Know What Your Patients are Taking, Including Over-the-Counter Medicines, Supplements, and Functional Foods

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania. Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida.

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Dear Colleagues,
Welcome to another issue of Bariatric Times. This month, we feature an article by Faria et al titled, “Is There Room for Functional Foods and Phyto Supplements in the Bariatric Patient Population?” I believe this is an excellent question to ask as natural remedies continue to gain in popularity among the general public. I believe that these functional foods and phyto supplements can have a place in the bariatric patient’s diet, but want to emphasize that they should not replace the required nutrients in any individual’s diet.

Probiotics are probably the strongest area of research not only for obesity, but also for other inflammatory diseases, such as inflammatory bowel disease and rheumatoid arthritis.[1,2] I think that our gut microbiome does change and probiotics can help, especially in individuals that have digestive issues after any type of gastrointestinal surgery.

Recently published studies[3,4] show that bariatric surgery can change the gut flora. Sweeney and Morton3 studied the changes in the distal gut microbiome composition in obese phenotypes, particularly after surgical weight loss. They found an overabundance of Proteobacteria in the distal gut microbiome of patients who underwent Roux-en-Y gastric bypass (RYGB), which is distinct from the changes seen in weight loss without RYGB. Another research group showed that among post-RYGB patients, supplementation with lactobacillus probiotics (phylum Firmicutes) led to greater weight loss and less bacterial overgrowth.[4]

Patients frequently ask me about the benefits of probiotics. I think this interest has stemmed from the yogurt industry and the marketing of the live active cultures contained in yogurt. While some patients may not understand the science behind why probiotics work, I think that they get a sense of the good flora and the bad flora.
Another item on the authors’ list is something I have discussed in past messages—omega 3. Controlled studies show that omega 3 supplementation may help to lower cholesterol and inflammatory pathways involved in the metabolic syndrome.[5–7]

While these studies show improvements in cholesterol and body weight, it is important to realize that these are case controlled studies and not randomized controlled studies; which is fine, but, they MAY infer a biased outcome in that IF such an individual commits to taking these supplements every day, he or she MAY also be more more apt to exercise regularly and have a higher diet quality.

An integrated health team that includes registered dietitians is advantageous in determining the proper nutrition plan for each individual patient. Patients should have the proper balance between their diet and supplementation, making sure he or she isn’t over supplementing. While it is sometimes easier to get vitamins, functional foods, and phyto supplements in the traditional pill form, I prefer to have patients add them into their diet as “real food” whenever possible. Fiber is a great example. Patients can take pectin or glucomannan, but I feel it is much better if they increase the fiber in their diets.

One should take a thorough medication history—prescription medications, over the counter medications, supplements, and other functional foods—in order to avoid over supplementation and interactions with prescription medications. Many electronic medical records will automatically flag drug-nutrient interactions, so a complete medication reconciliation at each patient appointment is important.

The integrated health team is usually aware of risks and interactions of of functional foods and phyto supplements as well. While green tea is a known antioxidant to fight cell damage, excessive consumption may lead to liver damage. Ginger and cinnamon, thermogenic foods discussed by Faria et al, may help lower cholesterol, improve insulin sensitivity, and energy expenditure, but overcomsumption can be dangerous (e.g., too much cinnamon can affect red blood cell division).

My main message to patients and healthcare providers is that moderation is key when considering all components of nutrition—food, vitamin supplements, functional foods, and phyto supplements. Lastly, we must be aware of everything our patients are taking to ensure there are no adverse interactions with prescription medications.

Sincerely,

Christopher Still, DO, FACN, FACP

References
1. Orel R, Trop TK. Intestinal microbiota, probiotics and prebiotics in inflammatory bowel disease. World J Gastroenterol. 2014; 20(33): 11505–11524.
2. Pineda Mde L, Thompson SF, Summers K, et al. A randomized, double-blinded, placebo-controlled pilot study of probiotics in active rheumatoid arthritis. Med Sci Monit. 2011;17(6):CR347–354
3. Sweeney TE, Morton JM. The human gut microbiome: a review of the effect of obesity and surgically induced weight loss. JAMA Surg. 2013;148(6):563-9.
4. Woodard GA, Encarnacion B, Downey JR, et al. Probiotics improve outcomes after Roux-en-Y gastric bypass surgery: a prospective randomized trial. J Gastrointest Surg. 2009;13(7):1198–1204.
5. Welty FK, Alfaddagh A, Elajami TK. Targeting inflammation in metabolic syndrome. Transl Res. 2015 Jul 3. pii: S1931–5244(15)00222-4.,
6. Lorente-Cebrián S, Costa AG, Navas-Carretero S, et al. Role of omega-3 fatty acids in obesity, metabolic syndrome, and cardiovascular diseases: a review of the evidence. J Physiol Biochem. 2013;69(3):633–651.
7. Belchior T1, Paschoal VA, Magdalon J, et al. Omega-3 fatty acids protect from diet-induced obesity, glucose intolerance, and adipose tissue inflammation through PPARγ-dependent. Mol Nutr Food Res. 2015;59(5):957–967.

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Category: Editorial Message, Past Articles