Ellen is a 60-year-old female who was referred from her primary care provider for evaluation of her dietary supplements. Medical history includes hypertension, hypercholesterolemia, osteopenia, mild depression, and memory problems. Two years ago, she had angioplasty (PTCA) with a stent placement in her coronary artery. Ellen is a retired school teacher, married, and has two grown children. Her neighbor works in a supplement store and recommended some herbs and supplements to address Ellen’s health concerns. At the initial consult Ellen reports she is taking the following supplements: calcium carbonate 1200 mg/d, garlic (Allium sativum) 500 mg/d, Ginkgo biloba 240 mg/d, and St. John’s wort (Hypericum perforatum) 900 mg/d. Her prescription medications include warfarin, simvastatin, sertraline, and atenolol. Height: 640 Weight 165 lbs BMI: 28.4 Blood pressure readings: 134/92, 140/95 “This is higher than it usually is” Ellen reports. Recent labs: Total cholesterol: 284 mg/dl HDL: 36 mg/dl LDL: 140 mg/dl Prothrombin times (INR) has been inconsistent lately. Typical dietary intake includes the following: Breakfast: Total cereal with milk and calcium fortified orange juice for breakfast Lunch: Frozen entrée—beef and broccoli with rice and a diet coke Snack: Strawberry yogurt and pretzels, coffee with milk Dinner: Meatloaf, mashed potatoes with gravy and carrots. Glass of red wine. Dessert: Chocolate ice cream, coffee with milk
1. Using the Office of Dietary Supplements Fact sheets (ODS website), identify what each dietary supplement Ellen is taking is used for and if it has good evidence to support use.
2. List any potential drug nutrient interactions (DNI) Ellen may have with her current concomitant use of medications and dietary supplements.
3. Looking at Ellen’s labs, is there any evidence she may be having a drug nutrient interaction (DNI)?
4. Does Ellen need to be taking a calcium supplement? Are there any potential risks with taking 1200 mg/day with a positive history of cardiovascular disease (CVD)?
5. Write a PES statement for your top concern based on your assessment.