(32), Among the supplements to promote wound healing, some recommend zinc. Copyright - Colorectal Cancer Alliance 2022 501(c)(3), Patient & Family Support Navigator Program. One week before your colonoscopy: Stop ALL vitamins and supplements, including fish oil and iron. The truth is that many powerful drugs (and poisons) are based on natural substances, so it's clear that many natural substances can have a potent effect on the body. When undergoing a procedure, we buy the bottles on Amazon to have on hand for post-op, with our surgeons blessings of course. Heparin has to be stopped 4-6 hours before your colonoscopy. National Library of Medicines list Fish oil contains a potent blood thinner and should be stopped 3 weeks prior to surgery. You will also get a list of what you can and cannot eat or drink. They are usually stopped for four (4) days prior to any procedure. Endoscopic Retrograde Cholangiopancreatography (ERCP), Percutaneous endoscopic gastrostomy placement (PEG tube), Medical Management of Gastrointestinal Disease, Patient instructions for procedures BEFORE 12pm, Patient instructions for procedures AFTER 12pm. o Coumadin / warfarin At least 3-5 days before procedure o Plavix / clopidogrel 5-7 days before procedure o Pradaxa / dabigatran 2-4 days before procedure I do not take anything from the list of (clearest) supplements to avoid except for a small amount of vitamin E (less than the author). complete answer on brighamandwomensfaulkner.org, View Based on all that research, the authors conclusion was this: Fish oil supplements reduced platelet aggregation in healthy subjects. Thats even more important for coffee, which has much higher caffeine content. So what do we know about vitamin D and colon cancer today? (17) (18). The American Society of Anesthesiologists warns against taking supplements like: In addition to these supplements, Stanford University School of Medicine's Department of Otolaryngology says you may need to stop taking certain medications like antiplatelet, blood thinning and anti-inflammatory drugs based on your health care practitioner's recommendations. Due to bleeding concerns, no green tea before surgery is sometimes advised. This is one of the most important reasons why every patient should keep a list of current medications. Although vitamin supplements are often a healthy choice, there are several you'll need to avoid before surgery. For aspirin (81 or 325 mg daily) used to prevent heart problems, this is usually safe to stop for seven (7) days prior to any procedure. We are not responsible for the content and performance of these web sites or for your transactions with them, and our inclusion of links to such web sites does not imply endorsement. Lets review them one at a time. Magnesium citrate or another supplemental form is sometimes recommended since the need for it increases during recovery. One day before, go on a clear-liquid diet. Garlic, onion and curcumin, a polyphenol found in turmeric, have strong anticoagulant and antiplatelet activity. You have reached the maximum number of saved studies (100). Fortunately, there is an even larger clinical trial going on now that will test whether a higher dose of vitamin D (2,000 units per day) can prevent colorectal cancer. How long before surgery should I stop taking fish oil? 5 days before your procedure stop taking bulkforming agents (such as Metamucil or Citrucel) If you take medication for blood pressure or your heart, please continue to take it even the morning of your procedure. Dont forget, the Colon Cancer Alliance serves as a source of information about colon health. (8). Results from following the information contained on EasyHealthOptions.com will vary from individual to individual. Thats based on an analysis of how much bromelain content there is in the average pineapple of 3 different varieties. A study found that 38% of hip and knee replacement patients had inadequate levels and 48% were so low, they were classified as deficient. Controlling those is already a balancing act and when under anesthesia, its even more complicated. amzn_assoc_default_category = "All"; (5) (6) (7), Omega 3 and fish oils are often at the top of the list when it comes to vitamins and supplements to stop taking before surgery. Products mentioned are not intended to diagnose, treat, cure or prevent any disease. complete answer on lexingtonclinic.com. Choosing to participate in a study is an important personal decision. Stop taking all anti-inflammatory medicines, including Advil, Anacin, Aleve, Alka Seltzer, Bufferin, Ecotrin, Indocin, Relafen, Naproxen, Naprosyn, Nuprin, Volaren, Votran. (23), Is turmeric safe before surgery? As with all other dietary supplements, regardless of the type of operation you are getting, it would be best to hold off on the CoQ10 unless your physician okays it. serving of seeds. Do not worry, as iron tablets have not affected the results. When used in typical dosages, ascorbic acid (vitamin C) is not believed to increase the risk of bleeding or to interact with anesthesia. Ephedra, Vitamin C has several effects on your body that could affect the accuracy of the test: 12 Weeks Prior to Your Colonoscopy: Arrange transportation. ; Step #2. 1 day before endoscopy. The National Institutes of Health and Food and Drug Administration currently maintain the stance that fish oil is safe. Some vitamins, like Vitamin E, may have blood thinning effects, but Vitamin D is not one of them. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. National Library of Medicines list Many pieces of research suggest it may be useful as an anti-inflammatory agent, including to reduce surgical swelling. 1. Your Five (5) Day Colonoscopy Checklist Five (5) days before your Colonoscopy. Cleveland Clinic advises that since it may lower blood sugar levels in diabetics and interacts with warfarin, patients need to discuss usage with their physician. If you can use it, consider natural CoQ10 sources. Anti-platelet medications are used to prevent stroke and heart attack. Its incredible how you mentioned that caffeine could stay in your system even 24 hrs after you have ingested it. (24) (25). THIS STUDY IS BEING CONDUCTED AT A MILITARY INSTALLATION. Step 2: Tweak Your Diet. Even though the aforementioned lists did not mention them, avoidance before an operation would be a good idea because research has found it to have an anti-platelet effect which may increase bleeding. (40). Any weight loss or fat burning supplements should be avoided for at least two weeks before surgery. Stop using ginkgo at least 2 weeks before a scheduled surgery. Yes there is a link but usually over a very long time period in which the B12 deficiency was not fully corrected or was left untreated. (202) 628-0123 Toll-free Helpline: (877) 422-2030 It is not known for being a blood thinner or for interacting with anesthesia drugs. an anti-anxiety supplement that can prolong the effects of anesthesia. However, a May 2014 study in the British Journal of Nutrition found that this is not the case. In addition to vitamins C and E, patients are encouraged to stop taking vitamins K, B, and all herbal supplements. 4. r/colonoscopy. Answer: Vitamin D is not a blood thinner, and we allow our patients to consume Vitamin D preoperative rhinoplasty. Chipotle is so unhealthy that just one spoon of their salsa has almost twice the salt of a large order of McDonalds fries. You should also avoid herbs and spices like: Sometimes, your doctor may ask you to continue taking your medications but make dietary changes. rolling stones san diego 2015 why stop vitamin d before colonoscopy One of the important supplements to avoid before surgery is Valerian, because it has sedative properties and can intensify the effects of anesthesia on your body. If you have any health concerns or concerns about potential risks, you should always check with your physician, licensed health provider or health care practitioner. If you need to cancel your appointment, call the office at (760) 783-0441. Review the diet you need to follow for the next 2 days. Someone is pouring vitamins into their hand. How many endings are there for Great Expectations? In plain English, these are very statistically significant results. In addition to their standard pain medications, of which they were allowed to take however many they wanted, 25 of these patients were put on a curcumin regimen, while the other 25 were placed on a placebo regimen. DO listen to all of your physician's recommendations. Do you think that will cause problems? What Herbs and Spices Are Anti-Inflammatory? 2022 SuperfoodlyA Part of Venture Pro Media. Step 1: Plan Your Prep. Garlic can increase the effects of medications used to control blood sugar, blood thinners, and some OTC pain relievers, and can increase bleeding during or after surgery. In most of the instructions tells you to stop taking vitamins with iron or iron suplements,7 days before procedure, one of them says 4 days before, I do take iron suplement, today in the morning I had one tablet,so now I am worry that I will have to be re-scheduled, because this doctor is very busy, who knows when he will have an opening, but in For planned procedures, your doctor(s) will need the drug list to advise you what to stop and what not to stop. The evening before, drink half of a prescription laxative drink to clean out your . Why Should I Register and Submit Results? 4. That being said you need to ask your PS which vitamins/supplements they want you to stop. Referred for a screening colonoscopy or polyp surveillance or had one in the last 2 weeks, we will obtain serum vitamin D blood levels from those scheduled for a screening colonoscopy or polyp surveillance. Normally these would be considered benefits, though while under anesthesia, they could add complexity to controlling your baseline metabolic parameters. I drink tea and I had forgotten or didnt know about the caffeine 24 hour issue. With garlic, chili pepper, and many foods/supplements, their avoidance is recommended simply out of an abundance of caution, based on very limited research. For example, here at Superfoodly, we take Garden of Lifes myKind Organic multi and per serving you get 40 IU, which equates to 59.6 mg of vitamin E or 130% of your daily value. Fish Oil, 12 Chia Seed Health Benefits and 1 Nasty Side Effect. If you have not heard from one of our nurses one week prior to your procedure, please contact Elliot Gastroenterology at 603-314-6907. *** Stop all supplements, vitamin E, fish oil, omega 3, iron, multivitamins *** If you need to stop an anticoagulant, we will need approval from your cardiologist/ neurologist or hematologist to do so. Any ingredients that contains seeds or nuts. And now my favorite tea is plain hibiscus (one cup a day) so its possible lowering blood pressure affect is something to remember. Read more: How Vegans Can Get All Their Nutrients (Without Taking Supplements). View complete answer on aedit.com In the meantime, guidelines set forth by the Institute of Medicine can be employed, which suggest that a dose of 1,000 mg daily is safe.. (12). Multivitamins often have a small fraction of that. As with other herbs, there isnt much of a consensus as to which teas are bad and good. Please be aware unexpected delays may occur. That being said, given the fact that production peaks at around age 20 and that statins further deplete our natural levels, its understandable why this has become one of the bestsellers. Foods containing high amounts of these can also be an issue. For most people it is unnecessary and self-dosing may actually make things worse, as iron is notorious for being a stomach irritant. Tylenol is ok. 6. complete answer on healthy.kaiserpermanente.org, View Why can't i take vitamins before a colonoscopy. (11). Two Weeks Pre-Op Two weeks before your surgical procedure, Dr. Rabach recommends laying off supplements (with a few key exceptions), as taking them increases the risk of bleeding, which could cause complications during surgery and slow the recovery process. This nutrient also contributes to a healthy immune system and cardiovascular system function. 2023 Easy Health Options, Prepping for surgery? You took one tablet two days before the procedure, but that might have dissolved before colonoscopy. (35) (36). The latter is the highest food source of vitamin E. You would get 9.3 mg from a 1 oz. 8 days ago. Excess bleeding in any surgery is never a good thing! How Soon to Stop Taking Fish Oil Before Surgery, University of Maryland Medical Center; Vitamin B-6 (Pyridoxine); Dr. Steven Ehrlich; June 2009, Linus Pauling Institute; All About E; Maret G. Traber, Ph.D.; 2004, Food and Drug Administration: Dietary Supplements, Annals of Internal Medicine: Enough Is Enough: Stop Wasting Money on Vitamin and Mineral Supplements. If You want convert kilograms to pounds, multiply the kilogram value by 2.2046226218, Thumbuddy To Love is a positive tool that teaches children how to stop thumb sucking, Low flow low gradient aortic stenosis case, Why cant you take vitamins before a colonoscopy. You can also use hard candy. that may prolong the effects of anesthesia. For instance, vitamin E is an essential nutrient that also acts as an antioxidant. At 1 PM. It is true that with many of these vitamins, minerals, and phytonutrients, no one really knows what effect theyre truly having, if any. Check out our review of the best pea protein. There are also other limitationsthe dose of vitamin D may not have been high enough to significantly raise vitamin D in the blood to desired levels, and subjects may not have taken the vitamin D and calcium long enough to see a benefit. These fats are known to be good for your health, particularly the health of your heart. Higher levels of magnesium are utilized during the healing phase, so you should also ask if additional amounts would be a good idea. Although the Aesthetic Surgery Journal study recommends against it and Stanford University School of Medicine's Department of Otolaryngology also warns against taking omega-3 fatty acids, fish oil is full of healthy, unsaturated fats. A whopping 43 percent of the participants in the trial had polyps detected on their follow-up colonoscopy 3-5 years later, and we know from studies of cancer statistics that not all of these polyps will turn into cancer. Even if you, as the patient, are not pressed for details, still provide your healthcare providers with a full list of what you are using. (20), A recent meta-analysis based on 31 relevant human studies found that overall, there was a correlation with low vitamin D levels and adverse outcomes after diverse surgical procedures., That comes from the University of Wisconsin Department of Population Health Sciences. In conclusion, this review supports the hypothesis that hypovitaminosis D is associated with adverse outcomes after diverse surgical procedures. In addition, some circumstances warrant caution when it comes to blood pressure, heart rate, and other metabolic markers. Open the Facebook app on your device and tap the menu button. The actual smoke is only a small portion of why they tell you to stop before a procedure or operation. This essential vitamin is used in over 300 different metabolic pathways within your body. You may have clear liquids up to 3 hours before your procedure. You will be given instructions that will explain what you should and should not do in preparation for the colonoscopy. Im having a knee replacement and am not suppose to take Vit. Analysis of data from a large trial has found evidence that using calcium supplements with and without vitamin D may raise the risk of developing certain types of polyp, or precancerous. Valerian. Your email address will not be published. These statements have not been evaluated by the Food and Drug Administration. Check with your managing provider for alternatives. No you can't. The prep for a colonoscopy doesnt allow you to have any solids or liquids the night before the exam. As an Amazon Associate, Easy Health Options may earn from qualifying purchases. For essential minerals like magnesium, calcium, phosphorus, potassium, iron and zinc, consumption up to the Recommended Dietary Allowance (RDA) is typically advised before and after surgery. Do not eat any solid food after midnight, the night before the procedure. Study Record Detail Save this study Vitamin D and Screening Colonoscopy or Polyp Surveillance (VitDColon) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. In other words, at the maximum dosage, that may be the equivalent of the bromelain found in up to 45 whole pineapples per day! Stop any fiber supplements such as Metamucil, Benefiber or Citrucel. The phase IV clinical study analyzes which people take Vitamin b12 and have Colonoscopy abnormal. Join. Its a publication of The American Society for Aesthetic Plastic Surgery. Related Articles. Reasons to Stop Supplements Before Surgery Learn why you may need to stop taking certain supplements like glucosamine, chondroitin and others before you have surgery. Even minor procedures may require these dietary changes, because certain products can increase your risk of bleeding and complications. Please DO NOT STOP MEDICATIONS . The trial was very well-designed, and most subjects were compliant with the supplements and follow-up colonoscopy. A multivitamin is ok. Stop taking aspirin, Plavix, Coumadin, and warfarin. . No one should be reluctant to update their informational articles when they can.]. Another reason your doctor might ask you to stop taking vitamins before surgery is to reduce uncertainty about what exactly it is that you're taking. Bear in mind that these are only examples. Your prescription will be called in to your local pharmacy approximately one week prior to your procedure date. Discontinue use of whatever your doctor tells you to. It may cause extra bleeding during and after surgery. Capsaicin in chili appears to interfere with platelet aggregation in one study, while another suggests it may do the opposite and help prevent gastric hemorrhaging. [heres a typo to fix: insert say into: Mayo Clinic, they dont one way or another. Does Sambucol Black Elderberry Really Work For Colds & Flu? Drink at least 8 glasses of water throughout the day. Vitamin C is an essential nutrient with many benefits. hip replacement, knee resurfacing) (. The phase IV clinical study analyzes which people take Vitamin e and have Colonoscopy. How long does 4 wisdom teeth removal take. An article in the Journal of the American Medical Association (JAMA) called out kava root, St. Johns wort, and valerian as herbs that might interfere. If you need emergency surgery, keeping a current medication list might save your life. Many surgical patients are magnesium-deficient because of the medications they take, poor absorption, or skimpy diets. DoD beneficiaries age 18 or older will be recruited from the clinics at the Mike O'Callaghan Federal Medical Center (MOFMC). (45), If your doctor recommends using it, your first inclination might be to drink pineapple juice. A review of multiple studies on vitamin D3 status and surgical recovery has found that adequate levels of vitamin D3 pre-surgery reduces the chance of post-surgery complications, including infections. Thank you. That includes teas and even the food sources of herbs and spices you may be eating in high amounts. It's good to see it beginning to make the rounds in mainstream . Stop everything by mouth, including all liquids, smoking and chewing gum. Vitamin D influences dozens of conditions, with emphasis on those related to heart disease; yet there is a broad epidemic of vitamin D deficiency in America. Some patients may need to use a very short acting anticoagulant, up to one day prior to colonoscopy, to prevent blood clots Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02269332. However, people who are taking blood thinning medications, like warfarin, may need to check in more regularly with their healthcare providers. Clicking "Start Over" will empty your resources Not all insurance policies cover screening colonoscopies. I have been telling my readers this for years. You want as few unknown variables as possible. Three (3) days before your Colonoscopy Stop fiber supplements such as Metamucil, Fibercon, etc. complete answer Is Meat Bad For You? It causes high levels of homocystein in the body and that encourages cancer, although I think studies are limited to only a few cancers. Take vitamin D3 supplements. Use ONLY flavors that are yellow, orange, or green in color DO NOT use flavors that are red, blue, or purple. Rest the remainder of the day, and resume normal activity the next day. Stop takin iron and iron containing vitamins. a cognitive enhancer that can increase your risk of bleeding. 18 December, 2018 Many people take prescribed or over-the-counter medications they must stop using before a colonoscopy. You will need 6 tablets. Assistant Professor of Medicine, Harvard Medical School, Director of Clinical Research, Center for Gastrointestinal Oncology. complete answer on healthy.kaiserpermanente.org, View Stop ALL vitamins and supplements, including fish oil and iron. When do you stop taking clopidogrel for colonoscopy? Superfoodly is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to amazon.com. When it comes to surgically "traumatized tissue," we know the body has to rebuild and repair tissue on the cellular level. We require a one week notice for all procedure cancellations. amzn_assoc_search_bar = "true"; Copyright - Colorectal Cancer Alliance 2022 501(c)(3) Disclaimer Privacy Policy Non-discrimination Statement Sitemap. Discontinue use of whatever your doctor instructs. Purchase your OSMO pills (prescription enclosed in the packet) from your pharmacy. The information contained on EasyHealthOptions.com is not intended to be a substitute for professional medical advice or treatment and is for educational purposes only. (47). Its volatile oil, ajoene, does appear to interfere with platelet aggregation. on elliothospital.org, View From what I have read it sounds like it would be a good idea if she continued to take Calcium, Vit.D , Vit.C and Magnesium up to and after surgery as well as restarting her other supplements including Omega 3, Green Tea, Turmeric. Please remove one or more studies before adding more. Rates of preoperative anemia are high, with studies indicating the percentage of patients with it may be up to: This is why its wise for everyone to get a complete blood count (CBC) to test hemoglobin levels, which is the iron-rich protein found in red blood cells. Begin low-residue and low-fiber diet. How long before surgery should I stop fish oil? (41). Subjects meeting the inclusion/exclusion criteria will be offered an opportunity to participate: Visit 1 (within two weeks of their screening colonoscopy): -Subjects will have the following research-driven blood test drawn which include: Serum 25-OH vitamin D via 1 venipuncture (5-10 mls, approximately 1-2 teaspoons of blood will be drawn). If you still wish to take a multivitamin leading up to surgery on the premise that it contains a low dose of vitamin E or another banned ingredient, you should discuss this with them first. DO NOT get the suppository or the stool softener. The aforementioned Aesthetic Surgery Journal cited research both for and against the theory that it can thin blood. 18 Years and older (Adult, Older Adult), Mike O'Callaghan Federal Hospital/Nellis Air Force Base, JillClark, Principal Investigator, Mike O'Callaghan Military Hospital. Two days before, continue eating only low-fiber foods. This biochemical effect was not reflected in increased bleeding risk during or after surgery evaluated in randomised controlled trials. High amounts interfere with the metabolism of vitamin K and that will inhibit platelet aggregation. Research from a university in Tokyo found that blood serum levels of vitamin C falls after surgeries. If you have an upcoming medical procedure scheduled, your doctor has likely mentioned specific foods, supplements and vitamins not to take before surgery. Two weeks before your surgical procedure, Dr. Rabach recommends laying off supplements (with a few key exceptions), as taking them increases the risk of bleeding, which could cause complications during surgery and slow the recovery process. Thats the reason you may be advised to stop drinking coffee and tea 48 or even 72 hours prior. If you are diabetic, call your managing or prescribing doctor to determine how your diabetes medicine should be taken the day of the procedure. Learn how we can help. You may choose to use a powdered drink mix for flavor (such as Crystal Light). You may need to stop taking this nutrient up to seven days before surgery. VITAL is one such trial looking at vitamin D in cancer prevention, and we are leading another large phase II trial of high-dose vitamin D in combination with standard chemotherapy in patients with metastatic colorectal cancer. Bob Livingston has been writing most of his adult life on matters of health, nutritional supplements, natural alternatives and social importance. . Why Herbal Supplements Get Missed in the Pre-Surgery Checklist . So what do we know about vitamin D and colon cancer today? Check with your managing provider for alternatives. They said: Therefore, it is clear that additional studies in humans are needed to determine whether a positive association indeed exists between vitamin E and bleeding risk. The FDA banned it in 2003. Should you avoid vitamin C before surgery? Check with your managing provider for alternatives. Do not take supplements in gummy form. Some dependable writers say that up to 85 percent of Americans have insufficient vitamin D levels. Record: Date of birth, age, gender, race, ethnicity, current email address, height (in inches), weight (in pounds), waist circumference (in inches) measurement, blood pressure, and whether subject is taking or has taken any vitamin D supplement or derivative, and if so, note the dosage, frequency, and duration of therapy. I'm no doctor, but here's a few variables I came up with off the top of my head, especially if your vape contains any nicotine. Because it also decreases blood clotting, it should not be taken ahead of time. 39 kilogram is equal to 85.98028218 pounds. This enzyme is frequently recommended by orthopedic, plastic, and many other types of surgeons for inflammation and pain post-op. Being fat-soluble means you can overdose on it as it builds up in your liver. On the other hand, many types are scheduled days, weeks, or even months in advance. Thank You. To normalize them and reduce oxidative stress, they say: In uncomplicated surgical patients, more than 500 mg/day of vitamin C may be required, with much higher doses in surgical intensive care unit patients., To be clear, both of those are reporting research and neither should be construed as advice. Five of 31 studies (16%) found no association. I am scheduled for major surgery in 6 days. Valerian, Supplements are of greater concern because they can contain exponentially more than the amount of say, omega 3 in a serving of fish, or the vitamin E in sunflower seeds. This study reported that consumption of these unsaturated fatty acids actually could help improve surgical outcomes. You need to stop before colonoscopy certain medications and foods. Which Curcumin Supplement Has The Best Absorption? They found that people taking vitamin D and/or calcium did not have a lower rate of polyps detected on their follow-up colonoscopy as compared to those taking placebo. High-fiber foods such as wheat germ. take 2 Dulcolax tablets with 8 ounces of water. Kava and valerian were said to possibly increase the effects of anesthesia, while St. Johns wort might increase the metabolism of drugs used before and after the operation. Especially for those who have related diseases, like high blood pressure or diabetes. The second colonoscopy four years later they found I believe six. The Aesthetic Surgery Journal study reported that fish oil consumption could be detrimental because it has the potential to prolong bleeding and increase the risk of hematomas after surgery. Bromelain: 5001,000 mg per day, beginning a week before surgery. Nulytely (pronounced new-lightly) is a prescription bowel preparation. Ephedra Was Found To Clear The Body Via The Kidneys Very Quickly. 4 hours prior to your procedure time, shake the remaining solution and finish drinking it within 1 hour. Vitamin E: While vitamin E is known to be a blood thinner at high doses, most studies suggest that these effects don't emerge if you take less than 400 International Units (IU) per day. Information provided by (Responsible Party): JillClark, Mike O'Callaghan Military Hospital. Subjects will be told to fast for at least 10 hours prior to Visit 1, Previous diagnosis of colorectal cancer, adenomatous polyps, and/or cancer. Garlic: Garlic supplements are used to lower blood pressure and cholesterol. 6. If you have diabetes, be sure you have contacted your managing or prescribing provider for medication instructions. All other prescription medications are permitted, except if specifically instructed. Tylenol is ok. 3 DAYS BEFORE THE PROCEDURE Clicking "Exit" will permanently close your resource drawer Most surgeons will instruct you to avoid preparations with Vitamin E before surgery, however, so it is important to check your dietary supplements/multivitamin carefully. You need to stop before colonoscopy certain medications and foods. (19), Both before and after surgical operations, its important to have healthy vitamin D levels. These changes are extremely important because of the interaction between certain medicines and supplements or foods.