Natural Medicines…monthly update

	Natural Medicines Comprehensive Database eUPDATE and eCE Here are just a few of the hundreds of updates we’ve made to Natural Medicines Comprehensive Database this month. You can learn more about these and thousands of other natural medicines by accessing the Database. Plus you can get fully accredited continuing education credits. • Vitamin K is now showing up along with calcium and vitamin D in supplements used to prevent bone loss and osteoporosis. Some of these include Bone & Joint Care, Bone Care, Nutra K2 Osteo, OsteoPrime, and many others. Vitamin K is a cofactor in some bone forming processes. Low vitamin K levels are associated with reduced bone mineral density and increased fracture risk. But clinical research using vitamin K supplements is conflicting. Some studies show that taking certain forms of vitamin K supplements increases bone mineral density and might reduce fracture risk, but other research shows no benefit. Tell patients that the jury is still out on using vitamin K-containing supplements for preventing osteoporosis. Caution patients taking warfarin (Coumadin) not to take calcium with vitamin K unless they are prepared to take it consistently. INR monitoring is needed when starting or stopping vitamin K-containing supplements. Continue to recommend calcium and vitamin D supplements for those who need it. • Pomegranate juice has been suspected of potentially interacting with a long list of drugs, similar to grapefruit juice. This was based on test tube and animal studies showing that pomegranate inhibits the drug metabolizing enzyme cytochrome P450 3A4 (CYP3A4). But new research in humans shows that pomegranate does NOT significantly increase serum levels of drugs metabolized by CYP3A4. This interaction still shows up in some interaction screening programs. Keep in mind that it is not likely to be clinically significant. • Cran-Max is a dietary supplement promoted for urinary tract infections (UTI). It contains cranberry whole fruit concentrate. A recent clinical trial shows that taking Cran-Max 500 mg daily for 6 months is comparable to trimethoprim 100 mg daily for preventing recurrent UTI in women. For women who want to try cranberry, recommend drinking cranberry juice or cranberry juice cocktail. These have the best evidence. But Cran-Max is worth considering for women who don’t want to drink the juice. Breast cancer is the most common cancer in women and second only to lung cancer in cancer-related deaths. Many women turn to natural medicines for preventing and treating breast cancer. Get the latest scientific evidence on soy, red clover, flaxseed, European mistletoe, and many other natural medicines used for breast cancer in our new course, Natural Medicines in the Clinical Management of Breast Cancer.