Natural Dietary Supplements
Since N-nitroso compounds (NOCs) were found to be potent experimental carcinogens more than 20 years ago, a succession of epidemiological studies has investigated the hypothesis that exposure to preformed NOCs or their precursors can cause brain tumors in humans 8 . The results of a meta-analysis of seven case-control studies suggest that maternal consumption of cured meat during pregnancy may be a risk factor for childhood brain tumors, especially astrocytomas 17 . An earlier review of the same studies, however, noted that some were based on rather small numbers of cases, the dietary information was apparently not validated, and selection bias could not be ruled out 18 . A pooled analysis of nine studies of adults did not show clear evidence for an elevated risk of brain tumors with ingestion of NOCs from cured meat in adulthood 19 . There is limited evidence for a reduction in risk of CNS tumors with increased fruit and vegetable consumption and with use of vitamin supplements,...
Tryptophan is a naturally occurring amino acid, used for over 15 years in dietary supplements and infant formulas, and as a treatment for a number of conditions including depression, obesity, and insomnia. In late 1989, it was connected with a sudden outbreak of a debilitating syndrome that resulted in dozens of deaths in the U.S. and caused a variety of adverse effects in as many as 5,000 people. The case also had fallout that was more political than scientific. The responsibility of the FDA for controlling dietary supplements (as distinct from food and drugs) has been a gray area. In 1991, the Commissioner of Food and Drugs used the tryptophan example as a reason to take a completely new look at how these products should be regulated. The industry countered that this was unnecessary since the epidemic was not the result of dangerous dietary supplements, but rather the lack of regulation of biotechnology.
Depending on the underlying cause of energy imbalance (decreased dietary intake or increased nutritional requirements), initial nutritional therapy may range from adaptations of the dietary behaviour and food pattern to implementation of nutritional supplements. Nutritional support should be given as energy-dense supplements well-divided during the day to avoid loss of appetite and adverse metabolic and ventilatory effects resulting from a high caloric load. When feasible, patients should be encouraged to follow an exercise program. For severely disabled cachectic patients unable to perform exercise training, even simple strength manoeuvres combined with ADL training and energy conservation techniques may be effective. Exercise not only improves the effectiveness of nutritional therapy, but also stimulates appetite. After 4-8 weeks, the response to therapy can be determined. If weight gain and functional improvement are noted, the caregiver and the patient have to decide whether...
Since chronic fatigue syndrome is manifested as a lack of energy, some people have suggested thatNAD+ itself, given as a dietary supplement, might reenergize the patients. There is no scientific evidence for this idea, but nevertheless many chronic fatigue syndrome sufferers buy and take NAD+ in the hope that it may help.
Thiamine pyrophosphate (TPP) is an important cofactor of the enzyme transketolase, which is involved in glucose metabolism. Deficiency develops in various clinical settings malnutrition, malabsorption syndromes, chronic gastritis, gastrointestinal malignancies, persistent vomiting, and prolonged intravenous feeding without vitamin supplement. Alcoholics are at particular risk for the disease because of malnutrition moreover, alcohol interferes with the metabolism, absorption, and storage of thiamine.
Currently the major commercial application of post-ruminal delivery systems is for the delivery of amino acids, particularly methionine and lysine. These amino acids are used primarily as nutritional supplements for dairy and beef cattle in order to improve milk and or milk protein production, reproductive performance, meat and or wool production or growth. As with other nutrients, responses depend on the diet, physiological stage and other variables which must be taken into account when developing and assessing a rumen-stable or post-ruminal drug delivery system.
Among all categories of dietary supplements, antioxidant vitamins were among those used most frequently by a large group of people with MS who were surveyed through a study at the Rocky Mountain Multiple Sclerosis Center (the full results of this survey may be seen at www.ms-cam.org). Antioxidant vitamins include If people with MS choose to use antioxidant vitamin supplements, it is reasonable to take modest doses. Modest daily doses of these vitamins are
There is a tendency to put great trust in herbs because they are natural and, therefore better than artificially produced pharmaceutical drugs. Herbs are not considered drugs by the FDA, but rather dietary supplements that are largely unregulated, unlike drugs. As a result, the amount of active ingredient can vary between products manufactured by different companies, and even between batches produced by the same company. A company that produces herbs has to provide a reasonable assurance that their products are not harmful and the company cannot claim that its product cures or prevents a disease. Otherwise, a company can make any other claim about the supposed benefits without supporting evidence. No legal requirement stipulates that herb manufacturers list the contents, side effects, safety, efficacy, or drug interaction information on the label. The FDA can only recall an herb if harmful effects are found. This information highlights the fact that patients should find out as much as...
Interactions of these herbs with other medications. It is impossible to advocate for the use of diets and dietary supplements without the same degree of careful testing. This applies even more strongly to invasive procedures, such as bloodletting, that have no scientific basis for the treatment of epilepsy.
Doris Balboni, a 67-year-old retired nurse with polycystic kidney disease, was found to have severe renal failure, with a glomerular filtration rate of 10.2 ml per minute and a serum creatinine concentration of 4.2 mg per dl. She was placed on a very-low-protein diet supplemented alternately by an essential amino acid mixture and by a ketoacid amino acid mixture, both devoid of tryptophan. (Tryptophan was omitted because the Food and Drug Administration had decreed that it could not be used as a dietary supplement until the cause of a severe form of muscle disease, related to one particular commercial source of tryptophan, was clarified.) Serum tryptophan concentration fell, reaching a low of 4.16 uM (normal
And Parkinson's disease (12,13), no evidence shows that antioxidants reduce seizure activity or the negative long-term effects of epilepsy, such as impaired short-term memory. In many physical data and laypeople's assessment, however, the benefits of nutritional and vitamin supplements outweigh the risks.
When using herbs, it is important to purchase them from companies that produce high-quality, consistent preparations. Some of the highest quality preparations are produced in Europe. Brands chosen should be standardized and contain specified amounts of active ingredients. The product also should list other specific information common and scientific name of the herb, the manufacturer's name and address, batch and lot number, expiration date, dose recommendations, potential side effects, and quality control information. Higher-quality herbal products in the United States have the symbols for the United States Pharmacopeia (USP) or the National Formulary (NF). To evaluate the quality of some herbs and other dietary supplement products, independent laboratory evaluations of products have been done by Consumer Reports and by an organization known as Consumerlab.com (www.consumerlab.com). The results of these evaluations are available from these sources.
These preparations, as well as pure amino acids, are considered dietary supplements and are therefore not subject to regulation by the Food and Drug Administration. The advantage is that they are readily available the big disadvantage is that most insurers won't reimburse you for the cost. However, reimbursement for these products by Medicaid has been granted in several states.
That has also been used to identify the amino acids that limit protein synthesis 22, 23 . This method is based on the differential behaviour of infused amino acids depending on whether the infusion oversupplies or undersupplies amino acids relative to requirements. If an amino acid is undersupplied, its plasma concentration will not rise during an amino acid infusion, because of its use for protein synthesis. By contrast, infusion of an amino acid that is already present at or above required amounts, will result in a steep rise in its plasma concentration. This approach has been used in HIV AIDS patients 22 and was also used to manipulate parenteral amino acid formulation to meet the specific needs of hospitalised patients in an intensive care unit 23 . The linear regression of plasma plateau concentrations of amino acids in response to an amino acid infusion was used to determine which amino acids were oversupplied or undersupplied in each individual patient. A par-enteral amino acid...
Saudny-Unterberger 86 administered nutritional support (10 kcal kg day) over 2 weeks in COPD patients who were admitted for an exacerbation of their disease. Forced vital capacity increased in the treatment group by 8.7 whereas it decreased by 3.5 in the control group. There were no changes in handgrip strength or respiratory muscle but there was a trend towards an improvement in general well-being. No measures of body weight or fat-free mass were made. Creutzberg et al. 87 characterised the factors that appeared to be related to non-response to a nutritional intervention (extra 500-750 kcal day) in individuals with COPD. They reported that the systemic inflammatory response (serum TNF-receptor 55, and intra-cellular adhesion molecule), aging and relative level of anorexia were associated with the non-responsiveness to nutritional intervention. In an 8-week pulmonary rehabilitation program, Creutzberg et al. 88 evaluated the administration of two or three liquid nutritional...
The three main groups of nutraceuticals are dietary supplements, functional foods, and medicinal foods. Dietary supplements are ingredients intended to supplement the diet. They include vitamins, minerals, and botanicals (plant-based supplements) such as ginseng, ginkgo biloba, and St. John's wort. Functional foods are products made with naturally occurring ingredients specifically to improve health or performance. Such foods include oats, bran, canola oil, stanols (such as Benecol ), enriched cereals and breads, sports drinks, teas, and vitamin-enriched snack foods. Medicinal foods are those for the treatment or prevention of diseases. They include foods from genetically altered animals and plants, proteins (such as lactoferrin, which is iron-enriched), and health bars with added medications.
DHEA (dehydroepiandrosterone) is a hormone available as a dietary supplement. It is marketed as an antiaging compound and as a miracle cure for many medical conditions. Claimed benefits of DHEA of potential interest to people with MS include improvement in fatigue, sex drive, and mood.
Austin American Botanical Council, 1998. Bowling AC, Stewart TS. Dietary Supplements and Multiple Sclerosis A Health Medicines. Philadelphia Lippincott, Williams, & Wilkins, 2004. Fragakis AS. The Health Professional's Guide to Popular Dietary Supplements. The
As an example, a practical approach towards providing nutritional interventions in patients with advanced cancer may include the following elements (1) relative importance of a starvational component (bowel obstruction 5,6 , radiotherapy for head and neck cancers, intake, surgery 7, 8 , high-dose chemotherapy 9 ) (2) probability of a reversible inflammation (infection, treatment-responsive cancer disease) (3) expected life expectancy 10 (4) integrity of the upper and lower gastrointestinal tract (5) goals of the nutritional intervention and meaningful outcomes (6) dietary counselling (assessment of nutritional status, dietary and educational needs, provision of educational and nutritional supplements, alleviate anxiety and conflict around patient's inability to consume what would normally be considered as normal diet) 11 (7) discussion of the option of enteral nutrition in patients with a starvational component and functioning bowel (8) consideration of parenteral nutrition for a...
McCrory et al. found that a wide variety of sweets, snacks, condiments, and high-carbohydrate entrees coupled with a smaller variety of vegetables promoted long-term increase in energy intake and body fat 17 . Providing nutritional supplements consisting of a wide variety of sweets and carbohydrates may be helpful as the second step for the treatment of weight loss. In addition, loss of taste and smell are common in the elderly, and medications and medical conditions play a major role in taste losses and distortions 18 . Thus, the use of flavour-enhanced food has a correspondingly positive effect on food intake.
Studies have revealed that dietary intervention and nutritional supplements improve malnutrition. By this approach, weight gain occurred in 50 of admitted malnourished patients, although 37 of patients remained malnourished despite the intervention 14 . Increased awareness of the importance of malnutrition may decrease the prevalence of malnutrition over time 40 .
Team and be used to develop the safest possible treatment plan. The clinician should ask about specific illicit substances such as heroin, cocaine, marijuana, and the club drugs (see below). For taking a history of alcohol use, some clinicians have suggested the use of the CAGE questionnaire (Ewing, 1984) 1. Can you cut down on your drinking 2. Are you annoyed when asked to stop 3. Do you feel guilty about your drinking 4. Do you need an eye-opener when you wake up in the morning One should also ask about sedative or stimulant use, whether prescribed or nonprescribed, and any dietary supplements or herbs the patient may be taking. A substance abuse review of systems, focusing on renal, cardiac, gastrointestinal, and, for HIV patients especially, neurological symptoms, is essential. Other points of inquiry are the date the substance was first used patterns, amount, and frequency of use and routes of administration and reactions to the use. The time of last use is important to know to...
Cium, because very-low-protein diets usually contain inadequate amounts of these substances. Almost any multivitamin suffices, unless it contains added phosphate. However, vitamin requirements for those with advanced kidney failure are different. Specially formulated multivitamin preparations are available. (See Appendix 1.)
An herb is a leafy plant without a woody stem, but herbal preparations include all natural, alternative, and traditional remedies. Twenty-five percent of current, proprietary pharmaceuticals come from plant-herb sources. As a result of the Dietary Supplement and Health Education Act of 1994, the FDA has no authority over regulating herbal and vitamin products, unless they prove to be toxic. 80 of the world's population use herbal products and vitamins daily most are benign, and offer no health benefit (e.g., vitamin C and Echinacea) or potentially lethal drug interactions (e.g., St. John's wort and SSRIs garlic, ginkgo, and ginseng, and anticoagulants ASA, heparin, warfarin ).
Should safe and effective CAM therapies be integrated into pain clinic services Are they cost effective A 2005 survey of 39 US academic health centers found that while 23 offered CAM services (particularly acupuncture, massage, dietary supplements, mind-body therapies, and music therapy), none had written policies concerning malpractice liability or credentialing practices 61 Nothing is currently known of the policy issues regarding integration of such practices in chronic pain centers in Canada. The mechanics of providing integrated (CAM plus conventional) care in Canada deserve to be further explored.
Nutritional status and specific nutrients may impact on the immune system. In addition, altered immune status can impact on nutritional status. For example, immune response to injury (infection, cancer, etc.) can change the efficiency of the body to adsorb and utilise nutrients, alter metabolic rate, modify hormone secretion, alter hepatic synthesis of proteins or lipids, change intracel-lular enzymes (gluconeogenesis, lipogenesis, etc.). Mediators of immune response such as proinflammatory cytokines and CRP are involved in the pathogenesis of several metabolic disorders (diabetes mellitus, insulin resistance, obesity, cachexia associated with different chronic diseases) and have a well-recognised role as prognostic factors of disease outcome and survival. So, the assessment of immunological parameters has to be included in an exhaustive global assessment of nutritional status, especially with the aim to develop and to monitor the effect of nutritional approaches. Another exciting...
In most settings, the primary purpose of drug testing is to identify individuals who are using illegal or illicit drugs. Falsely accusing someone of using drugs is highly problematic and undermines the testing program. Similarly, not being able to identify active drug users because of false-negative results renders a program of limited value. It does not deter use or identify users. This is so both for the emergency room physician wondering if the agitated patient used PCP, and for the consultant to the local college track team. For these situations, highly sensitive qualitative screening tests should be employed, even if this leads to some false-positive results. On the other hand, definitive tests should have the highest level of specificity They should exclude as many true negatives as possible. For nonusers who are subjected to drug testing, issues related to false-positive results are of great concern. Questions addressing which foods, prescribed medications, dietary supplements,...
Although melatonin is not an herb, its widespread use warrants discussion. Melatonin is a chronobiotic, a term analogous to nutribiotic when used for vitamins and herbs. Melatonin is a derivative of serotonin metabolism. It is marketed as a dietary supplement because it is found in some plants. It is neither FDA-approved nor regulated. Melatonin is normally produced by the pineal gland, and it is secreted to the hypothalamus, where it likely promotes sleep. The circadian rhythm of melatonin production reveals secretion beginning in the evening, with peak melatonin levels about 2-3 a.m., and then a rapid fall at approximately 6 a.m. Melatonin can be helpful for jet lag and disorders of delayed sleep phase. Normal sleep phase can be restored in patients with delayed sleep phase syndrome after administration of melatonin for 2 to 6 weeks.
Reduced food intake may be caused by systemic effects of disease (anorexia, altered taste and smell, early satiety, nausea or vomiting, pain), local effects of the tumour (dysphagia, gastrointestinal obstruction) or psychological factors (fear, anxiety, depression) 14, 23 . Furthermore, anticancer treatment (both chemotherapy and radiation therapy) induces several side-effects such as anorexia, alteration in taste and smell, fatigue or mucositis, which can decrease food intake 1 . A variety of medications may interfere with nutrition, by decreasing appetite and impairing digestion and absorption of nutrients. Taste alterations are reported in 15-100 of all cancer patients, receiving different cancer treatments 24-31 . Decreased taste or taste loss is reported in 13-50 of cancer patients receiving different treatments 25,26, 28, 30 and seems to involve all four taste modalities (sweet, salty, sour, bitter) 23, 30-33 . Due to taste alterations or taste loss, preference for foods or...
Weight loss is an important issue in patients with COPD. About 20-30 of COPD patients are underweight 63 . In addition, although some patients have normal weight, they may have a low fat-free mass (FFM) 64 . FFM and body weight are very important, as it has been shown that these are related to survival and exercise capacity 64,65 . Nutritional support was found to be beneficial in patients with COPD in improving respiratory and peripheral muscle strength, as well as improving exercise tolerance. In a large trial, Schols et al. investigated the physiological effects of daily nutritional supplements, alone or in combination with anabolic steroids, as an integrated part of a rehabilitation programme 66 . Treatment with exercise and nutrition resulted in increased weight, fat-free mass and PImax. Another finding in this study was that not all patients responded to therapy i.e. some did not gain weight or improve their respiratory muscle strength. It appeared that weight gain and increase...
Androstenedione became well known to the public after the baseball player Mark McGwire acknowledged that he used it in 1998. Androstenedione is a hormone sold as a dietary supplement. In the body, it is converted to testosterone, the male sex hormone. Androstenedione is of potential interest to people with MS because it is claimed to increase strength and energy.
Parenteral feeding may be helpful during acute hospital admissions in older persons. Often, only a small number of calories are ingested by the elderly during hospitalisation, either due to the underlying disease or to medical interventions. We have found peripheral parenteral nutrition to be a particularly useful method to supplement calories, and with minimal side effects. In malnourished older persons, parenteral vitamin supplements may decrease delirium. Nonetheless, in general, providing calories through the gut is preferable to using parenteral feeding, except for very short periods of time.
Pycnogenol has been used as a dietary supplement for approximately 15 years. It is made from the bark of the French maritime pine tree. Pycnogenol is a mixture of chemicals known as oligomeric proanthocyani-dins (OPCs). These chemicals, which are similar to those in grape seed extract and green tea leaves, appear to act as antioxidants.
Cachexia may be responsible for one third of cancer deaths, independent of tumour burden or metastases, and therefore is a critical factor to consider when initiating treatment modalities for this population 7 . Patients with cancer cachexia often have specific problems that lead to a reduction in nutritional intake. However, nutritional supplements alone cannot correct cachexia. In a meta-analysis of published trials, patients undergoing total parenteral nutrition while receiving chemotherapy showed decreased survival, a poorer tumour response, and significant increases in infectious complications 8 .
GHB was initially developed as an anesthetic but was found to have too many side effects to be used regularly. In the club scene, GHB is taken for its sedating and euphoric effects. It has also been used as a date-rape drug, leading to concerns of HIV exposure through unprotected sexual intercourse. Because of its amnestic effects, the victim may not even know that they have been exposed. GHB has a relatively narrow therapeutic range its toxic effects include seizures, coma, and death. In addition, a severe withdrawal syndrome among chronic users has been reported (Bialer, 2002). Gamma-butyrolactone (GBL) and 1,4-butanediol (1,4- BD) are precursors that can be converted to GHB after ingestion. They are available in a variety of dietary supplements for purported but un-proven anabolic effects. Camacho et al. (2004) showed
The lack of human testing results from a number of factors. Herbs are considered dietary supplements rather than drugs by the FDA and, therefore, clinical trials for usefulness and toxicity are not required. Western medicine also has ignored and avoided alternative therapies until recently, and pharmaceutical companies lack interest because patents cannot be issued for naturally occurring products. In addition, Western medical and pharmaceutical research favors the study of isolated chemical compounds, as
The absorption of drug and nutritional supplements can be reduced or slowed in the CKD patient due to delayed gastric emptying. Given that diabetes mellitus is a common cause of CKD, diabetic gastroparesis is a frequent comorbidity. Delayed gastric emptying will alter the absorption profile of orally administered drugs. The absorption of many drugs is affected by gastric pH. Gastric acidity is reduced in predialysis CKD patients compared to controls 6 . Gastric acidity is further mitigated by the ubiquitous use of phosphate-binding antacids by CKD patients. A practical clinical example in which there is an absorption alteration in CKD patients is when furo-semide is prescribed in a predialysis CKD patient and a blunted effect is observed. Patients with CKD do not have a particularly high bioavailability of furosemide 7 . Similarly, oral ferrous sulfate is frequently prescribed to CKD patients in combination with erythropoietic agents. Oral ferrous sulfate is poorly absorbed in an...
Supplements are one of the most popular forms of CAM used by people with MS. The largest and most detailed survey of dietary supplement use among people with MS was conducted at the Rocky Mountain Multiple Sclerosis Center. Of the respondents to this survey, more than 90 percent had used dietary supplements since being diagnosed with MS, and more than 80 percent were using some type of dietary supplement at the time of the survey. The full results of the survey are available at www.ms-cam.org, the CAM website of the Rocky Mountain Multiple Sclerosis Center.
Global DNA methylation patterns are influenced by the nutritional availability of methionine or folate and by polymorphisms in folate metabolic enzymes (Cravo et al., 1998 Rampersaud et al., 2000 Kim et al., 2001 Friso et al., 2002 Paz et al., 2002 reviewed in Oommen et al., 2005). Diet is known to be a particularly important determinant in the manifestation of late-onset disease. Indeed, dietary supplements such as folate or vitamins, known to affect the activity of enzymes involved in methylation processes, can influence the rate of disease manifestations such colon cancer (reviewed in Jaenisch and Bird, 2003). The molecular mechanisms have not yet been understood, but some studies emphasize
Two groups of chiropractors are recognized straights and mixers. Straights use only spinal manipulation. Mixers, who represent the majority of chiropractors in the United States, use manipulation techniques and other measures, which may include ultrasound, massage, herb or vitamin supplements, and dietary recommendations.
By the time you have read the last chapter, you should have a clear understanding of many important biological principles. You will also be able to think like a scientist and critically evaluate which information is most reliable instead of simply accepting all the information you read in the paper or hear on the radio or television. Even though you may not be planning to be a practicing biologist, well-developed critical thinking skills will enable you to make decisions that affect your own life, such as whether or not to take nutritional supplements, and decisions that affect the lives of others, such as whether or not to believe the DNA evidence presented to you as a juror in a criminal case.
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