PEN eNews 12(8) August 2022 - Promoting dietetic cultural competence in PEN content

What is the Latest on Dyslipidemia and Dietary Supplements?

How beneficial are dietary supplements (e.g. berberine, coenzyme Q10, garlic, guggul, lecithin, niacin, policosanol, red clover, red yeast rice, rice bran oil) in the treatment of dyslipidemia?

Recommendation

Data from a systematic review and meta-analysis of RCTs suggests efficacy in the use of berberine for improving blood lipid levels in adults with dyslipidemia. No adverse events were reported; however, due to high heterogeneity and the risk of bias, additional research is needed to confirm these findings.

Recommendation

Clinical trials provide conflicting data regarding the benefit of coenzyme Q10 (CoQ10, ubiquinone, ubiquinol) for improving the lipid profile of adults with dyslipidemia. Studies reporting beneficial effects for CoQ10 on the lipid profile have been criticized as being poor quality trials due to having small sample sizes and inconsistent findings. The efficacy of CoQ10 for managing serum lipids is therefore unknown until high quality studies are published.

Recommendation

Data from systematic reviews and meta-analyses provide inconsistent evidence for the effectiveness of garlic supplements on blood lipid levels, with pooled results showing no effect to a 5% decrease in total cholesterol levels and no effect to a 6% decrease in LDL-C levels. Reported effects appear to be greater in individuals with baseline hypercholesterolemia. Data from clinical trials consistently report no overall effects of garlic supplements on HDL-C levels; however, garlic oil compared to other garlic preparations was shown to significantly increase HDL-C. Reported mild adverse effects of garlic include breath and body odour and gastrointestinal disturbances. Garlic has anticoagulant and antiplatelet effects and is not recommended for individuals taking warfarin, aspirin or other anticoagulant medication.  

The use of garlic supplements for the management of hypercholesterolemia may warrant discussion with clients with consideration given to the trade-offs between the potential modest beneficial effects on total and LDL-C levels with mild side-effects. 

To read the full practice question, including recommendations for guggul, lecithin, niacin, policosanol, red clover, red yeast rice and rice bran oil, click here.

Knowledge Pathway Alert: Lactation!

The Lactation Knowledge Pathway has been updated! Check out these new and updated practice questions:

Do trans fatty acids (from hydrogenated omega-6 fatty acids) consumed by a lactating individual have adverse effects on their infant?

Does the conjugated linoleic acid (CLA) content of a lactating individual's diet affect the total fat content and the CLA composition of their milk?

Are there safety concerns for the ingestion of fish in individuals who are pregnant, planning to become pregnant or breastfeeding related to mercury contamination?

What is the impact of caffeine intake in pregnancy and lactation?

What are the infant and gestational-parent health outcomes associated with breastfeeding for six to 12 months or more compared to outcomes of infants and gestational-parents who stop breastfeeding before six months?

What are the benefits of breastfeeding on cancer prevention for the lactating individual and infant?

Is lactation associated with a decreased risk of developing type 2 diabetes among parous individuals without a history of gestational diabetes?

See the complete Lactation Knowledge Pathway for 11 more new or updated practice questions.

Curious about the language used in this Knowledge Pathway? Learn about how the PEN Team contributes to improving cultural competence in dietetics.

We recently moved the updated and existing practice questions in the Men’s Health and Women’s Health Knowledge Pathways to the Urogenital System Knowledge Pathway as part of our inclusivity efforts. See below for the practice questions that now make up this knowledge pathway. Also, learn about how the PEN Team contributes to improving cultural competence in dietetics. 

Is Lactobacillus (e.g. live preparations of Lactobacillus or foods containing live Lactobacillus such as yogurt) effective in the treatment and prevention of vaginitis (bacterial vaginosis and vulvovaginal candidiasis)?

Do dietary restrictions affect the growth of Candida albicans?

Do dietary supplements reduce the symptoms of premenstrual syndrome (PMS)?

Can saw palmetto (Serenoa repens) help alleviate the symptoms of benign prostatic hyperplasia? 

Are there any foods or dietary supplements that can help treat erectile dysfunction?

There are more than just practice questions! To see the Summary of Recommendations and Evidence, the Related Tools and Resources and Pathway Contributors, click here.

Wondering about Summaries of Evidence and Recommendations (SREs)? The SRE organizes all of the questions in a knowledge pathway by topic. It is your one-stop shop to find the key practice points (including recommendations and graded evidence) for the topics covered in the knowledge pathway. See the New and Upcoming Content for a list of the latest updated SREs and other content.

Do you love the PEN Handouts? Reviewers are Needed!

We want to share a fantastic opportunity to help shape PEN content to ensure it is relevant to Canadian dietitians in everyday food and nutrition practice.

We are looking for volunteers to be peer reviewers for our PEN client handouts. Handouts to be reviewed are:

• Eating Guidelines to Prevent and Manage Osteoporosis
• Functions and Food Sources of Vitamins
• Food Sources of Vitamin C
• Eating Guidelines for a Low Tyramine Diet
• Eating Guidelines and Inflammatory Bowel Disease.

Do any of these topic areas fall within your practice setting? If so, the handout review would entail:

• Using your professional knowledge/clinical expertise provide feedback on the information/content provided in the handout.
• Based on interactions with your clients and questions they may have about the related diet in your practice, is there any information missing within the handout that we should consider adding?
• General feedback - flow of information, clarity, what doesn't work well.

Thank you in advance for considering. Please contact Jane Bellman, PEN Resource Manager at jane.bellman@dietitians.ca if you are interested.

The PEN Team is continuously exploring our role in promoting culturally safe, competent, inclusive practice globally. We've applied our learning in recent PEN content updates.

Our Lactation and Breastfeeding Knowledge Pathways were reviewed to ensure practice recommendations are up to date with the latest evidence. The PEN Team also used this as an opportunity to review the terminology related to breastfeeding/human milk feeding and associated behaviours. Using an evidence-informed approach, we referred to the Academy of Breastfeeding Medicine Position Statement and Guidelines. We also consulted with our stakeholders of front-line dietitians who rely on PEN content to support them in everyday practice. Our consultation led to new and updated practice questions in these Knowledge Pathways framed with client-centered safety in mind, for example: Do trans fatty acids (from hydrogenated omega-6 fatty acids) consumed by a lactating individual have adverse effects on their infant? and others.

We recognize language as one of the many ways to signify inclusion and suggest substituting gender-inclusive terms when communicating recommendations regarding lactation-related behaviours and parental identity. You can learn about our intention by reading the Message to Our Readers on relevant PEN content so you can stay informed about our process.

The PEN Team is also looking at the inclusivity of the titles of our Knowledge Pathways. Most recently, practice questions in the Men's Health and Women's Health Knowledge Pathways were moved to the Urogenital System Knowledge Pathway.

Stay tuned as we continue to update content in the PEN System to support dietitians in practice.