Bad and medicine: interaction and contraindications
I. Introduction: boundaries and intersections
Biologically active additives (dietary supplements) and drugs (drugs) often coexist in the life of a modern person. However, unlike drugs that pass strict clinical trials and are regulated by state bodies, dietary supplements are usually classified as food products or dietary supplements and are regulated less strictly. This creates the potential for interactions between them, which can be both useful and harmful. Understanding these interactions and contraindications is crucial for ensuring the safety and effectiveness of treatment.
II. The main categories of dietary supplements and their common properties
Bades are a variety of products of products designed to supplement the diet. They can contain vitamins, minerals, herbs, amino acids, probiotics, enzymes and other substances. It is important to understand that dietary supplements are not intended for the treatment, diagnosis or prevention of diseases, although some of them can have certain therapeutic properties.
- Vitamins and minerals: The most important micronutrients necessary to maintain health and normal functioning of the body. Examples: vitamin D, vitamin C, vitamins of group B, calcium, iron, magnesium.
- Herbs and plant extracts: Used in traditional medicine for centuries. They can have antioxidant, anti -inflammatory, immunomodulating and other properties. Examples: echinacea, ginseng, St. John’s wort, ginkgo bilobe.
- Amino acids: Building blocks of proteins necessary for growth, restoration of tissues and other functions. Examples: glutamine, creatine, BCAA (amino acids with an extensive chain).
- Probiotics: Living microorganisms, which, when entering the body in sufficient quantities have a positive effect on health. Support the balance of intestinal microflora. Examples: Lactobacillus, Bifidobacterium.
- Omega-3 fatty acids: Paul -saturated fatty acids that are important for the health of the heart, brain and joints. Contained in fish, linseed oil and other sources.
- Enzymes: Proteins that catalyze biochemical reactions in the body. Used to improve digestion and assimilation of nutrients. Examples: amylase, protease, lipase.
III. Mechanisms for the interaction of dietary supplements and drugs
Interactions between dietary supplements and drugs can occur at various levels, including:
- Pharmacokinetic interactions: Affect absorption, distribution, metabolism and elimination of drugs.
- Impact of absorption: Bades can change the speed and degree of absorption of drugs in the gastrointestinal tract. For example, fiber (contained in some dietary supplements) can bind drugs and reduce their absorption. Some minerals, such as calcium, can affect the absorption of certain antibiotics.
- Influence on the distribution: Bades can affect the binding of drugs to blood plasma proteins, which can change the concentration of a free (active) form of drugs in the body.
- Influence on metabolism: Many dietary supplements, especially herbs, can affect the activity of liver enzymes involved in the metabolism of drugs (for example, cytochrome P450). This can lead to an increase or decrease in the concentration of drugs in the blood.
- Influence on excretion: Bades can affect the excretion of drugs by kidneys or through bile. For example, some dietary supplements can change pH urine, which affects the excretion of some drugs.
- Pharmacodynamic interactions: Affect the action of drugs on the body.
- Synergism: Bad and drugs enhance each other’s action. This can be useful, but can also increase the risk of side effects.
- Antagonism: Bad and drugs weaken the action of each other. This can reduce the effectiveness of treatment.
- Additative effect: Bad and drugs have similar effects on the body. With simultaneous use, the risk of side effects increases.
IV. Specific examples of interactions and contraindications
Below are examples of interactions between specific dietary supplements and drugs, as well as related contraindications:
- St. John’s wort (Hypericum Perforatum) and antidepressants: The St. John’s wort is an inducer of the P450 cytochrome and glycoprotein P. He can reduce the blood concentration of many drugs in the blood, including selective serotonin (SIOS), tricyclic antidepressants, monoaminoxidase inhibitors (IMEO) and others. This can lead to a decrease in the effectiveness of antidepressants and exacerbation of depression. Simultaneous use is contraindicated. In addition, joint intake can lead to serotonin syndrome (hyperthermia, muscle rigidity, cramps, impaired consciousness).
- St. John’s wort and warfarin (anticoagulant): St. John’s wort reduces the anticoagulant effect of warfarin, increasing the risk of thrombosis. It is necessary to avoid simultaneous use.
- St. John’s wort and digoxin (heart glycoside): St. John’s wort reduces the concentration of digoxin in the blood, which can lead to a deterioration in heart function. It is necessary to avoid simultaneous use.
- Vitamin K and Warfarin: Vitamin K is the antagonist of Varfarin. Taking large doses of vitamin K can reduce the anticoagulant effect of warfarin, increasing the risk of thrombosis. It is necessary to control the consumption of vitamin K when taking warfarin.
- Ginkgo Biloba (Ginkgo Biloba) and Antiquesyants / Antiagregants (Aspirin, Klopidogrell): The ginkgo bilobe has anti -aggregate properties and can enhance the effect of anticoagulants and antiplatelet agents, increasing the risk of bleeding. Simultaneous use should be avoided or used with caution under the supervision of a doctor.
- Garlic (Allium sativum) and anticoagulants/antiplatelets: Garlic also has anti -aggregate properties and can enhance the effect of anticoagulants and anti -agents, increasing the risk of bleeding. The simultaneous use of large doses of garlic should be avoided or used with caution under the supervision of a doctor.
- Fish oil (omega-3 fatty acids) and anticoagulants/antiplatelets: High doses of fish oil can have an anti -aggregate effect and enhance the effect of anticoagulants and antiplatelet agents, increasing the risk of bleeding. It should be used with caution under the supervision of a doctor.
- Echinacea (Echinacea purpurea) and immunodepressants: Echinacea stimulates the immune system and can reduce the effectiveness of immunosuppressants. Simultaneous use should be avoided.
- Ginseng (Panax Ginseng) and warfarin: Ginseng can reduce the anticoagulant effect of warfarin, increasing the risk of thrombosis. It is necessary to avoid simultaneous use.
- Coenzim Q10 (COQ10) I WARFARIN: Coenzyme Q10 can reduce the anticoagulant effect of warfarin, increasing the risk of thrombosis. It is necessary to avoid simultaneous use or use with caution under the supervision of a doctor.
- Calcium and tetracycline antibiotics: Calcium binds to tetracycline antibiotics in the gastrointestinal tract, reducing their absorption and effectiveness. It is necessary to take calcium and tetracycline antibiotics with an interval of at least 2-3 hours.
- Iron and levotiroxin (thyroid hormone): Iron can reduce the absorption of levotiroxin, reducing its effectiveness. It is necessary to take iron and levotyroxin with an interval of at least 4 hours.
- Magnesium and antacids: Magnesium contained in some antacids can reduce the absorption of some drugs, such as digoxin and some antibiotics. It is necessary to take magnesium and these drugs with an interval of at least 2 hours.
- Cranberry (Vaccinium Macrocarpon) and Warfarin: Cranberries can enhance the anticoagulant effect of warfarin, increasing the risk of bleeding. The simultaneous use of large doses of cranberry juice or cranberry extract should be avoided.
- Grapefruit juice and many drugs: Grapefruit juice inhibits the enzymes of cytochrome P450, participating in the metabolism of many drugs. This can lead to an increase in the concentration of drugs in the blood and an increase in the risk of side effects. Examples: statins (to reduce cholesterol), some antidepressants, immunosuppressants. The simultaneous use of grapefruit juice and these drugs should be avoided.
- Probiotics and antibiotics: Antibiotics can destroy beneficial bacteria in the intestines, violating the balance of microflora. Taking probiotics during antibiotic treatment can help restore microflora balance and reduce the side effects of antibiotics (for example, diarrhea). However, it is recommended to take probiotics and antibiotics with an interval of at least 2 hours so that antibiotics do not destroy probiotics.
- Solo root (Glycyrhiza Glabra) and diuretics (diuretics): The licorice can cause sodium delay and potassium loss, which can enhance the effect of diuretics and lead to hypokalemia (low blood potassium in the blood). Simultaneous use should be avoided.
- Kurcuma longa and antiquity / antiagregants: Turmeric has anti -aggregate properties and can enhance the effect of anticoagulants and anti -agents, increasing the risk of bleeding. The simultaneous use of large doses of turmeric should be avoided or used with caution under the supervision of a doctor.
- Melatonin and anticoagulants: Melatonin can enhance the effect of anticoagulants, increasing the risk of bleeding. It should be used with caution under the supervision of a doctor.
- 5-HTP (5-hydroxyryptophan) and antidepressants: 5-HTP is the precursor of serotonin and can enhance the effect of antidepressants, especially the SIOOS and IMAO, increasing the risk of serotonin syndrome. Simultaneous use should be avoided.
V. Special population groups
Some groups of the population are especially vulnerable to interactions between dietary supplements and drugs:
- Elderly people: Often they take several drugs at the same time (polypragmasis), which increases the risk of interactions. The functions of the liver and kidneys are reduced with age, which can affect metabolism and excretion of drugs and dietary supplements.
- People with chronic diseases: People with liver diseases, kidneys, heart, diabetes and other chronic diseases can be more susceptible to interactions between dietary supplements and drugs.
- Pregnant and lactating women: Many dietary supplements have not been investigated for safety during pregnancy and breastfeeding. Some dietary supplements can be harmful to the fetus or newborn.
- Children: Dos of dosages for children are often not installed, and some dietary supplements can be dangerous for children.
VI. The importance of consulting a doctor
Before starting to take any dietary supplements, especially if you are already taking medications, you need to consult a doctor or pharmacist. It is important to inform the doctor about all your medicines, dietary supplements and other additives. The doctor will be able to evaluate potential risks of interactions and give recommendations on the safe and effective use of dietary supplements.
VII. Quality and safety of dietary supplements
The quality and safety of dietary supplements can vary significantly. It is important to choose dietary supplements from reliable manufacturers who adhere to quality standards. Pay attention to the availability of quality certificates such as GMP (good manufacturing practice). It is also useful to study the reviews of other consumers. It is important to remember that even “natural” products can be unsafe and cause side effects or interact with medicines.
VIII. The role of the pharmacist
Pharmacists play an important role in counseling patients on the use of dietary supplements and drugs. They can help identify potential interactions, provide information about the correct use and dosages, as well as answer questions regarding safety and efficiency. The pharmacist can also recommend alternative treatment options, if necessary.
IX. Informing about side effects and interactions
It is important to inform the doctor or pharmacist about any side effects that you experience after taking dietary supplements or medicines. This will help to identify potential interactions and take the necessary measures. It is also important to report any changes in your state of health or in the drugs you take.
X. Recommendations for patients
- Always consult a doctor or pharmacist before taking dietary supplements, especially if you are already taking medication.
- Report the doctor about all your medicines, dietary supplements and other additives.
- Choose dietary supplements from reliable manufacturers who adhere to quality standards.
- Carefully read the labels of dietary supplements and medicines.
- Follow the recommended dosages.
- Pay attention to any side effects and inform the doctor or pharmacist about them.
- Do not replace medicines with dietary supplements without consulting a doctor.
- Be especially careful while taking several drugs or dietary supplements.
- Feel free to ask questions to the doctor or pharmacist about dietary supplements and medicines.
XI. Resources for additional information
There are many resources where you can get additional information about dietary supplements and medicines, including:
- Websites of medical organizations (for example, the National Institute of Health of the United States (NIH)).
- Dressing databases (for example, Lexicomp, Micromedex).
- Web sites of dietary supplements.
- Pharmaceutical reference books.
XII. Future research
Further studies are needed for a more complete understanding of interactions between dietary supplements and drugs. Particular attention should be paid to the study of the mechanisms of interactions, the identification of risk factors and the development of strategies to prevent adverse consequences. It is also important to conduct research on the assessment of the effectiveness and safety of dietary supplements for various population groups.
XIII. Legal regulation of dietary supplements
Legal regulation of dietary supplements is significantly different in different countries. In some countries, dietary supplements are regulated as food products, and in others as drugs. It is important to know the legal norms acting in your country to understand what requirements are made to producers of dietary supplements and how to protect themselves from poor -quality products.
XIV. Self -medication and dietary supplements
Bado self -medication can be dangerous, especially if you have chronic diseases or you take medications. It is important to understand that dietary supplements are not a replacement for drugs, and they are not intended for the treatment of serious diseases. If you experience any health problems, you must consult a doctor for diagnosis and treatment.
XV. Marketing Badov
Marketing of dietary supplements is often aggressive and can mislead consumers. It is important to critically treat advertising statements and not believe everything that you see or hear. Remember that dietary supplements do not go through the same strict clinical trials as medicines, and their effectiveness and safety may not be proven.
XVI. Bades and athletes
Athletes often use dietary supplements to improve their results, but it is important to remember that some dietary supplements may contain prohibited substances that can lead to disqualification. Athletes should be especially careful when choosing dietary supplements and consult a doctor or a sports nutritionist.
XVII. Dietary supplement and alternative medicine
Bades are often used in alternative medicine, but it is important to understand that the effectiveness of many methods of alternative medicine has not been proven. If you consider the possibility of using dietary supplements as part of alternative treatment, you need to consult a doctor and get information about risks and advantages.
XVIII. BADs and Vegetary/Vegan
Vegetarians and vegans may need additional dietary supplements to make up for a lack of certain nutrients, such as vitamin B12, iron, calcium and omega-3 fatty acids. It is important to consult a doctor or nutritionist to determine which dietary supplements are needed for you.
XIX. Bades and immunity
Many dietary supplements are advertised as means to strengthen immunity, but it is important to understand that the immune system is complex, and there are no magical means that can guarantee immunity. A healthy lifestyle, including a balanced diet, sufficient sleep and regular physical exercises, is the best way to maintain immunity.
XX. Final recommendations
In conclusion, it is important to remember that dietary supplements are not a panacea for all diseases and should not replace the medicines prescribed by the doctor. Take dietary supplements consciously, consult a doctor or pharmacist, choose quality products and report any side effects. This is the only way you can use the advantages of dietary supplements and avoid potential risks.
XXI. Additional examples of interactions:
- Selenium and chemotherapy: Selenium can enhance the toxicity of some chemotherapeutic drugs. Consultation with an oncologist is needed.
- Kava-kawa (Piper Methysticum) and benzodiazepines: Kava-kawa has a sedative effect and can enhance the action of benzodiazepines, causing excessive drowsiness and oppression of breathing. Avoid simultaneous use.
- Chromium and Insulin/Diabetes Drugs: Chrome can improve insulin sensitivity, which can lead to hypoglycemia (low blood sugar) in people taking insulin or other drugs for diabetes. Careful control of blood sugar is necessary.
- Valeriana Officinalis and sedatives: Valerian root has a sedative effect and can enhance the effect of other sedatives such as benzodiazepines and antihistamines, causing excessive drowsiness. Avoid simultaneous use or use with caution.
- Gotha ASIATICA and high blood pressure medicines: Gota Cola can influence blood pressure and interact with drugs from high blood pressure. It is necessary to control blood pressure and consult a doctor.
- Diaghil medicinal (angelica sinensis) and anticoagulants/antiplatelets: Diagil medicinal can have anticoagulant properties and enhance the effect of anticoagulants and antiplatelet agents, increasing the risk of bleeding. Simultaneous use should be avoided or used with caution under the supervision of a doctor.
- Trigonella Foenum-Graecum) and diabetes medicines: The fencing can reduce blood sugar and interact with diabetes, leading to hypoglycemia. Careful control of blood sugar is necessary.
- Food fibers (fiber) and medicine: A large number of dietary fibers can reduce the absorption of many drugs. It is recommended to take medicines an hour before or two hours after eating products rich in fiber or fiber additives.
XXII. Interactions requiring monitoring:
Some interactions are not absolutely contraindicated, but require careful monitoring of a doctor:
- The combination of iron and inhibitors of the proton pump (IPP): IPP reduce the acidity of the stomach, which can reduce iron absorption. It may be required to adjust the dose of iron.
- Calcium and bisphosphonates (medicines for osteoporosis): Calcium can contact bisphosphonates and reduce their absorption. It is recommended to take them with an interval of at least 2 hours.
- Vitamin D and diuretics (thiazide): Tiazide diuretics can increase the level of calcium in the blood, and simultaneous intake with vitamin D can enhance this effect, leading to hypercalcemia. Calcium is required.
- Caffeine and medicines for asthma (theophylline): Caffeine and theophylline are bronchodilators and can enhance the effect of each other, leading to side effects, such as nervousness, insomnia and heartbeat. Limit caffeine consumption.
XXIII. Development of drugs based on dietary supplements:
Some dietary supplements are studied as potential drugs. If clinical trials confirm effectiveness and safety, they can be developed and approved as drugs. This requires strict quality control, standardization of dosages and clinical trials in accordance with the requirements of regulatory authorities.
XXIV. The influence of genetic factors on interaction:
Genetic factors can affect the metabolism of both drugs and dietary supplements. Genetic variations in enzymes involved in metabolism can lead to differences in the speed and degree of metabolism, which can affect the concentration of drugs and dietary supplements in the blood and the risk of interactions.
XXV. The interaction of dietary supplements and drugs for oncological diseases:
People undergoing treatment from cancer should be especially careful when taking dietary supplements. Some dietary supplements can interact with chemotherapy, radiotherapy and other treatment methods, reducing their effectiveness or increasing side effects. It is imperative to consult with an oncologist before taking any dietary supplements.
XXVI. Integrative medicine and the role of dietary supplements:
Integrative medicine involves combining traditional medical methods with complementary approaches, including the use of dietary supplements. It is important that the integrative approach is based on the evidence base and is used under the leadership of a qualified doctor.
XXVII. Interactions associated with impaired renal function:
In case of impaired renal function, the excretion of many drugs and dietary supplements slows down, which increases the risk of accumulation and side effects. Dosages of drugs and dietary supplements may require adjustments. It is necessary to consult a nephrologist.
XXVIII. Interactions related to impaired liver function:
In case of impaired liver function, the metabolism of many drugs and dietary supplements is disturbed, which also increases the risk of accumulation and side effects. Dosages of drugs and dietary supplements may require adjustments. It is necessary to consult a hepatologist.
XXIX. The role of patients in the prevention of interactions:
Patients play an important role in the prevention of interactions between dietary supplements and medicines. They must:
- Keep a list of all drugs taken, dietary supplements and other additives.
- To inform the doctor and pharmacist about any changes in his state of health.
- Ask questions if something is incomprehensible.
- Store medicines and dietary supplements in an inaccessible place for children.
- Do not share your medicines with other people.
XXX. Long -term consequences of interactions:
Some interactions between dietary supplements and drugs may have long -term health consequences. For example, a long-term decrease in the effectiveness of drugs due to interaction can lead to the progression of the disease. It is important to identify and prevent interactions as early as possible.
XXXI. Interactions associated with cardiovascular diseases:
People with cardiovascular diseases should be especially careful when taking dietary supplements, since some dietary supplements can interact with drugs from cardiovascular diseases, such as anticoagulants, anti-cargans, beta-blockers and ACE inhibitors.
XXXII. Economic aspects of interactions:
Interactions between dietary supplements and drugs can have significant economic consequences, including an increase in medical care costs due to side effects, hospitalizations and a decrease in treatment effectiveness.
XXXIII. Ethics of counseling on dietary supplements:
Doctors and pharmacists should provide patients with objective and evidence -based information about dietary supplements, including potential risks and advantages, as well as possible interactions with drugs. They should not promote or recommend dietary supplements if there is no sufficient evidence of their effectiveness and safety.
Xxxiv. The role of the media in informing about dietary supplements:
The media play an important role in informing the public about dietary supplements. It is important that the information is accurate, balanced and based on scientific data. The media should avoid sensationality and exaggeration of the advantages of dietary supplements.
XXXV. The influence of culture on the use of dietary supplements:
Cultural factors can affect the use of dietary supplements. In some cultures, dietary supplements are widely used in traditional medicine, and people can rely on them as the main means of treatment. It is important to consider cultural characteristics when advising patients on dietary supplements.
XXXVI. Information about risks when buying dietary supplements online:
Buying dietary supplements online can be associated with risks such as buying fake or poor -quality products. It is important to buy dietary supplements only from reliable suppliers and check the authenticity of products.
XXXVII. Actual research and publications on the interactions of dietary supplements and drugs:
New studies are constantly being published on the interactions of dietary supplements and drugs. Doctors and pharmacists must monitor updates in this area in order to provide patients with the most relevant information.
XXXVIII. Development of educational materials for patients:
It is necessary to develop educational materials for patients about dietary supplements, including brochures, websites and videos. These materials should be written in a simple and understandable language and should contain information about the risks, advantages and interactions of dietary supplements.
XXXIX. The role of the associations of pharmacists and doctors in the regulation of dietary supplements:
Associations of pharmacists and doctors can play an important role in regulating dietary supplements, developing quality standards, conducting educational programs for specialists and participating in the development of legislation.
XL. Difficulties in identifying interactions of dietary supplements and drugs:
Identification of interactions between dietary supplements and drugs can be difficult, since patients often do not tell the doctor about dietary supplements, and doctors may not know about all possible interactions. It is important to create a system for collecting and analyzing interactions.
XLI. Using databases to verify interactions:
There are many databases that can be used to check interactions between dietary supplements and medicines. Doctors and pharmacists should use these databases when prescribing drugs and advising patients about dietary supplements.
XLII. Risk and benefit assessment of dietary supplements:
When making a decision on the appointment of dietary supplements, it is necessary to evaluate risk and benefit. The doctor should take into account the patient’s health status, the medicines taken by him and other factors.
XLIII. Prospects for the development of legislation on dietary supplements:
It is necessary to develop a more clear and effective legislation on dietary supplements, which would protect consumers from low -quality products and inaccurate information.
XLIV. The influence of economic factors on the choice of dietary supplements:
Economic factors can affect the choice of dietary supplements. Dietary supplements are often cheaper than drugs, and people can choose them due to considerations of savings. It is important that people make health decisions based on information, and not just on the basis of price.
XLV. Differences in the metabolism of dietary supplements and drugs in men and women:
Metabolism of dietary supplements and drugs can vary in men and women due to hormonal differences and other factors. It is important to consider these differences when prescribing drugs and advice on dietary supplements.
XLVI. Using dietary supplements for the prevention of diseases:
Some dietary supplements can be used to prevent diseases, but it is important to understand that this is not a guarantee of protection against the disease. A healthy lifestyle is the best way to prevent diseases.
XLVII. Interaction of dietary supplements with alcohol:
Some dietary supplements can interact with alcohol, enhancing its effects or causing undesirable side effects. It is important to avoid simultaneous intake of dietary supplements and alcohol.
XLVIII. Safe use of dietary supplements in children:
The use of dietary supplements in children requires particular caution. It is necessary to consult a pediatrician before giving a child any dietary supplement.
Xlix. Using dietary supplements during pregnancy and breastfeeding:
The use of dietary supplements during pregnancy and breastfeeding requires special caution. Many dietary supplements have not been investigated for safety for pregnant and lactating women. It is necessary to consult a doctor before taking any dietary supplement during this period.
L. The influence of dietary supplements on the results of laboratory research:
Some dietary supplements can affect the results of laboratory tests, which may complicate the diagnosis of diseases. It is important to inform the doctor about all the dietary supplements before the tests.
Li. The connection of dietary supplement for living expectancy:
Despite the fact that some dietary supplements can positively affect health, there are no reliable data confirming that the intake of dietary supplements increases life expectancy in general.
LII. The effect of dietary supplements on cognitive functions:
Some dietary supplements, such as ginkgo biloba and omega-3 fatty acids, are studied on the subject of their effect on cognitive functions. However, the results of the studies are contradictory, and additional studies are needed to confirm effectiveness.
LIII. The influence of dietary supplements on sports results:
Some dietary supplements, such as creatine and protein, are widely used by athletes to improve sports results. However, it is important to remember that some dietary supplements may contain prohibited substances.
LIV. Bad and traditional medicine of the peoples of the world:
In various cultures of the world, plant and animal products that have healing properties are traditionally used. Many of these products have become the basis for modern dietary supplements.
LV. The influence of seasonal factors on the effectiveness of dietary supplements:
The effectiveness of some dietary supplements may depend on seasonal factors. For example, vitamin D is more effective in winter, when there is less sunlight.
LVI. The relationship between dietary supplements and genetic diseases:
In people with genetic diseases, such as phenylketonuria or hemochromatosis, the use of dietary supplements requires special caution and consultation with a geneticist.
LVII. Using dietary supplements in geriatrics:
In geriatrics (medicine for the elderly), the use of dietary supplements requires special attention due to increased risk of interactions with drugs and age-related changes in metabolism.
LVIII. The role of dietary supplements in palliative care:
In palliative care, some dietary supplements can be used to relieve symptoms, such as pain, nausea and fatigue. However, it is important that the use of dietary supplements is part of a comprehensive treatment plan and is carried out under the supervision of a doctor.
LIX. BAD and autoimmune diseases:
People with autoimmune diseases should be especially careful when taking dietary supplements, as some dietary supplements can stimulate the immune system and worsen the course of the disease.
LX. The influence of stress on the metabolism of dietary supplement:
Stress can affect dietary supplements, changing the activity of liver enzymes and other organs.