perfect way. Actually. We say thyroid medicine needs to go down with water all by itself. Okay. Doesn't always play nice with others or others don't play nice with it, I guess we should say.
I'm always relieved when I got good. Good information. Yes. No, that is, that is good information. Um, and you should tell every physician you go to which [00:20:00] supplements you take it. I will say sadly in our healthcare provider, not just physicians. , sometimes I don't care.
I, myself was in a specialist appointment this morning for something minor. Um, and they asked me if I have prescriptions and I offered to tell them the supplements I take. She said, no, that's okay. We don't need them. Hmm. Okay. Now, this was not someone who was going to prescribe medications for me. However, I would think you'd want, I mean, I offered, um, so please do offer.
And if that provider is prescribing a medication, you have to advocate yourself and get a little insistent to just see everything I take. So. Yeah. Yeah. Good tip. Well, uh, shop with caution. Always talk to your experts and make sure it's a good idea for you to take that supplement if you decide that's for you.
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Today's episode was recorded at ADRC's podcast studio. That's it for now. We're looking forward to our next visit.