Natural Dietary Supplements
Ephedra has been used as a natural medicine for thousands of years by numerous cultures with very little concern about toxicity. Its most recent popularity is related to its purported weight loss or performance enhancing attributes. In spite of that in 2004, concerns over safety resulted in the banning of all over-the-counter (OTC) sales of ephedra-containing dietary supplements by the Food and Drug Administration. With the ban of ephedra-containing dietary supplements and severe restrictions in access to ephedrine-containing OTC products, the landscape of clinical use associated with agents of this nature has been dramatically changed forever. Interest in further clinical study will likely be severely limited.
European medical researchers have, for several years, used ephedrine to help promote weight loss, at least in the morbidly obese (11,12), and nutritional supplements containing naturally occurring ephedra alkaloids are sold in the United States for the same purpose. Clinical trials confirm that, taken
Recent surveys in Europe indicate that far more people are concerned about their food and their health than in the past. However, while consumers say they want to eat in a healthier manner, the reality is that they want to eat more easily, hence the claim of an enormous market potential for dietary supplements, nutrient enriched and functional foods, each of which contains perhaps one, or just a
Encourage makers of conventional foods and dietary supplements to make accurate, up-to-date, scientific based claims about the health benefits of their products, and to help eliminate bogus labeling claims by pursuing marketers of human dietary supplements and others who make false or misleading claims about the health benefits or other effects of their products.15
Summary (Adapted from Investigator's Abstract) In the United States, heart disease is the leading cause of death in postmenopausal women. Estrogen replacement therapy is beneficial for heart disease risk factors as well as for bone density. However, a large proportion of postmenopausal women are not compliant with therapeutic regimens. Phytoestrogens are naturally occurring compounds found in plants and soy products that have estrogenic effects, and may represent an alternative treatment for the prevention of heart disease and osteoporosis in postmenopausal women. However, few intervention trials have examined the extent to which it is possible to improve heart disease risk factors, bone density, and quality of life in postmenopausal women through use of a dietary supplement of Phytoestrogen. The proposed randomized, double-blind, placebo controlled study is designed to determine the acceptability and benefits of use of a dietary supplement of Phytoestrogen (genistein) versus placebo...
Alternative medicine has been defined as the use of various treatment modalities that are not usually used in traditional medicine, taught in medical schools, or covered by insurance companies. Terminology, however, is changing and these treatments are being incorporated more and more into traditional therapies and hence the term complimentary medicine is now used more frequently (Complimentary-Alternative Medicine CAM ). In 1991, the National Institutes of Health (NIH) established the office for Alternative Medicine to address the growing use of these treatments. It has been estimated that two-thirds of the American population has used some form of CAM (59). Of importance, 70 ofthose patients using CAM did not disclose this use to their physician (60). In 1998 the Alternative Medicine office changed its name to the National Center for Complimentary and Alternative Medicine (NCCAM). Alternative therapies include things such as imagery, biofeedback, acupuncture, reiki, dietary...
Kushi et al. studied over 34000 postmenopausal women with no cardiovascular disease who in early 1986 completed a questionnaire that assessed, among other factors, their intake of vitamins A, E and C from food sources and supplements.38 After 7 years of follow-up, results suggested that in post-menopausal women the intake of vitamin E from food was inversely associated with the risk of death from coronary heart disease. This association was particularly striking in the subgroup of 21 809 women who did not consume vitamin supplements (relative risks from lowest to highest quintile of vitamin E intake, 1.0, 0.68, 0.71, 0.42 and 0.42 P for trend 0.008). After adjustment for possible confounding variables, this inverse association remained (relative risks from lowest to highest quintile, 1.0, 0.70, 0.76, 0.32 and 0.38 P for trend 0.004). By contrast, the intake of vitamins A and C was not associated with lower risks of dying from coronary disease.38
Echinacea is regulated as a dietary supplement in the United States (40). The Homeopathic Mother tincture is a Class C over-the-counter drug official in the Homeopathic Pharmacopoeia of the United States (41), Official Compendium (1992). E. angustifolia powdered and powdered extract, E. pallida powdered and powdered extract, E. purpurea root, powdered root extract, and powdered extract have monographs for their identity, quality, and other
In 1972, Burkitt described the relationship between diet and incidence of bowel cancer he hypothesised that a diet rich in fibre was associated with regular bulky stools and reduced bowel carcinogenesis, perhaps by reducing exposure of colonic mucosa to dietary carcinogens. It does seem likely that the combination of high fibre and low fat may be protective against bowel cancer. Protection against colorectal carcino-genesis is also derived from dietary supplements of calcium and folate and evidence from the Nurses Health Study (North America) suggested that oestrogen in the form of hormone replacement therapy (HRT) lowers the incidence of colorectal neoplasia. There has been interest in the potential influence of non-steroidal anti-inflammatory drugs in colorectal carcinogenesis. Cyclooxygenase (COX)-2 inhibition appears to have potent effects on the colonic mucosa, increasing apoptosis and reducing cellular proliferation. It is also likely that these drugs function through...
As stated above, in the US functional foods are not recognized as a special legal entity, but are covered by the federal Food, Drug and Cosmetic Act. Other relevant legislation includes the Nutrition, Labeling and Education Act (1990) and the Dietary Supplement, Health and Education Act (1994),
Subjects were excluded from the study if they had any of the following Underwent prior experimental therapy for chemoprevention, evidence of PCA on initial evaluation (local, regional, and or distant metastasis), active systemic viral, bacterial, or fungal infections requiring treatment, a serious concurrent illness or psychological, familial, sociological, geographical, or other concomitant conditions which did not permit adequate follow-up and compliance with the study protocol, concurrent treatment with other investigational agents, were taking finasteride or T, herbal medicine or dietary supplements for prostate health, and had a history of thromboembolic disease.
This survey did not determine the time between OTC use and first contact with the healthcare system. However, it did ascertain whether OTC use was an individual's first action after the onset of symptoms. Of the individuals reporting headache symptoms, 54 said their first course of action was to take an OTC medication (34 said their first course of action was to wait and see if the symptoms would go away, and only 4 said their first course of action was to consult a physician). For individuals with cold, cough, flu, and sore throat symptoms, the first course of action was self-treatment with an OTC product in 42 , watchful waiting in 34 , using a dietary supplement in 9 , and consulting a physician in less than 9 .
Extensive comparisons among LAB genomes are generating fundamental insights regarding aspects of microbial metabolism that may be important for strain selection in numerous dairy food applications. LAB appear to have many transporters at the cell surface that facilitate uptake and utilization of carbohydrates and proteins. The increased understanding of metabolic pathways may yield improved strain selection and food processing strategies. Knowledge of the genomic sequence has yielded bio-informatic strategies for prediction of nutrient requirements in L. plantarum (Teusink, 2005). The curated database for L. plantarum (http www.lacplantcyc.nl) contained 129 pathways and 704 predicted reactions. The actual experimental results that tested amino acid and vitamin requirements agreed with results predicted from knowledge of functional genomics and pathways (Teusink, 2005). These results support the future importance of systems biology approaches that will effectively combine functional...
BOX-PCR was used to differentiate reference strains of bifidobacteria (Gomez Zavaglia et al., 2000). These patterns were then compared to those obtained from isolates obtained from fermented milk products to identify species, which correlated well with those obtained by whole cell protein SDS-PAGE. Using BOX-PCR for species identification, the majority of 58 food and dietary supplements evaluated were found to contain B. animalis ssp. lactis (Masco et al., 2005).
Case Reports of Toxicity Caused By Commercially Available Products or Traditional Uses by Various Specialty Populations
In another case, a 52-year-old woman experienced tachycardia shortly after taking a dry herbal extract of unripe C. aurantium fruit (45). The patient took no medications except for a 10-year history of thyroxine (50 g day) treatment. The woman had ingested a dietary supplement for weight loss and consumed 500 mg of C. aurantium titrated at 6 synephrine (30 mg). Later in the same day of her first dose, she experienced unrelenting tachycardia and was admitted to the emergency room. She stated that she had never experienced prolonged tachycardia in the past. She was released from the ER after the tachycardia subsided, and felt well. After approx 1 month of feeling well, the woman took another dose of the supplement. Again, later in the day after ingestion of the supplement, she experienced a new episode of prolonged tachycardia. She was seen at the same hospital and released without incident. At the time of publication, she had not taken any more of the supplement and had no reports of...
An example from the drug-doping arena is a report on the use of 1H NMR for measuring creatine in urine samples as a biomarker for the use ofillegal dietary supplements by French athletes 41 . Creatine is not typically measured in clinical laboratories, and common methods such as LC-MS and capillary electrophoresis require much sample preparation. The detection limits by NMR were 1.31 mg L-1, and the analysis of untreated urine samples took less than 10 min. Although forensic toxicology reports are scarce, it is evident that some forensic laboratories have access to conventional NMR systems.
The necessity to prove health benefits in appropriately designed and peer-reviewed human studies might seem an obvious milestone, but it represents a step not traditionally taken by companies selling food and dietary supplements (which is mostly the form used for probiotics). Low profit margins and an inability to make health claims have been cited as reasons for not doing clinical trials, but these can no longer be acceptable. This is not only necessary because of the growing interest in probiotic applications to medicine, but also because the expectation of consumers is that probiotics are not just foods, but they confer other health benefits. Companies are often quick to make wide sweeping health claims about their 'probiotic' products, yet too many are unwilling to invest in the research required to ensure that their products do in fact function as promised. The need for human studies is therefore ethical and responsible. In terms of what constitutes an appropriate level of...
Showed no change in HDL cholesterol (McComsey 2007). There are no known negative interactions of uridine with the efficacy of the antiretroviral treatment (Sommadossi 1988, Koch 2003, McComsey 2007, Sutinen 2007). In Europe and North America, Mitocnol is available as a dietary supplement called NucleomaxX and can be acquired in pharmacies and the internet (www.nucleomaxX.com). In symptomatic hyperlactatemia and in lactic acidosis, all NRTIs should be immediately discontinued (Brinkman 2000). The supplementation of vitamin cocktails has been recommended, but there are no data that demonstrate the efficacy of this intervention with respect to mtDNA-depletion (Walker 1995, Venhoff 2002). After discontinuation of NRTIs, normalization of lactate may require several weeks. More mitochondrial friendly NRTIs may then be reintroduced, but patients should be monitored closely. The proposed supportive treatment of hyperlactatemia and lactic acidosis is summarized in Table 2.
In the United States, feverfew may be marketed as a dietary supplement, but is not approved as a drug. A United States Pharmacopeia advisory panel, although recognizing that feverfew has a long history of use and lack of documented adverse effects, does not recommend its use owing to the paucity of scientific evidence of safety and efficacy. The panel encourages further research, including at least one properly designed clinical trial (4).
Citrus aurantium has enjoyed a rich history of uses in food, cosmetics, and medicine. Recent misuse of this product for weight loss, however, is threatening to tarnish the holistic reputation of this fruit. Manufacturers are isolating and concentrating the synephrine content from the 0.33 mg g contained in the pulp of whole fruit to 20 mg g in some dietary supplements, and over 100-fold increase to 35 mg g in extracts. With the known cardiovascular effects of synephrine, this may be creating a potentially dangerous or abuseable supplement out of what people once safely enjoyed. The use of C. aurantium for weight loss has little support in the literature, but this has not stopped producers from marketing the drug for this purpose since the void left after the ban of ephedra. The increased frequency in which case reports of toxicity have emerged since this product has started being used for weight loss should serve as a cautionary note for more vigilant monitoring of safety.
The use of the Internet for the prevention of morbidity and mortality is lower than for treatment issues but is nonetheless significant 51 of Americans with Internet access report using the Internet for information about diet, nutrition, vitamins, or nutritional supplements 42 for information about exercise or fitness and 7 for information about how to quit smoking (Fox, 2005). While 7 of all adult Internet users may
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