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Grazina L, Mafra I, Monaci L, Amaral JS. Mass spectrometry-based approaches to assess the botanical authenticity of dietary supplements. Compr Rev Food Sci Food Saf 2023; 22:3870-3909. [PMID: 37548598 DOI: 10.1111/1541-4337.13222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023]
Abstract
Dietary supplements are legally considered foods despite frequently including medicinal plants as ingredients. Currently, the consumption of herbal dietary supplements, also known as plant food supplements (PFS), is increasing worldwide and some raw botanicals, highly demanded due to their popularity, extensive use, and/or well-established pharmacological effects, have been attaining high prices in the international markets. Therefore, botanical adulteration for profit increase can occur along the whole PFS industry chain, from raw botanicals to plant extracts, until final PFS. Besides the substitution of high-value species, unintentional mislabeling can happen in morphologically similar species. Both cases represent a health risk for consumers, prompting the development of numerous works to access botanical adulterations in PFS. Among different approaches proposed for this purpose, mass spectrometry (MS)-based techniques have often been reported as the most promising, particularly when hyphenated with chromatographic techniques. Thus, this review aims at describing an overview of the developments in this field, focusing on the applications of MS-based techniques to targeted and untargeted analysis to detect botanical adulterations in plant materials, extracts, and PFS.
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Affiliation(s)
- Liliana Grazina
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Isabel Mafra
- REQUIMTE-LAQV, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Linda Monaci
- ISPA-CNR, Institute of Sciences of Food Production of National Research Council of Italy, Bari, Italy
| | - Joana S Amaral
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Bragança, Portugal
- Laboratório Associado para a Sustentabilidade e Tecnologia em Regiões de Montanha (SusTEC), Instituto Politécnico de Bragança, Bragança, Portugal
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Costantini E, Masciarelli E, Casorri L, Di Luigi M, Reale M. Medicinal herbs and multiple sclerosis: Overview on the hard balance between new therapeutic strategy and occupational health risk. Front Cell Neurosci 2022; 16:985943. [PMID: 36439198 PMCID: PMC9688751 DOI: 10.3389/fncel.2022.985943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Multiple sclerosis (MS) is an autoimmune disease characterized by demyelination and axonal loss of the central nervous system (CNS). Despite its spread throughout the world, the mechanisms that determine its onset are still to be defined. Immunological, genetic, viral, and environmental factors and exposure to chemicals may trigger MS. Many studies have highlighted the anti-inflammatory and anti-oxidant effects of medicinal herbs, which make them a natural and complementary treatment for neurodegenerative diseases. A severe reduction of several MS symptoms occurs with herbal therapy. Thus, the request for medicinal plants with potential beneficial effects, for MS patients, is constantly increasing. Consequently, a production increase needs. Unfortunately, many medicinal herbs were untested and their action mechanism, possible adverse effects, contraindications, or interactions with other drugs, are poorly or not investigated. Keeping in mind the pathological mechanisms of MS and the oxidative damages and mitochondrial dysfunctions induced by pesticides, it is important to understand if pesticides used to increase agricultural productivity and their residues in medicinal plants, may increase the risk of developing MS in both workers and consumers. Studies providing some indication about the relationship between environmental exposure to pesticides and MS disease incidence are few, fragmentary, and discordant. The aim of this article is to provide a glance at the therapeutic potential of medicinal plants and at the risk for MS onset of pesticides used by medicinal plant growers and present in medicinal herbs.
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Affiliation(s)
- Erica Costantini
- Department of Medicine and Science of Aging, G. d’Annunzio University of Chieti–Pescara, Chieti, Italy
| | - Eva Masciarelli
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Laura Casorri
- Department of Technological Innovations and Safety of Plants, Products and Anthropic Settlements, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Marco Di Luigi
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL Research Center, National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Marcella Reale
- Department of Innovative Technologies in Medicine and Dentistry, G. d’Annunzio University of Chieti–Pescara, Chieti, Italy
- *Correspondence: Marcella Reale,
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MARQUES JNADV, CAPELA JP. Potential health risks surrounding ingredients of pre-workout and post-workout dietary supplements: a thorough label analysis. REV NUTR 2022. [DOI: 10.1590/1678-9865202235e200148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
ABSTRACT Objective Dietary supplements use is increasing. Dietary supplements may contain high doses of substances or dangerous ingredient combinations. This article aims to investigate, by analyzing dietary supplements labels, if there are any doping substances or dangerous amounts of any other component in the reviewed dietary supplements. Methods Several brands which possessed their supplements sorted in pre-workout and post-workout were analyzed. 40 dietary supplements with all ingredients described were included. The minimum and maximum dosages of dietary supplements were statistically described as Mean±SD. Results Citrus aurantium extract, Yohimbe extract, Garcinia cambogia extract and Maca root extract were reported in some of the analyzed dietary supplements. Regarding caffeine, the pre-workout group displayed higher mean caffeine (241±86mg) than the post-workout group (183±68mg), and the minimal mean dose was 226±84mg; meanwhile, the maximal mean dose was 242±88mg. Concerning creatine, the pre-workout group displayed lower mean creatine (3106±1079mg) than the post-workout group (4137±4177mg), and the minimal mean dose was 3167±1728mg; meanwhile, the maximal mean dose was 3917±3643mg. The salt content in the post-workout group displayed a much higher mean (2155±4486mg) than the pre-workout group (464±605mg), and the minimal mean dose was 1635±3930mg; meanwhile, the maximal mean dose was 1708±3926g. Conclusions No doping substances were reported in the dietary supplements, but consumption recommendations on the label could lead to excessive consumption of some not yet fully tested ingredients.
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Affiliation(s)
| | - João Paulo CAPELA
- Universidade Fernando Pessoa, Portugal; Universidade do Porto, Portugal
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Veatch-Blohm ME, Chicas I, Margolis K, Vanderminden R, Gochie M, Lila K. Screening for consistency and contamination within and between bottles of 29 herbal supplements. PLoS One 2021; 16:e0260463. [PMID: 34813619 PMCID: PMC8610273 DOI: 10.1371/journal.pone.0260463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/09/2021] [Indexed: 11/19/2022] Open
Abstract
In the United States the marketing of dietary supplements, of which the majority are herbal supplements, is currently a multibillion-dollar industry involving use from over half of the adult population. Due to their frequency of use and the lack of regulation of herbal supplements by the Food and Drug Administration (FDA) it is important for the health and safety of consumers to know about consistency of supplements and any possible contamination by harmful products, such as heavy metals or microorganisms. The purpose of the study was to determine consistency and contamination within and between bottles of common herbal supplements. Duplicate bottles of 29 herbal supplements were tested for consistency for antioxidant activity, phenolic concentration and flavonoid concentration under methanolic and water extraction. The supplements were also analyzed for the presence of metals and fungal contaminants. For all of the supplements tested there was high variability around the mean in antioxidant activity, phenolic concentrations and flavonoid concentrations, with coefficients of variation (CV) ranging from 0-120. Zinc was found in almost 90% of the supplements, nickel in about half of the supplements and lead in none of the supplements. Approximately 60% of the supplements contained fungal isolates. Although the majority of the fungi that were found in the supplements are generally not hazardous to human health, many of them could be problematic to sensitive groups, such as immunocompromised individuals. The data, which demonstrates contamination and a lack of consistency, in conjunction with previous studies on supplement contamination, strengthen the case that the FDA should regulate over-the-counter herbal supplements the same way that they regulate food and drugs. Until such time it is crucial that consumers are informed that many of the supplements that they take may lack the standardization that would reduce the chance of contamination and lead to consistency from one pill to the next.
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Affiliation(s)
- Maren E. Veatch-Blohm
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Iris Chicas
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Kathryn Margolis
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Rachael Vanderminden
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Marisa Gochie
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Khusmanie Lila
- Department of Biology, Loyola University Maryland, Baltimore, Maryland, United States of America
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Hunter ES, Literman R, Handy SM. Utilizing Big Data to Identify Tiny Toxic Components: Digitalis. Foods 2021; 10:1794. [PMID: 34441571 PMCID: PMC8391216 DOI: 10.3390/foods10081794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 12/23/2022] Open
Abstract
The botanical genus Digitalis is equal parts colorful, toxic, and medicinal, and its bioactive compounds have a long history of therapeutic use. However, with an extremely narrow therapeutic range, even trace amounts of Digitalis can cause adverse effects. Using chemical methods, the United States Food and Drug Administration traced a 1997 case of Digitalis toxicity to a shipment of Plantago (a common ingredient in dietary supplements marketed to improve digestion) contaminated with Digitalis lanata. With increased accessibility to next generation sequencing technology, here we ask whether this case could have been cracked rapidly using shallow genome sequencing strategies (e.g., genome skims). Using a modified implementation of the Site Identification from Short Read Sequences (SISRS) bioinformatics pipeline with whole-genome sequence data, we generated over 2 M genus-level single nucleotide polymorphisms in addition to species-informative single nucleotide polymorphisms. We simulated dietary supplement contamination by spiking low quantities (0-10%) of Digitalis whole-genome sequence data into a background of commonly used ingredients in products marketed for "digestive cleansing" and reliably detected Digitalis at the genus level while also discriminating between Digitalis species. This work serves as a roadmap for the development of novel DNA-based assays to quickly and reliably detect the presence of toxic species such as Digitalis in food products or dietary supplements using genomic methods and highlights the power of harnessing the entire genome to identify botanical species.
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Affiliation(s)
| | | | - Sara M. Handy
- Center for Food Safety and Applied Nutrition, Office of Regulatory Science, U.S. Food and Drug Administration, College Park, MD 20740, USA; (E.S.H.); (R.L.)
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Ichim MC, Booker A. Chemical Authentication of Botanical Ingredients: A Review of Commercial Herbal Products. Front Pharmacol 2021; 12:666850. [PMID: 33935790 PMCID: PMC8082499 DOI: 10.3389/fphar.2021.666850] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022] Open
Abstract
Chemical methods are the most important and widely used traditional plant identification techniques recommended by national and international pharmacopoeias. We have reviewed the successful use of different chemical methods for the botanical authentication of 2,386 commercial herbal products, sold in 37 countries spread over six continents. The majority of the analyzed products were reported to be authentic (73%) but more than a quarter proved to be adulterated (27%). At a national level, the number of products and the adulteration proportions varied very widely. Yet, the adulteration reported for the four countries, from which more than 100 commercial products were purchased and their botanical ingredients chemically authenticated, was 37% (United Kingdom), 31% (Italy), 27% (United States), and 21% (China). Simple or hyphenated chemical analytical techniques have identified the total absence of labeled botanical ingredients, substitution with closely related or unrelated species, the use of biological filler material, and the hidden presence of regulated, forbidden or allergenic species. Additionally, affecting the safety and efficacy of the commercial herbal products, other low quality aspects were reported: considerable variability of the labeled metabolic profile and/or phytochemical content, significant product-to-product variation of botanical ingredients or even between batches by the same manufacturer, and misleading quality and quantity label claims. Choosing an appropriate chemical technique can be the only possibility for assessing the botanical authenticity of samples which have lost their diagnostic microscopic characteristics or were processed so that DNA cannot be adequately recovered.
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Affiliation(s)
- Mihael Cristin Ichim
- “Stejarul” Research Centre for Biological Sciences, National Institute of Research and Development for Biological Sciences, Piatra Neamt, Romania
| | - Anthony Booker
- Research Centre for Optimal Health, School of Life Sciences, College of Liberal Arts and Sciences, University of Westminster, London, United Kingdom
- Pharmacognosy and Phytotherapy, UCL School of Pharmacy, London, United Kingdom
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Prevalence and Correlates of Complementary and Alternative Medicine Use among Patients with Lung Cancer: A Cross-Sectional Study in Beirut, Lebanon. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:8434697. [PMID: 28912824 PMCID: PMC5587961 DOI: 10.1155/2017/8434697] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/24/2017] [Indexed: 12/18/2022]
Abstract
Patients with lung cancer are increasingly seeking complementary and alternative medicine (CAM) to improve their physiological and psychological well-being. This study aimed to assess CAM use among lung cancer patients in Lebanon. Using a cross-sectional design, 150 lung cancer patients attending the Basile Cancer Institute at the American University of Beirut Medical Center were interviewed. Participants completed a questionnaire addressing sociodemographic characteristics, lung cancer condition, and use of CAM. The main outcome of interest was “use of any CAM therapy since diagnosis.” Prevalence of CAM use was 41%. The most commonly used CAM modality among study participants was “dietary supplements/special foods.” Results of the multiple logistic regression analyses showed that CAM use was positively associated with Lebanese nationality and paying for treatment out of pocket and was negatively associated with unemployment and having other chronic diseases. About 10% of patients used CAM on an alternative base, 58% did not disclose CAM use to their physician, and only 2% cited health professionals as influencing their choice of CAM. This study revealed a prevalent CAM use among lung cancer patients in Lebanon, with a marginal role for physicians in guiding this use. Promoting an open-communication and a patient-centered approach regarding CAM use is warranted.
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Curtis P, Gaylord S. Safety Issues in the Interaction of Conventional, Complementary, and Alternative Health Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/1533210105275144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article reviews issues of safety in health care, applied particularly to the interface between conventional medicine and complementary and alternative medicine. These issues include errors in treatment and medical management, adverse effects of pharmaceuticals, and defining risk for patients. For complementary and alternative medicine, especially dietary supplements, problems of quality control, licensing, regulation, and misrepresentation are discussed. An important issue is the interface between conventional and complementary therapies, in terms of drug/herb interactions, laboratory diagnosis, and lack of communication between clinicians about patients. Improvements in safety and quality will come from a commitment to better education and understanding between both types of care.
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Affiliation(s)
- Peter Curtis
- Department of Family Medicine, CB# 7595, University of North Carolina School of Medicine, Chapel Hill, NC 27599
| | - Susan Gaylord
- Department of Physical Medicine and Rehabilitation, School of Medicine, UNC, Chapel Hill
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9
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Fong HHS. Integration of Herbal Medicine Into Modern Medical Practices: Issues and Prospects. Integr Cancer Ther 2016; 1:287-93; discussion 293. [PMID: 14667286 DOI: 10.1177/153473540200100313] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The integration of herbal medicine into modern medical practices including cancer treatments must take into account the interrelated issues of quality, safety, and efficacy. Quality is the paramount issue because it can affect the efficacy and/or safety of the herbal products being used. Current product quality ranges from very high to very low due to intrinsic, extrinsic, and regulatory factors. Intrinsically, species differences, organ specificity, diurnal and seasonal variations can affect the qualitative and quantitative accumulation of active chemical constituents in the source medicinal plants. Extrinsically, environmental factors; field collection methods such as cultivation, harvest, post-harvest transport and storage; manufacturing practices; inadvertent contamination and substitution; and intentional adulteration are contributing factors to the quality of herbal medicinal products. Source plant materials that are contaminated with microbes, microbial toxins, environmental pollutants, or heavy metals; or finished products that are adulterated with foreign toxic plants or synthetic pharmaceutical agents can lead to adverse events. Substandard source materials or finished products will yield therapeutically less effective agents. Herbal medicine quality can also be attributed to regulatory practices. In a number of countries, herbal medicines are unregulated, which has led to product quality differences. Product quality improvement may be achieved by implementing control measures from the point of medicinal plant procurement under good agricultural practices (GAPs) and the manufacture of the finished botanical products under good manufacturing practices (GMPs), plus post-marketing quality assurance surveillance. The lack of pharmacological and clinical data on the majority of herbal medicinal products is a major impediment to the integration of herbal medicines into conventional medical practices. For valid integration, pharmacological and especially, clinical studies, must be conducted on those plants lacking such data. Adverse events, including drug-herb interaction must also be monitored to promote a safe integration of efficacious herbal medicine into conventional medical practices.
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Affiliation(s)
- Harry H S Fong
- UIC/NIH Center for Botanical Dietary Supplements Research, College of Pharmacy, University of Illinois at Chicago, 60612, USA.
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10
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Mudge EM, Betz JM, Brown PN. The Importance of Method Selection in Determining Product Integrity for Nutrition Research. Adv Nutr 2016; 7:390-8. [PMID: 26980823 PMCID: PMC4785475 DOI: 10.3945/an.115.010611] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The American Herbal Products Association estimates that there as many as 3000 plant species in commerce. The FDA estimates that there are about 85,000 dietary supplement products in the marketplace. The pace of product innovation far exceeds that of analytical methods development and validation, with new ingredients, matrixes, and combinations resulting in an analytical community that has been unable to keep up. This has led to a lack of validated analytical methods for dietary supplements and to inappropriate method selection where methods do exist. Only after rigorous validation procedures to ensure that methods are fit for purpose should they be used in a routine setting to verify product authenticity and quality. By following systematic procedures and establishing performance requirements for analytical methods before method development and validation, methods can be developed that are both valid and fit for purpose. This review summarizes advances in method selection, development, and validation regarding herbal supplement analysis and provides several documented examples of inappropriate method selection and application.
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Affiliation(s)
- Elizabeth M Mudge
- Centre for Applied Research and Innovation, British Columbia Institute of Technology, Burnaby, Canada; and
| | | | - Paula N Brown
- Centre for Applied Research and Innovation, British Columbia Institute of Technology, Burnaby, Canada; and
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Abstract
Regulated differently than drugs or foods, the market for botanical dietary supplements continues to grow worldwide. The recently implemented U.S. FDA regulation that all botanical dietary supplements must be produced using good manufacturing practice is an important step toward enhancing the safety of these products, but additional safeguards could be implemented, and unlike drugs, there are currently no efficacy requirements. To ensure a safe and effective product, botanical dietary supplements should be developed in a manner analogous to pharmaceuticals that involves identification of mechanisms of action and active constituents, chemical standardization based on the active compounds, biological standardization based on pharmacological activity, preclinical evaluation of toxicity and potential for drug-botanical interactions, metabolism of active compounds, and finally, clinical studies of safety and efficacy. Completing these steps will enable the translation of botanicals from the field to safe human use as dietary supplements.
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Affiliation(s)
- Richard B. van Breemen
- UIC/NIH Center for Botanical Dietary Supplements Research,
Department of Medicinal Chemistry and Pharmacognosy, University of Illinois College of Pharmacy, 833 S. Wood Street, Chicago, Illinois 60612, United States
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Wu L, Sun W, Wang B, Zhao H, Li Y, Cai S, Xiang L, Zhu Y, Yao H, Song J, Cheng YC, Chen S. An integrated system for identifying the hidden assassins in traditional medicines containing aristolochic acids. Sci Rep 2015; 5:11318. [PMID: 26270958 PMCID: PMC4535178 DOI: 10.1038/srep11318] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 04/24/2015] [Indexed: 01/08/2023] Open
Abstract
Traditional herbal medicines adulterated and contaminated with plant materials from the Aristolochiaceae family, which contain aristolochic acids (AAs), cause aristolochic acid nephropathy. Approximately 256 traditional Chinese patent medicines, containing Aristolochiaceous materials, are still being sold in Chinese markets today. In order to protect consumers from health risks due to AAs, the hidden assassins, efficient methods to differentiate Aristolochiaceous herbs from their putative substitutes need to be established. In this study, 158 Aristolochiaceous samples representing 46 species and four genera as well as 131 non-Aristolochiaceous samples representing 33 species, 20 genera and 12 families were analyzed using DNA barcodes based on the ITS2 and psbA-trnH sequences. Aristolochiaceous materials and their non-Aristolochiaceous substitutes were successfully identified using BLAST1, the nearest distance method and the neighbor-joining (NJ) tree. In addition, based on sequence information of ITS2, we developed a Real-Time PCR assay which successfully identified herbal material from the Aristolochiaceae family. Using Ultra High Performance Liquid Chromatography-Mass Spectrometer (UHPLC-HR-MS), we demonstrated that most representatives from the Aristolochiaceae family contain toxic AAs. Therefore, integrated DNA barcodes, Real-Time PCR assays using TaqMan probes and UHPLC-HR-MS system provides an efficient and reliable authentication system to protect consumers from health risks due to the hidden assassins (AAs).
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Affiliation(s)
- Lan Wu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
- College of Pharmacy, Hubei University of Chinese Medicine, Wuhan, China
| | - Wei Sun
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bo Wang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haiyu Zhao
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaoli Li
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University Health Science Centre, Beijing, China
| | - Shaoqing Cai
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University Health Science Centre, Beijing, China
| | - Li Xiang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingjie Zhu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hui Yao
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingyuan Song
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yung-Chi Cheng
- Department of Pharmacology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Shilin Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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Araujo JL, Worman HJ. Acute liver injury associated with a newer formulation of the herbal weight loss supplement Hydroxycut. BMJ Case Rep 2015; 2015:bcr-2015-210303. [PMID: 25948859 DOI: 10.1136/bcr-2015-210303] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Despite the widespread use of herbal and dietary supplements (HDS), serious cases of hepatotoxicity have been reported. The popular herbal weight loss supplement, Hydroxycut, has previously been implicated in acute liver injury. Since its introduction, Hydroxycut has undergone successive transformations in its formulation; yet, cases of liver injury have remained an ongoing problem. We report a case of a 41-year-old Hispanic man who developed acute hepatocellular liver injury with associated nausea, vomiting, jaundice, fatigue and asterixis attributed to the use of a newer formulation of Hydroxycut, SX-7 Clean Sensory. The patient required hospitalisation and improved with supportive therapy. Despite successive transformations in its formulation, potential liver injury appears to remain an ongoing problem with Hydroxycut. Our case illustrates the importance of obtaining a thorough medication history, including HDS, regardless of new or reformulated product marketing efforts.
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Affiliation(s)
- James L Araujo
- Department of Medicine, Columbia University, New York, New York, USA
| | - Howard J Worman
- Department of Medicine, Columbia University, New York, New York, USA Department of Pathology and Cell Biology Columbia University, New York, New York, USA
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Schramek N, Wollein U, Eisenreich W. Pyrazolopyrimidines in ‘all-natural’ products for erectile dysfunction treatment: the unreliable quality of dietary supplements. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2014; 32:127-40. [DOI: 10.1080/19440049.2014.992980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Amariles P, González LI, Giraldo NA. Prevalence of self-treatment with complementary products and therapies for weight loss: A randomized, cross-sectional Study in Overweight and Obese Patients in Colombia. Curr Ther Res Clin Exp 2014; 67:66-78. [PMID: 24678084 DOI: 10.1016/j.curtheres.2006.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2005] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of complementary and alternative medicine for weight loss is becoming increasingly common worldwide. In overweight or obese patients, this practice could be harmful. Available data concerning the use of complementary therapies and products (CTPs) for weight loss in these patients in Colombia are limited. OBJECTIVES The aims of this study were to determine the prevalence of self-treatment with CTPs in overweight or obese patients in Colombia and to explore the relationship between CTP use and demographic, anthropometric, and biochemical parameters. METHODS This randomized, cross-sectional study was conducted at a registered dieticians' office located at the Center for Nutritional Care, School of Nutrition and Dietetics, University of Antioquia, Medellín, Colombia, and at an outpatient clinic attended by a registered dietician located at the Pablo Tobón Uribe Hospital, Medellín, Colombia. The study enrolled a random sample of overweight (body mass index [BMI], 25-30 kg/m(2)) or obese (BMI, >30 kg/m(2)) male and female patients aged 20 to 50 years received nutritional treatment in Colombia in 2002. Data concerning the use of weight-loss CTPs were gathered, and their possible association with demographic, anthropometric, and biochemical data was explored. RESULTS This randomized study comprised 94 patients (70 women, 24 men; mean [SD] age, 36.5 [9.7] years; mean [SD] BMI, 28.4 [4.2] kg/m(2)). Forty-nine (52.1%) patients reported self-treatment with weight-loss CTPs; 40 (42.6%) patients used complementary products, and 21 (22.3%) used complementary therapies. Among the products, inadequately identified herbal medicines (ie, absence of available information concerning the composition of the products or information could not be obtained from the patient [many of the products used were not authorized for distribution in Colombia]), folkloric or home remedies, and commercial diets were most commonly used (40.0%, 40.0%, and 27.5%, respectively). The use of CTPs was more prevalent in women compared with men (P < 0.001; odds ratio [OR] = 6.43). In women, CTP use was significantly higher in patients with a higher educational level (P = 0.008; OR = 3.82) and in those who were single (P = 0.038; OR = 2.97). The use of CTPs was also more frequent in patients with a negative view of their current nutritional therapy (P = 0.002; OR = 6.8). CONCLUSIONS In the small group of overweight and obese patients in this study, 52.1% used CTPs. In obese women, those with a higher educational level and/or who were single were more likely to use CTPs. Patients were also more likely to use CTPs if they had a negative view of their current nutritional therapy.
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Affiliation(s)
- Pedro Amariles
- Faculty of Pharmaceutical Chemistry, University of Antioquia, Medellin, Colombia ; Research Group on Pharmaceutical Care, University of Granada, Granada, Spain
| | - Laura I González
- School of Nutrition and Dietetics, University of Antioquia, Medellin, Colombia ; Research Group on Human Nutrition, University of Antioquia, Medellin, Colombia
| | - Nubia A Giraldo
- School of Nutrition and Dietetics, University of Antioquia, Medellin, Colombia
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Whitsitt V, Beehner C, Welch C. The role of good manufacturing practices for preventing dietary supplement adulteration. Anal Bioanal Chem 2013; 405:4353-8. [PMID: 23361225 DOI: 10.1007/s00216-012-6663-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Al-Omari A, Al-Qudimat M, Abu Hmaidan A, Zaru L. Perception and attitude of Jordanian physicians towards complementary and alternative medicine (CAM) use in oncology. Complement Ther Clin Pract 2013; 19:70-6. [PMID: 23561063 DOI: 10.1016/j.ctcp.2013.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 01/07/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine general perception and attitudes to CAM among Jordanian physicians at King Hussein Cancer Center (KHCC), and challenges facing formal integration of CAM into conventional practice. METHOD A cross-sectional survey of KHCC physicians using a semi-structured questionnaire. RESULTS Response rate was 71%(71/100). 84%(41/49) defined CAM as "not evidence-based" treatments and/or "Herbs". More than 80% reported interest to learn about CAM. 70% believed that herbal remedies were harmful, though only 17%(12/71) reported some knowledge about their composition. Physicians' concern of harmful interactions was the most significant reason for asking their patients about use (p < 0.0001). >90%(32/35) of physicians who estimated a low rate (<10%) of CAM usage by patients had minimal knowledge of herbal remedies (p = 0.06). CONCLUSION KHCC physicians have very little knowledge but high interest to learn about CAM use in oncology. An educational component will be crucial for the implementation of a formal CAM program at KHCC.
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Affiliation(s)
- Amal Al-Omari
- Office of Scientific Affairs and Research, King Hussein Cancer Center, P.O. Box 1269 Al-Jubeiha, Amman 11941, Jordan.
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18
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Zakaryan A, Martin IG. Regulation of Herbal Dietary Supplements: Is There a Better Way? ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0092861512452121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Castello LM, Negro S, Santi F, Zanotti I, Vidali M, Bagnati M, Bellomo G, Avanzi GC. Accidental digitoxin intoxication: an interplay between laboratory and clinical medicine. Biochem Med (Zagreb) 2012; 22:380-4. [PMID: 23092069 PMCID: PMC3900044 DOI: 10.11613/bm.2012.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Two Italian adults arrived at the Emergency Department referring diarrhea, nausea and vomiting for 4 days; weakness, fatigue and visual hallucinations were also complained of. Patients reported the ingestion of some leaves of a plant, which they supposed to be “donkey ears”, a week before. Physical examination showed hypotension and bradycardia and ECG examination disclosed sinus rhythm and repolarization abnormalities (scooping of the ST-T complex) in both patients and a 2:1 AV block in the man. Materials and methods: Digoxin concentration was evaluated twice for each patient (at the admission and after 4 hours) by the automated immunoassay system ADVIA Centaur®. Digitoxin concentration was evaluated by liquid chromatography-mass spectrometry (LC-MS/MS). Results: Despite clinical picture was suggestive of digitalis intoxication, digoxin levels were undetectable. Due to the more severe clinical picture, the male patient was treated with anti-digoxin antibodies (Digifab®) achieving a good clinical improvement and remission of the AV block within two hours. Initial diagnosis was confirmed by LC-MS/MS showing high digitoxin concentrations, but digoxin was undetectable. Patients remained stable and 48 hours later were discharged from the hospital. Conclusion: Whereas digoxin determination frequently relies on monoclonal antibodies which do not cross-react to digitoxin, polyclonal antibodies constituting Digifab® recognize a large spectrum of cardiac glycosides, including digitoxin. This report emphasizes the primary role of the clinical approach to patients in the emergency setting and how an active communication and a continuous sharing of professional experiences between Laboratory and Clinicians ensure an early and correct diagnosis.
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Affiliation(s)
- Luigi M Castello
- Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliero-Universitaria Maggiore della Carità, Scuola di Specializzazione in Medicina d'Emergenza-Urgenza, Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
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20
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Red ginseng extract attenuates kainate-induced excitotoxicity by antioxidative effects. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:479016. [PMID: 23133495 PMCID: PMC3485976 DOI: 10.1155/2012/479016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/11/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
Abstract
This study investigated the neuroprotective activity of red ginseng extract (RGE, Panax ginseng, C. A. Meyer) against kainic acid- (KA-) induced excitotoxicity in vitro and in vivo. In hippocampal cells, RGE inhibited KA-induced excitotoxicity in a dose-dependent manner as measured by the MTT assay. To study the possible mechanisms of the RGE-mediated neuroprotective effect against KA-induced cytotoxicity, we examined the levels of intracellular reactive oxygen species (ROS) and [Ca2+]i in cultured hippocampal neurons and found that RGE treatment dose-dependently inhibited intracellular ROS and [Ca2+]i
elevation. Oral administration of RGE (30 and 200 mg/kg) in mice decreased the malondialdehyde (MDA) level induced by KA injection (30 mg/kg, i.p.). In addition, similar results were obtained after pretreatment with the radical scavengers Trolox and N, N′-dimethylthiourea (DMTU). Finally, after confirming the protective effect of RGE on hippocampal brain-derived neurotropic factor (BDNF) protein levels, we found that RGE is active compounds mixture in KA-induced hippocampal mossy-fiber function improvement. Furthermore, RGE eliminated 1,1-diphenyl-2-picrylhydrazyl (DPPH) radicals, and the IC50 was approximately 10 mg/ml. The reductive activity of RGE, as measured by reaction with hydroxyl radical (•OH), was similar to trolox. The second-order rate constant of RGE for •OH was 3.5–4.5 × 109 M−1·S−1. Therefore, these results indicate that RGE possesses radical reduction activity and alleviates KA-induced excitotoxicity by quenching ROS in hippocampal neurons.
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Marraffa JM, Cohen V, Howland MA. Antidotes for toxicological emergencies: a practical review. Am J Health Syst Pharm 2012; 69:199-212. [PMID: 22261941 DOI: 10.2146/ajhp110014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Appropriate therapies for commonly encountered poisonings, medication overdoses, and other toxicological emergencies are reviewed, with discussion of pharmacists' role in ensuring their ready availability and proper use. SUMMARY Poisoning is the second leading cause of injury-related morbidity and mortality in the United States, with more than 2.4 million toxic exposures reported each year. Recently published national consensus guidelines recommend that hospitals providing emergency care routinely stock 24 antidotes for a wide range of toxicities, including toxic-alcohol poisoning, exposure to cyanide and other industrial agents, and intentional or unintentional overdoses of prescription medications (e.g., calcium-channel blockers, β-blockers, digoxin, isoniazid). Pharmacists can help reduce morbidity and mortality due to poisonings and overdoses by (1) recognizing the signs and symptoms of various types of toxic exposure, (2) guiding emergency room staff on the appropriate use of antidotes and supportive therapies, (3) helping to ensure appropriate monitoring of patients for antidote response and adverse effects, and (4) managing the procurement and stocking of antidotes to ensure their timely availability. CONCLUSION Pharmacists can play a key role in reducing poisoning and overdose injuries and deaths by assisting in the early recognition of toxic exposures and guiding emergency personnel on the proper storage, selection, and use of antidotal therapies.
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Affiliation(s)
- Jeanna M Marraffa
- Upstate New York Poison Center, 750 East Adams Street, Syracuse, NY 13210, USA.
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Burger J, Gochfeld M. Conceptual environmental justice model for evaluating chemical pathways of exposure in low-income, minority, native American, and other unique exposure populations. Am J Public Health 2011; 101 Suppl 1:S64-73. [PMID: 21551379 PMCID: PMC3222515 DOI: 10.2105/ajph.2010.300077] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2010] [Indexed: 11/04/2022]
Abstract
Risk assessment determines pathways, and exposures that lead to poor health. For exposures that fall disproportionately on urban low-income communities, minorities, and Native Americans, these pathways are often more common than in the general population. Although risk assessors often evaluate these pathways on an ad hoc basis, a more formal way of addressing these nonstandard pathways is needed to adequately inform public health policy. A conceptual model is presented for evaluating nonstandard, unique, or excessive exposures, particularly for environmental justice communities that have an exposure matrix of inhalation, dermal, ingestion, and injection. Risk assessment can be improved by including nonstandard and unique exposure pathways as described in this conceptual model.
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Affiliation(s)
- Joanna Burger
- Division of Life Sciences, Rutgers University, Piscataway, NJ 08854, USA.
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Thoppil RJ, Bishayee A. Terpenoids as potential chemopreventive and therapeutic agents in liver cancer. World J Hepatol 2011; 3:228-49. [PMID: 21969877 PMCID: PMC3182282 DOI: 10.4254/wjh.v3.i9.228] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 08/15/2011] [Accepted: 08/22/2011] [Indexed: 02/06/2023] Open
Abstract
Despite significant advances in medicine, liver cancer, predominantly hepatocellular carcinoma remains a major cause of death in the United States as well as the rest of the world. As limited treatment options are currently available to patients with liver cancer, novel preventive control and effective therapeutic approaches are considered to be reasonable and decisive measures to combat this disease. Several naturally occurring dietary and non-dietary phytochemicals have shown enormous potential in the prevention and treatment of several cancers, especially those of the gastrointestinal tract. Terpenoids, the largest group of phytochemicals, traditionally used for medicinal purposes in India and China, are currently being explored as anticancer agents in clinical trials. Terpenoids (also called "isoprenoids") are secondary metabolites occurring in most organisms, particularly plants. More than 40 000 individual terpenoids are known to exist in nature with new compounds being discovered every year. A large number of terpenoids exhibit cytotoxicity against a variety of tumor cells and cancer preventive as well as anticancer efficacy in preclinical animal models. This review critically examines the potential role of naturally occurring terpenoids, from diverse origins, in the chemoprevention and treatment of liver tumors. Both in vitro and in vivo effects of these agents and related cellular and molecular mechanisms are highlighted. Potential challenges and future directions involved in the advancement of these promising natural compounds in the chemoprevention and therapy of human liver cancer are also discussed.
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Affiliation(s)
- Roslin J Thoppil
- Roslin J Thoppil, Anupam Bishayee, Cancer Therapeutics and Chemoprevention Group, Department of Pharmaceutical Sciences, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Rootstown, OH 44272, United States
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Abdel-Rahman A, Anyangwe N, Carlacci L, Casper S, Danam RP, Enongene E, Erives G, Fabricant D, Gudi R, Hilmas CJ, Hines F, Howard P, Levy D, Lin Y, Moore RJ, Pfeiler E, Thurmond TS, Turujman S, Walker NJ. The safety and regulation of natural products used as foods and food ingredients. Toxicol Sci 2011; 123:333-48. [PMID: 21821733 DOI: 10.1093/toxsci/kfr198] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The use of botanicals and dietary supplements derived from natural substances as an adjunct to an improved quality of life or for their purported medical benefits has become increasingly common in the United States. This review addresses the safety assessment and regulation of food products containing these substances by the U.S. Food and Drug Administration (FDA). The issue of safety is particularly critical given how little information is available on the toxicity of some of these products. The first section uses case studies for stevia and green tea extracts as examples of how FDA evaluates the safety of botanical and herbal products submitted for consideration as Generally Recognized as Safe under the Federal Food, Drug, and Cosmetics Act. The 1994 Dietary Supplement Health Education Act (DSHEA) created a regulatory framework for dietary supplements. The article also discusses the regulation of this class of dietary supplements under DSHEA and addresses the FDA experience in analyzing the safety of natural ingredients described in pre-market safety submissions. Lastly, we discuss an ongoing interagency collaboration to conduct safety testing of nominated dietary supplements.
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Affiliation(s)
- Ali Abdel-Rahman
- Division of Dietary Supplement Programs, Office of Nutrition, Labeling, and Dietary Supplements, College Park, Maryland 20740, USA
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25
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Zhang A, Xue C, Fong H. Integration of Herbal Medicine into Evidence-Based Clinical Practice. OXIDATIVE STRESS AND DISEASE 2011. [DOI: 10.1201/b10787-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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26
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Girard L, Vohra S. Ethics of Using Herbal Medicine as Primary or Adjunct Treatment and Issues of Drug–Herb Interaction. OXIDATIVE STRESS AND DISEASE 2011. [DOI: 10.1201/b10787-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Gershwin ME, Borchers AT, Keen CL, Hendler S, Hagie F, Greenwood MRC. Public safety and dietary supplementation. Ann N Y Acad Sci 2010; 1190:104-17. [PMID: 20388141 DOI: 10.1111/j.1749-6632.2009.05270.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Approximately 6 in 10 Americans report regularly using some type of dietary supplement, and approximately 1 in 6 Americans reports using herbal remedies on a regular basis. The diversity of manufacturers, manufacturing processes, and quality control issues are enormous. As with all plant products, herbal products are complex mixtures of a variety of chemical constituents with considerable variation in the growth, harvesting, and storage conditions, including different extraction procedures. Furthermore, not only is there variation in batches, but also the potential for contamination. In addition, herbal products have the potential to interact with pharmaceuticals. These problems have led to consumer and physician confusion about the use of herbal products and have not been satisfactorily resolved, because the Food and Drug Administration has only very recently started to fulfill its mission of consumer protection in the realm of dietary supplements. More importantly, we provide a working plan for addressing this important issue.
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Affiliation(s)
- M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, California 95616, USA.
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Red ginseng extract protects against aflatoxin B1 and fumonisins-induced hepatic pre-cancerous lesions in rats. Food Chem Toxicol 2010; 48:733-42. [DOI: 10.1016/j.fct.2009.12.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 11/06/2009] [Accepted: 12/11/2009] [Indexed: 11/18/2022]
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29
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Maffè S, Cucchi L, Zenone F, Bertoncelli C, Beldì F, Colombo ML, Bielli M, Paino AM, Parravicini U, Paffoni P, Dellavesa P, Perucca A, Pardo NF, Signorotti F, Didino C, Zanetta M. Digitalis must be banished from the table: a rare case of acute accidental Digitalis intoxication of a whole family. J Cardiovasc Med (Hagerstown) 2009; 10:727-32. [PMID: 19491701 DOI: 10.2459/jcm.0b013e32832c2314] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Advanced Digitalis intoxication is a rare event, mainly associated with overdose in patients with Digitalis therapy. We report an unusual case of acute 'familiar' digitalis poisoning in three patients who had eaten potato dumplings flavoured with leaves of Borago officinalis L. unconsciously mixed with leaves of Digitalis purpurea L. A complicated clinical course with marked bradyarrhythmias was presented, with good evolution thanks to the use of digoxin-specific antibody Fab fragments. The theme of the domestic use of plants with medicinal effects has been treated and discussed.
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Affiliation(s)
- Stefano Maffè
- Division of Cardiology, Department of Emergency, SS Trinità Borgomanero Hospital, ASL No-Novara, Novara, Italy.
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Komesaroff PA, Black CVS, Cable V, Sudhir K. Effects of wild yam extract on menopausal symptoms, lipids and sex hormones in healthy menopausal women. Climacteric 2009. [DOI: 10.1080/cmt.4.2.144.150] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
The case of a 64 year old female patient is presented who has treated herself for 9 months with various Indian Ayurvedic herbal products for her vitiligo and experienced a causally related severe hepatotoxicity (ALT, 601 U/L; AST, 663 U/L; Bilirubin, 5.0 mg/dL). After discontinuation, a rapid improvement was observed. Causality assessment with the updated CIOMS (Council for International Organizations of Medical Sciences) scale showed a probable causality (+8 points) for Bakuchi tablets containing extracts from Psoralea corylifolia leaves with psoralens as ingredients, as the primary candidate causing the hepatotoxic reaction. The degree of probability was lower with +6 points for other used herbs: Khadin tablets containing extracts from Acacia catechu leaves; Brahmi tablets containing Eclipta alba or Bacopa monnieri; and Usheer tea prepared from Vetivexia zizaniodis. The case is the first report of Indian Ayurvedic herbal products being potentially hepatotoxic in analogy to some other herbs.
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Sabatini-Sáez I, Guerra-Velásquez M, Reyna-Villasmil E, Mejía-Montilla J, Reyna-Villasmil N, Torres-Cepeda D, Delgado-Delgado O, Santos-Bolívar J. Lípidos y lipoproteínas en pacientes menopáusicas tratadas con diosgenina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Frishman WH, Beravol P, Carosella C. Alternative and complementary medicine for preventing and treating cardiovascular disease. Dis Mon 2009; 55:121-92. [PMID: 19215737 DOI: 10.1016/j.disamonth.2008.12.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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[Significance of herbal drugs legislation for their rational use]. VOJNOSANIT PREGL 2009; 66:53-6. [PMID: 19195265 DOI: 10.2298/vsp0901053c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
<zakljucak> Kvalitet i bezbednost upotrebe biljnih preparata ostaju i dalje prioritet koji treba zakonski urediti na svetskom nivou. Za registraciju biljnog preparata kao leka postoje isti zahtevi kao i za registraciju drugih lekova u pogledu dokumentacije koja treba da sadrzi predklinicka i klinicka ispitivanja. Ovakva ispitivanja vrlo su zahtevna, a kako slozenost molekulske gradje, cak i jednokomponentnih biljnih preparata, ometa utvrdjivanje jedinstvenih kriterijuma za jasno pracenje njihovih terapijskih efekata, ispunjavanje zahteva za registrovanje biljnih preparata kao lekova u praksi jos uvek je izazov i za naucnike i za proizvodjace.
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Alvarez-Hernández E, César Casasola-Vargas J, Lino-Pérez L, Burgos-Vargas R, Vázquez-Mellado J. [Complementary and alternative medicine in patients attending a rheumatology department for the first time. Analysis of 800 patients]. ACTA ACUST UNITED AC 2008; 2:183-9. [PMID: 21794326 DOI: 10.1016/s1699-258x(06)73044-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 03/24/2006] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To determine the frequency of the use of complementary and alternative medicine (CAM) in patients attending a rheumatology department in a general hospital for the first time. SUBJECTS AND METHODS We included consecutive patients attending our rheumatology department for the first time. All the patients completed a self-administered questionnaire containing items on demographic data, and prior diagnosis. The patients were also given a list of 22 different CAM and marked those they had previously used. RESULTS Eight hundred patients were studied. Eighty percent were women. The mean age was 44.8±14.9 years and the mean number of years of education was 7±4. The main diagnoses were osteoarthritis (29.4%), rheumatoid arthritis (22.3%), and fibromyalgia (6.5%). Seventy-one percent had previously used CAM, with a median of two (0-14) different types. The most common were vitamin supplements (38%), arnica (18%), Aloe vera (15%) and homeopathy (15%). No significant differences were found in sex, age, educational level, or diagnosis. The use of CAM was more frequent in patients with longer disease duration. CONCLUSIONS The frequency of use of CAM is high in patient with rheumatologic manifestations.
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Haller CA, Meier KH, Olson KR. Seizures Reported in Association with Use of Dietary Supplements. Clin Toxicol (Phila) 2008; 43:23-30. [PMID: 15732443 DOI: 10.1081/clt-44771] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Seizures in persons using dietary supplements (DS) have been reported through the Food and Drug Administration's (FDA) MedWatch system, but not formally reviewed. METHODS Sixty-five cases of DS-associated seizures reported to MedWatch from 1993 to 1999 were obtained through the Freedom of Information Act and independently evaluated by three reviewers for probability of causation based on temporal relationship, biological plausibility, and underlying risk factors. Our aims in this review were 1) to assess the probability of causation in each case; 2) to characterize the patterns of use and types of supplements involved in cases of seizures; and 3) to identify trends that may explain potential risks factors for dietary supplement-related seizures. RESULTS Twenty seizures were judged as probably related, 13 possibly related, and 10 as unrelated to DS use. Five cases were not seizures, and 17 cases contained insufficient information. In the 20 probably related cases, 19 involved ephedra, 14 involved herbal caffeine, and in one case, the supplement contained no herbal constituents but an array of elemental salts. Ephedra was also associated with 7 of the 13 possibly related cases, and caffeine was contained in 5 of these supplement products. Creatine, St. John's wort, and ginkgo biloba were other DS implicated in possibly related seizure events. Seizures were associated with hypoglycemia in 3 cases, and secondary to stroke in 2 cases and cardiac arrest in 2 cases. Weight loss (45%) and athletic performance enhancement (30%) were the most often cited reasons for supplement use. In most cases, DS use was within manufacturers' guidelines. CONCLUSION Ephedra was implicated in 27 of 33 DS-associated seizures reported to the FDA over a 7-year period, further underscoring that significant health risks are associated with use of this herbal product.
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Affiliation(s)
- Christine A Haller
- University of California, San Francisco, San Francisco, California 94143, USA.
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Kleinschmidt S, Rump G, Kotter J. [Herbal medications. Possible importance for anaesthesia and intensive care medicine]. Anaesthesist 2008; 56:1257-66. [PMID: 17898965 DOI: 10.1007/s00101-007-1264-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published.
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Affiliation(s)
- S Kleinschmidt
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland.
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Who's talking? Communication between health providers and HIV-infected adults related to herbal medicine for AIDS treatment in western Uganda. Soc Sci Med 2008; 67:165-76. [PMID: 18406030 DOI: 10.1016/j.socscimed.2008.02.027] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Indexed: 11/22/2022]
Abstract
Communication between patients and physicians about herbal medicine is valuable, enabling physicians to address issues of potential herb-drug interactions and ensuring appropriate medical care. As seemingly harmless herbal remedies may have detrimental interactions with various HIV antiretroviral drugs, the importance of communication is intensified, but often stifled around the use of herbal medicine in the treatment of HIV/AIDS. In western Uganda, 137 HIV-infected adults attending conventional HIV/AIDS treatment programmes (67 of whom were receiving antiretroviral therapy) shared their experiences and perceptions about traditional herbal medicine and related patient-physician communication issues through interviews and focus group discussions. Although close to 64% of respondents reported using herbal medicine after being diagnosed with HIV, only 16% of these respondents had informed their conventional medical practitioners about using these herbs. Furthermore, only 13% of antiretroviral therapy recipients had inquired about concurrent herb-antiretroviral drug use with their HIV/AIDS treatment providers, largely because they perceived a low acceptance and support for herbal medicine by conventional medical practitioners. Importantly however, almost 68% of HIV-infected adults indicated they would be willing to discuss herbal medicine use if directly asked by a conventional medical practitioner, and the overwhelming majority (91%) said they were amenable to following physician advice about herbal medicine. As such, improved patient-physician communication about herbal medicine is needed, and we recommend that herbal medicine histories be completed when patient histories are taken. Also, HIV/AIDS treatment programmes should be encouraged to develop specific patient-physician communication standards and best practice guidelines to ensure that patients can make informed decisions about herb and pharmaceutical drug co-therapy based on known risks, particularly in the case of AIDS patients receiving antiretroviral therapy. Communication about herbal medicine usage should be viewed as a timely and cost-effective component of antiretroviral therapy programmes, one which may contribute to the overall success of AIDS treatment in Africa.
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Cardioactive steroid poisoning: a comparison of plant- and animal-derived compounds. J Med Toxicol 2008; 2:152-5. [PMID: 18072135 DOI: 10.1007/bf03161183] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Cardioactive steroids (CASs) are found in plants, animals, and insects. Their affinity for Na+-K+ ATPase is attenuated by the type of lactone at carbon 17 (C17) of the steroid backbone: those with 5-membered lactone rings, or cardenolides, are derived mostly from plants with 6-membered rings or from animals with bufadienolides. A systematic review of CAS poisoning was performed to compare the mortality rate of cardenolides and bufadienolides. METHODS MEDLINE was searched for articles using commonly reported names of CASs, and keywords were limited to human cases only. We searched cases from 1982 to 2003, so that supportive care was similar and digoxin-specific Fab was available. Identified reports of CAS poisoning were read to exclude cases involving licensed pharmaceuticals. Inclusion criteria included hyperkalemia, gastrointestinal symptoms, electrocardiographic evidence of CAS toxicity, digoxin serum concentration, or history of exposure to a substance containing a CAS. Clinical data was collected, including information about treatment with digoxin-specific Fab and treatment outcome. RESULTS Fifty-nine articles, describing 924 patients, were identified. Eight hundred ninety-seven patients (97%) ingested a CAS with a 5-membered lactone ring, and mortality was 6% (n = 54). Twenty-seven patients (2.9%) ingested a CAS with a 6-membered lactone ring, and mortality was 29.6% (n = 8). The difference in mortality rates was statistically significant (p < 0.001, [X2]). CASs with 6-member rings accounted for the highest percentage of nonsuicidal exposures. CONCLUSION Although cardenolides accounted for the majority of exposures, bufadienolides were five times more lethal than cardenolides.
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Abstract
This cross-sectional survey sought to document complementary and alternative medicine (CAM) use by Texas midwives, as well as to determine whether licensed direct-entry midwives (LMs) and certified nurse-midwives (CNMs) differed significantly in their patterns of use. All respondents (n = 69) indicated that they used, recommended, or referred their clients for at least one CAM therapy during the preceding year. Ninety percent (90%) of respondents used, recommended, or referred their clients for an herbal remedy (not including homeopathic tinctures). Herbal therapies were among the top three modalities recommended for 7 of 12 (58%) clinical indications. Herbs were the most salient CAM therapy used for cervical ripening (83%), followed closely by use for nausea, vomiting, and hyperemesis (80%), and labor induction (77%). Herbal therapies also constituted 50% or more of the CAM therapies used for the following indications: anemia/iron supplementation (70%), perineal healing (66%), and anxiety/stress/fatigue (50%). LM respondents used, recommended, or referred their clients for a greater number of herbal therapies compared to CNMs. While several of the CAM modalities used or recommended by Texas midwives show potential for clinical benefit, few have been studied sufficiently to determine their efficacy or safety during pregnancy.
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Affiliation(s)
- Bryan P Bayles
- Center for Integrative Health, Department of Family and Community Medicine, The University of Texas Health Science Center, San Antonio, TX 78229-3900, USA.
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Hildreth J, Hrabeta-Robinson E, Applequist W, Betz J, Miller J. Standard operating procedure for the collection and preparation of voucher plant specimens for use in the nutraceutical industry. Anal Bioanal Chem 2007; 389:13-7. [PMID: 17572883 DOI: 10.1007/s00216-007-1405-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 05/22/2007] [Accepted: 05/25/2007] [Indexed: 11/29/2022]
Abstract
A vital part of the development of any standardized protocol for the extraction of plant-derived crude extracts to be used in herbal medicine or nutritional supplementation is proper documentation of the original botanical source of the extract via acquisition of a voucher specimen. The purpose of this document is to serve as an accepted protocol for voucher specimen collection, handling, and storage, with specific guidelines to address commercial and research uses.
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Affiliation(s)
- Jana Hildreth
- Blaze Science Industries LLC, 4547 West 171st St., Lawndale, CA 90260, USA.
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van Breemen RB, Fong HHS, Farnsworth NR. The role of quality assurance and standardization in the safety of botanical dietary supplements. Chem Res Toxicol 2007; 20:577-82. [PMID: 17362032 PMCID: PMC2570109 DOI: 10.1021/tx7000493] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Richard B van Breemen
- UIC/NIH Center for Botanical Dietary Supplements Research, Department of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, Illinois 60612, USA.
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Alkhateeb FM, Doucette WR, Ganther-Urmie JM. Influences on consumer spending for herbal products. Res Social Adm Pharm 2006; 2:254-65. [PMID: 17138511 DOI: 10.1016/j.sapharm.2006.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Despite the rapid growth in consumer spending on herbal products, we know little about factors that influence such spending. OBJECTIVE To use a model of adoption to investigate consumers' spending on herbal products. METHODS The study used a mail survey of a stratified random sample of 1,300 consumers. The population consisted of consumers aged 18 years and older residing in the United States. The sampling frame was a mailing list purchased from KM Lists. The independent variables were consumer characteristics, social systems, communication channels, and herbal characteristics. The amount of spending on herbs was the dependent measure, with responses divided into monthly spending of 10 dollars or less and more than 10 dollars . Binary logistic regression was performed to investigate the association between adoption model variables and spending on herbs. RESULTS Of the 1,300 mailed surveys, there were 77 undeliverable surveys and 456 usable returned surveys, yielding a usable response rate of 37.3%. A total of 181 (39.7%) respondents reported using herbal products. The logistic regression was performed using the 168 herbal users who reported that they spent money in the past month on herbal products. The overall regression model was significant (P<.05, Nagelkerke R(2)=0.499). The significant influences on spending on herbals were age, over-the-counter (OTC) drug use, and use of an herb professional as an information source about herbs. Older people reported spending more on herbal products than younger people. OTC drug use was positively related to spending on herbals and appears to complement herbal usage. Finally, consumers who obtain information about herbals from an herb professional tend to spend more on herbals. CONCLUSION An adoption model may be useful in explaining consumers' spending on herbal products.
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Affiliation(s)
- Fadi M Alkhateeb
- Division of Clinical and Administrative Pharmacy, University of Iowa, Iowa City, IA 52246, USA
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Swarup AB, Barrett W, Jazieh AR. The Use of Complementary and Alternative Medicine By Cancer Patients Undergoing Radiation Therapy. Am J Clin Oncol 2006; 29:468-73. [PMID: 17023781 DOI: 10.1097/01.coc.0000221326.64636.b2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Use of complementary alternative medicine (CAM) is widespread among patients with chronic diseases including cancer. The purpose of our study was to examine the pattern of alternative medicine use in patients undergoing radiation treatment of cancer. METHODS AND MATERIALS A cross-sectional study was conducted among cancer patients treated with radiation therapy from July 2003 through July 2005 at the University of Cincinnati. We defined CAM as the use of dietary supplements, massage therapy, prayer, acupuncture, chiropractic, and other novel therapies undertaken after their diagnosis with cancer. RESULTS There were 152 patients that participated in the study. Their median age was 59 (range, 21-85), 82 (54%) were males, 108 (69%) were Caucasian. Out of 152 patients, 104 (68%) patients were users of CAM. The most common CAM modality reported was prayer 85 (82%) and use of dietary supplements 84 (80%). The majority of users were female and well-educated. Among CAM users 60 (58%) had discussed its use with their physician. Level of education, employment status and income showed a significant correlation with the use of CAM. CONCLUSION This study demonstrates that the use of complementary alternative medicine among cancer patients receiving radiation therapy is frequent. Given the potential risks with some CAM therapies, physicians should actively ask patients whether they use CAM and provide appropriate counseling.
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Affiliation(s)
- Anu B Swarup
- Division of General Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Jiang B, Kronenberg F, Nuntanakorn P, Qiu MH, Kennelly EJ. Evaluation of the botanical authenticity and phytochemical profile of black cohosh products by high-performance liquid chromatography with selected ion monitoring liquid chromatography-mass spectrometry. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2006; 54:3242-53. [PMID: 16637680 PMCID: PMC3204370 DOI: 10.1021/jf0606149] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Black cohosh (Actaea racemosa L., syn. Cimicifuga racemosa L.) has become increasingly popular as a dietary supplement in the United States for the treatment of symptoms related to menopause, but the botanical authenticity of most products containing black cohosh has not been evaluated, nor is manufacturing highly regulated in the United States. In this study, 11 black cohosh products were analyzed for triterpene glycosides, phenolic constituents, and formononetin by high-performance liquid chromatography-photodiode array detection and a new selected ion monitoring liquid chromatography-mass spectrometry method. Three of the 11 products were found to contain the marker compound cimifugin and not cimiracemoside C, thereby indicating that these plants contain Asian Actaea instead of black cohosh. One product contained both black cohosh and an Asian Actaea species. For the products containing only black cohosh, there was significant product-to-product variability in the amounts of the selected triterpene glycosides and phenolic constituents, and as expected, no formononetin was detected.
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Affiliation(s)
- Bei Jiang
- The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine, Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| | - Fredi Kronenberg
- The Richard and Hinda Rosenthal Center for Complementary & Alternative Medicine, Department of Rehabilitation Medicine, College of Physicians & Surgeons, Columbia University, New York, New York 10032
| | - Paiboon Nuntanakorn
- Department of Biological Science, Lehman College and The Graduate Center, City University of New York, Bronx, New York 10468
| | - Ming-Hua Qiu
- State Key Laboratory of Phytochemistry and Plant Resource in West China, Kunming Institute of Botany, The Chinese Academy of Sciences, Kunming 650204, Yunnan, People’s Republic of China
| | - Edward J. Kennelly
- Department of Biological Science, Lehman College and The Graduate Center, City University of New York, Bronx, New York 10468
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Melethil S. Proposed rule: current good manufacturing practice in manufacturing, packing, or holding dietary ingredients and dietary supplements. Life Sci 2006; 78:2049-53. [PMID: 16516243 DOI: 10.1016/j.lfs.2005.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2005] [Accepted: 12/07/2005] [Indexed: 11/21/2022]
Abstract
The Dietary Supplement Health and Education Act (DSHEA) was enacted in October 1994 to promote the health of Americans by ensuring easier access to safe dietary supplements. Many supplements such as vitamins, minerals, herbs and amino acids have been reported to be helpful in chronic conditions (i.e., heart disease, cancer and osteoporosis). Under DSHEA, dietary supplements can be marketed without prior FDA approval; the burden is on this agency to show that a marketed dietary supplement is unsafe. However, DSHEA retained the FDA's authority to issue regulations that require the manufacture of dietary supplements be in compliance with current good manufacturing practice (cGMP) standards, which are needed to ensure their quality. Several quality-related concerns of marketed dietary supplements that came to light since the passage of DSHEA prompted the FDA in 2003 to propose rules for cGMP for the manufacture, packaging and holding (storage) of dietary supplements. This review will present the highlights of these proposed rules, focusing on the legislative history of DSHEA, rationale for proposing cGMPs along with a general discussion of the specific requirements. Given the voluminous nature of the specific details, the reader is directed to the pertinent FDA publications for details. In this analysis, selected scientific and legal issues are also discussed to promote a better understanding and implications of these rules.
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Abstract
Herbal product studies cannot be considered scientifically valid if the product tested was not authenticated and characterized in order to ensure reproducibility in the manufacturing of the product in question. Many studies refer to the use of standardized material, but in reality they are referring to chemical standardization. While chemical standardization is important, its utility is limited when the starting material is not well characterized botanically. Although the resulting studies are sound with respect to the actual product tested, adequate authentication of the product cannot be compared to other products on the market. Also, a comparison of one study to another cannot be made due to inconsistencies in the identity of the botanical matrix. The tools needed for authentication of the field plant material also depend on the plant and process involved. This could be as straightforward as botanical/morphological identification or as elaborate as genetic or chemical profiling. Authenticated raw material is the basic starting point for the development of a botanical product. However, harvesting, storing, processing and formulating methods may dramatically affect the quality and consistency of the final product by altering the desired marker components or by increasing the possibility of unwanted contaminants. Thus, validated methods to ensure quality control in manufacturing and storage are required tools for optimal efficacy and safety of the products. These controls are also critical for the evaluation of pharmacological, toxicological and clinical studies of the botanical supplements.
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Affiliation(s)
- Ikhlas A Khan
- National Center for Natural Products Research and Research Institute of Pharmaceutical Sciences, Department of Pharmacognosy, School of Pharmacy, The University of Mississippi, University, MS 38677, USA.
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Abstract
BACKGROUND Research on the scope of use and factors associated with herbal medicine use is limited. OBJECTIVES The aims of this work were to assess national usage patterns, reasons for use, and the perceived efficacy of herbal products and dietary supplements. METHODS This was a secondary analysis of the complementary and alternative medicine (CAM) supplement to the 2002 National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics (NCHS). Participants were asked whether they had used natural herbs for their own health and treatment. Those who responded yes were compared with those who responded no. Supplement users were asked whether they had used any of 36 specific herbs or nonherbal dietary supplements (eg, glucosamine, fish oil, bee pollen), how important the use of CAM treatment was to them, whether they had seen a CAM provider, and whether they had informed a conventional medical provider about their use. NCHS weights, derived from Decennial Census data, were used to calculate national prevalence estimates. Group comparisons of herbal use were conducted with the Wald x(2) test. RESULTS A total of 31,044 adults participated in the 2002 NHIS CAM survey; 632 were omitted from analyses due to incomplete information. In all, 5787 adults said they had used herbs or supplements during the previous 12 months, of whom 57.3% said they used these products to treat specific conditions. Based on these responses, an estimated approximately 38.2 million adults in the United States used herbs and supplements in 2002. More than half of all users said that herbs and natural products were important to their health and well-being. Use rates were higher for women than men (21.0% vs 16.7%; P < 0.001); adults aged 45 to 64 years (P < 0.001 vs other age groups); those of multiple races (32.2%), Asians (24.6%), or American Indians or Alaskan natives (21.9%) rather than whites (19.1%) or blacks (14.3%) (effect of race, P < 0.001); residents of the western United States (effect of region, P < 0.001), and college graduates (25.3% vs 10.4% among those who did not graduate high school; effect of education, P < 0.001). Only 33.4% told a conventional health care provider about their herb or supplement use use. CONCLUSION Herb and natural supplement use was widespread in the US adult population in 2002, according to data from the NHIS CAM survey, despite the fact that few participants informed their conventional health care providers about such use.
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Affiliation(s)
- Jae Kennedy
- Dept. Of Health Policy And Administrastion, College Of Pharmacy, Washington State Uniuversity, Spokane, WA 99210, USA.
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N Webb A, Hardikar W, Cranswick NE, Somers GR. Probable herbal medication induced fulminant hepatic failure. J Paediatr Child Health 2005; 41:530-1. [PMID: 16150075 DOI: 10.1111/j.1440-1754.2005.00698.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Annette N Webb
- Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Victoria, Australia.
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