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Background: Although many pharmacies sell natural health products (NHPs), there is no clear definition as to the responsibilities (if any) of pharmacists towards these products. Objective: The purpose of this study was to explore and compare pharmacy and stakeholder leaders’ perceptions of pharmacists’ professional NHP responsibilities. Methods: Semi-structured key informant interviews were conducted with pharmacy leaders and stakeholder leaders representing: consumers, complementary and alternative medicine practitioners, conventional healthcare practitioners, and industry across Canada. Results: Nearly all participants believed safety monitoring was a key responsibility of pharmacists. One challenge identified was pharmacists’ general lack of NHP knowledge. Stakeholder leaders did not expect pharmacists to be NHP experts, but should have a basic level of education on NHPs. Many pharmacy leaders seemed unfamiliar with current pharmacy NHP policies. Conclusion: Participants described pharmacists’ professional responsibilities for NHPs as similar to those for over-the-counter drugs. More awareness of existing NHP-related pharmacy policies is needed.

Objectives: To use the means-end chain (MEC) decision-making approach to compare two groups of participants using natural health products (NHPs) with and without scientific evidence support. Methods: The laddering technique was used to interview 25 participants with osteoarthritis. Hierarchical value maps were generated to depict the decision-making processes. Semi-structured questions probed the role of scientific evidence in the decision-making process and content analysis identified thematic similarities and differences between the two groups. Results: The dominant decision-making chain between participants in the two scientific evidence categories was similar. Scientific evidence is an important decision-making factor but not as important as the advice from health care providers, friends and family. Conclusions: The MEC-approach and its associated laddering methodology helped us understand how people make decisions about NHPs. There were essentially no differences in how consumers in our two groups incorporated scientific evidence into their choice of NHPs for OA.

Objectives: To use the means-end chain (MEC) decision-making approach to compare two groups of participants using natural health products (NHPs) with and without scientific evidence support. Methods: The laddering technique was used to interview 25 participants with osteoarthritis. Hierarchical value maps were generated to depict the decision-making processes. Semi-structured questions probed the role of scientific evidence in the decision-making process and content analysis identified thematic similarities and differences between the two groups. Results: The dominant decision-making chain between participants in the two scientific evidence categories was similar. Scientific evidence is an important decision-making factor but not as important as the advice from health care providers, friends and family. Conclusions: The MEC-approach and its associated laddering methodology helped us understand how people make decisions about NHPs. There were essentially no differences in how consumers in our two groups incorporated scientific evidence into their choice of NHPs for OA.

Background: Although many pharmacies sell natural health products (NHPs), there is no clear definition as to the responsibilities (if any) of pharmacists towards these products. Objective: The purpose of this study was to explore and compare pharmacy and stakeholder leaders’ perceptions of pharmacists’ professional NHP responsibilities. Methods: Semi-structured key informant interviews were conducted with pharmacy leaders and stakeholder leaders representing: consumers, complementary and alternative medicine practitioners, conventional healthcare practitioners, and industry across Canada. Results: Nearly all participants believed safety monitoring was a key responsibility of pharmacists. One challenge identified was pharmacists’ general lack of NHP knowledge. Stakeholder leaders did not expect pharmacists to be NHP experts, but should have a basic level of education on NHPs. Many pharmacy leaders seemed unfamiliar with current pharmacy NHP policies. Conclusion: Participants described pharmacists’ professional responsibilities for NHPs as similar to those for over-the-counter drugs. More awareness of existing NHP-related pharmacy policies is needed.

Hypercholesterolemia, a condition of high cholesterol levels in the circulation, poses a major risk for developing cardiovascular disease, such as atherosclerosis. A common method of reducing plasma cholesterol levels relies on the administration of drugs that limit cholesterol synthesis or uptake, many of which have undesirable side effects. Thus, some patients are turning to an alternative treatment, namely natural health products. Natural health products are often equally or even more effective at treating illness than synthetic drugs and may produce fewer side effects. The goal of this study was to identify a natural health product that regulates hepatic cholesterol synthesis by inhibiting HMG-CoA reductase, the enzyme which catalyzes the rate-limiting step of the cholesterol synthesis pathway. Several natural compounds were screened using the human hepatoma cell line HepG2. One compound, berberine, showed great potential as a regulator of cholesterol synthesis and so became the subject of this investigation. Berberine inhibited HMG-CoA reductase activity and decreased cellular accumulation of cholesterol. Berberine was shown to regulate HMG-CoA reductase through activation of metabolic regulator AMP-activated protein kinase, which modifies HMG-CoA reductase post-translationally and thereby decreases its activity. In conclusion, this study demonstrates that the natural health product berberine decreases cholesterol synthesis by activating a cellular signalling pathway to bring about post-translational modification of HMG-CoA reductase, and in doing so, inhibits this enzyme. This novel mechanism supports berberine’s potential for a cholesterol-lowering therapy and its role in reducing the risk for cardiovascular disease.

Hypercholesterolemia, a condition of high cholesterol levels in the circulation, poses a major risk for developing cardiovascular disease, such as atherosclerosis. A common method of reducing plasma cholesterol levels relies on the administration of drugs that limit cholesterol synthesis or uptake, many of which have undesirable side effects. Thus, some patients are turning to an alternative treatment, namely natural health products. Natural health products are often equally or even more effective at treating illness than synthetic drugs and may produce fewer side effects. The goal of this study was to identify a natural health product that regulates hepatic cholesterol synthesis by inhibiting HMG-CoA reductase, the enzyme which catalyzes the rate-limiting step of the cholesterol synthesis pathway. Several natural compounds were screened using the human hepatoma cell line HepG2. One compound, berberine, showed great potential as a regulator of cholesterol synthesis and so became the subject of this investigation. Berberine inhibited HMG-CoA reductase activity and decreased cellular accumulation of cholesterol. Berberine was shown to regulate HMG-CoA reductase through activation of metabolic regulator AMP-activated protein kinase, which modifies HMG-CoA reductase post-translationally and thereby decreases its activity. In conclusion, this study demonstrates that the natural health product berberine decreases cholesterol synthesis by activating a cellular signalling pathway to bring about post-translational modification of HMG-CoA reductase, and in doing so, inhibits this enzyme. This novel mechanism supports berberine’s potential for a cholesterol-lowering therapy and its role in reducing the risk for cardiovascular disease.

Introduction: Based on the perceived risk to newborns and pregnancy outcomes associated with certain drugs, women may be hesitant to prescribe and take drugs during pregnancy. In cases like these, pregnant women may seek treatment using natural health products (NHPs) as alternatives to drugs. Unfortunately, evidence of safety in pregnancy and lactation is unknown for many NHPs. Objectives: To review the present state of evidence on the safety of NHPs during pregnancy and lactation. To create a new system to validate evidence on NHPs during pregnancy and lactation designed to affect medical decision. Methodology: NHPs were systematically reviewed and in some cases, meta-analyzed for evidence of safety during pregnancy and lactation. Results: In total, 79 NHPs were systematically reviewed and 2 NHPs were meta-analyzed in order to determine the evidence of safety in pregnancy and lactation. Despite the presence of data (72/79 NHPs in pregnancy and 53/77 NHPs in lactation), the quality of the data was generally poor. Using evidence-based medicine principles, a new system of evaluating evidence was established for studies involving NHPs in pregnancy and lactation. A number of NHPs were identified as being of potential risk in pregnancy. A number of NHPs were identified as potentially being apparently safe in pregnancy and lactation. Blue cohosh is of potential concern for harm in pregnancy given an apparent dose-dependant relationship. Conclusion: There is a large knowledge gap on the safety of NHPs in pregnancy, even more so in lactation. The new system for evaluating NHP safety in pregnancy and lactation will require validation. In order to improve the knowledge gap, future studies are proposed on NHPs in pregnancy and lactation as part of the newly formed MotherNature research network.

Introduction: Based on the perceived risk to newborns and pregnancy outcomes associated with certain drugs, women may be hesitant to prescribe and take drugs during pregnancy. In cases like these, pregnant women may seek treatment using natural health products (NHPs) as alternatives to drugs. Unfortunately, evidence of safety in pregnancy and lactation is unknown for many NHPs. Objectives: To review the present state of evidence on the safety of NHPs during pregnancy and lactation. To create a new system to validate evidence on NHPs during pregnancy and lactation designed to affect medical decision. Methodology: NHPs were systematically reviewed and in some cases, meta-analyzed for evidence of safety during pregnancy and lactation. Results: In total, 79 NHPs were systematically reviewed and 2 NHPs were meta-analyzed in order to determine the evidence of safety in pregnancy and lactation. Despite the presence of data (72/79 NHPs in pregnancy and 53/77 NHPs in lactation), the quality of the data was generally poor. Using evidence-based medicine principles, a new system of evaluating evidence was established for studies involving NHPs in pregnancy and lactation. A number of NHPs were identified as being of potential risk in pregnancy. A number of NHPs were identified as potentially being apparently safe in pregnancy and lactation. Blue cohosh is of potential concern for harm in pregnancy given an apparent dose-dependant relationship. Conclusion: There is a large knowledge gap on the safety of NHPs in pregnancy, even more so in lactation. The new system for evaluating NHP safety in pregnancy and lactation will require validation. In order to improve the knowledge gap, future studies are proposed on NHPs in pregnancy and lactation as part of the newly formed MotherNature research network.

Ce projet découle du Canadian Sport Centre Dietary Study qui avait pour objectif d’évaluer les habitudes de consommation de suppléments alimentaires chez les athlètes canadiens et de déterminer si des différences régionales existaient. Un nombre de sujets était prédéterminé pour chaque province en considération du nombre d’athlètes identifiés comme Excellence, Élite ou Relève par les Centres d’entraînement nationaux et les organismes gouvernementaux. Pour ce mémoire, seules les données associées aux athlètes du Québec ont été considérées. Quarante-trois athlètes ont répondu à un questionnaire sur l’utilisation des suppléments alimentaires, 71 ont fourni un journal alimentaire de trois jours et 42 parmi ces derniers ont remis les deux documents. La prévalence d’utilisation des suppléments alimentaires était de 90,7%. Les utilisateurs consommaient en moyenne 3,35 produits différents, particulièrement des boissons énergétiques (48,8%), des multivitamines-minéraux (37,2%), des produits de santé naturels (37,2%) et des suppléments de protéines en poudre (34,9%). Les athlètes souhaitaient maintenir leur santé (27,9%) et améliorer leur niveau d’énergie (27,9%) ou leur récupération (25,6%). Les sources d’information citées étaient les entraîneurs physiques (25,6%), la famille ou les amis (16,3%) et les coéquipiers (16,3%). Les sujets se procuraient ces produits dans les épiceries (16,3%), les pharmacies (14,0%) et les magasins spécialisés (9,3%). Soixante-dix pour cent des sujets croyaient que l’arrêt de l’utilisation des suppléments alimentaires n’aurait aucun impact sur leurs performances ou ne savaient pas comment cela les influencerait. Ils démontraient un vif intérêt au sujet de l’efficacité (69,8%), la légalité (55,8%) et la sécurité (53,5%) de ces produits. Des sujets qui utilisaient un supplément de protéines, 81% présentaient un apport alimentaire supérieur à leurs besoins. L’utilisation de suppléments de multivitaminesminéraux permettait de combler l’apport insuffisant en calcium et en folate, mais pas en potassium. Nos résultats soulignent que ces utilisateurs présentaient des apports dépassant l’apport maximal tolérable pour le sodium, le magnésium, la niacine, le folate, la vitamine A et le fer. Nous pouvons donc conclure que ces deux types de suppléments alimentaires n’étaient pas utilisés d’une façon pertinente. / This project derives from the Canadian Sport Centre Dietary Study. The purpose of this global research project consisted in studying the consumption habits of Canadians elite athletes towards dietary supplements and evaluating if regional differences could be identified. The number of subjects needed for each province was calculated from the number of athletes identified as Excellence, Elite or Releve by the Canadian Sports Centres and governmental organisms. Only subjects from Québec had been considered for this research work. Forty three subjects completed the questionnaire on dietary supplement consumption habits, 71 filled a three day food diary and 42 of them returned both documents. Results showed that dietary supplements were used by 90.7% of our sample. Users were consuming an average of 3.35 different types of dietary supplements, mostly sports drinks (48.8%), multivitamins-minerals (37.2%) and protein powders (34.5%). Reasons behind the use of supplements were: to stay healthy (27.9%), to raise energy level (27.9%) and to accelerate recovery (25.6%). Athletes were getting their information from physical trainers (25.6%), family members or friends (16.3%) and teammates (16.3%). Dietary supplements were bought in grocery stores (16.3%), drug stores (14.0%) and specialised stores (9.3%). Seventy percent of our sample thought that stopping the use of dietary supplement would have no impact on their performance level or had no idea of the impact it could have. Nevertheless, participants showed a clear interest concerning the efficiency (69.8%), legality (55.8%) and safety (53.5%) of dietary supplements. Eighty one percent of the subjects who were using protein supplements had dietary intakes above their needs for that nutrient. The use of multivitamin-mineral supplements compensated for inadequate intakes in calcium and folic acid, but not in potassium. This investigation showed that multivitamin-mineral users had dietary intakes above the Upper Intake Levels for sodium, magnesium, niacin, folic acid, vitamin A and iron. From these results, we can conclude, in this athlete population, that protein and multivitamin-mineral supplements were not required or used adequately.