The Public Health Impact of Herbs and Nutritional Supplements

Effects of Resveratrol Co-Administration on Celecoxib Disposition and Pharmacokinetics in Healthy Volunteers

The objective of the current study was to investigate the effects of resveratrol (RSV), a natural herbal remedy used as an adjacent anti-inflammatory supplement on, the pharmacokinetics of celecoxib in healthy male volunteers. Twelve healthy human participants were involved in two-period open-labeled trial. Celecoxib (200 mg) was given as a single oral dose under fasting conditions as a control phase. Afterward, RSV (500 mg) commenced as a single oral dose for ten days as a treatment phase. Blood samples were collected during the control and treatment phases and analyzed using the validated High-performance liquid chromatography (HPLC) method. RSV pre-exposure significantly increased the area under the curve (AUC0-24), peak plasma concentration (Cmax), absorption rate constant (ka), and prolongated half-life (t1/2), along with a decrease in elimination rate constant (ke). Meanwhile, the volume of distribution (Vd/F) and apparent total body clearance (CL/F) were significantly decreased for celecoxib. There was no significant change in the time it takes for celecoxib to reach the maximum concentration (tmax) was observed. The obtained results suggested the presence of a beneficial pharmacokinetic interaction between RSV and celecoxib. Consequently, combining resveratrol as an herbal remedy and celecoxib as an anti-inflammatory drug may synergistically reduce inflammation and osteoarthritis with minimal side effects.

Associations between weight discrimination and the use of potentially harmful dietary supplements during the COVID-19 pandemic in the United States

The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m2 and 30-34.9 kg/m2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic.

Assessment of pharmacy students' knowledge, attitude, and practice toward herbal dietary supplements

Objective: Although there has been an expanded use of herbal supplements worldwide, data concerning their consumption patterns and knowledge are limited. Consequently, the present study aimed to assess the knowledge, attitude, and practice of Lebanese pharmacy students toward herbal dietary supplements. Participants and methods: A cross-sectional observational study was conducted by administering a 23-items' survey to a convenient sample of pharmacy students. Results: Out of 355 pharmacy students assessed, 168 were using at least one dietary supplement, mainly to treat health problems. Their primary source of information was the Internet. Health benefits of Ginkgo Biloba were known by 63% while that of Glucosamine by 12%. Similarly, side effects of Ginkgo Biloba were recognized by 62% while that of St. John's Wort by only 2%. Conclusion: Despite the comprehensive coverage of herbal supplements in the pharmacy curriculum, some were weakly known namely; Glucosamine and St. John's Wort. Consequently, emphasis should be done to fill the gap.

Phenolic Profile by HPLC-PDA-MS of Greek Chamomile Populations and Commercial Varieties and Their Antioxidant Activity

The phenolic profile of Greek chamomile populations was investigated by HPLC-PDA-MS. For comparison, three commercial varieties (Banatska, Lutea and Goral) cultivated under the same conditions were included in the study. All samples exhibited similar qualitative patterns but differed in their quantitative characteristics. Overall, 29 constituents were detected, belonging to phenolic acids, flavonol glycosides, flavone glycosides (mainly apigenin derivatives) and acylated polyamines. Quantitative results showed that both Greek populations had a high content in apigenin derivatives (0.39 and 0.31 %w/w) and caffeoylquinic acids (0.96 and 0.81 %w/w), whereas they had the highest amount of flavonol glycosides among the tested samples. Greek populations were comparable to the Banatska variety, while they were superior to the Lutea and Goral varieties cultivated under the same conditions. Results demonstrate that Greek chamomile populations studied here, are an excellent source of a wide range of phenolics which contribute to the medicinal and antioxidant properties of this herbal remedy. Antioxidant tests showed that chamomile extracts from the studied materials, especially from the Greek populations possess antioxidant activity, corresponding to their polyphenol content. This is the first report on the phenolic constituents of Matricaria recutita growing in Greece and well-established chamomile varieties.

Effect of Origanum dubium, Origanum vulgare subsp. hirtum, and Lavandula angustifolia essential oils on lipid profiles and liver biomarkers in athletes

This study aims to determine the effects of essential oils of Origanum dubium (DUB), Origanum vulgare subsp. hirtum (HIR), and Lavandula angustifolia (LAV) on lipid profiles and liver biomarkers in athletes. Thirty-four trained athletes were randomly assigned to one of three experimental groups or the control group (CON). The concentrations of serum lipids and liver biomarkers were assessed before and after the 14-day essential oil intervention. Gas chromatography-mass spectrometry analysis showed 68.0 and 82.1% carvacrol in DUB and HIR, respectively, and 34.50% linalyl acetate and 33.68% linalool in LAV essential oils. One-way analysis of covariance (ANCOVA) indicated a significant difference (p = 0.001) among the groups for high-density lipoprotein cholesterol (HDL-C) when the associated preintervention values were used as a covariate. The related pairwise comparisons revealed that DUB (p = 0.001) and HIR (p = 0.024) had greater HDL-C values than CON. From the two-way ANOVA, an interaction between time (before vs. after) and the groups (DUB vs. HIR vs. LAV vs. CON) was found for HDL-C (p = 0.030). Findings indicated a significant increase in DUB (p = 0.0001) and HIR (p = 0.010) for HDL-C, and there was a significant decrease in DUB (p = 0.023) for low-density lipoprotein cholesterol. However, there was no difference in total cholesterol, triglycerides, and all liver biomarkers.

Analysing Clusters of Consumers Who Use Medicinal and Aromatic Plant Products

The trend towards health and environmental protection has led to an increase in the consumption of medicinal and aromatic plant (MAP) products. The market for MAP products is influenced by consumer behaviour and therefore the aim of this study was to identify consumer segments that use MAP products for phytotherapeutic, cosmetic and personal care purposes according to their perceptions, attitudes and consumption habits and possible correlations between consumption of MAP products and interest in a healthy lifestyle and sustainable behaviour. Data collection was performed by administering a questionnaire to Cluj-Napoca residents. The final sample consisted of two groups of MAP consumers: the first with 231 respondents who use these products for phytotherapeutic purposes, the second group—with 297 respondents who use them as cosmetic and personal care products. The collected data were statistically analysed using the k-means clustering model, resulting in two distinct clusters in both consumer groups: cluster 1, the “Curious”, and Cluster 2, the “Knowledgeable”. For the consumers of the second cluster, consumption was positively correlated with healthcare and environmental protection, while they exhibited a growing interest in environmentally certified MAP products. The results obtained contribute to a better understanding of the MAP products consumption behaviour while tackling the practical implications for stakeholders in the pharmaceutical and cosmetics industry through the development and innovation of products tailored to consumer needs.

Nutrition Interventions for Healthy Ageing in Indonesia

Background: Including Indonesia, the elderly population worldwide is on the rise. This situation is closely related to the increase in the incidence and prevalence of non-communicable diseases. Eating behavior is related to the risk of non- communicable the risk of NCDs in the elderly. Therefore, nutrition intervention should be carried out from old age.Objectives: The purpose of this study is to review potential nutritional interventions to prepare for a healthy ageing process in an Indonesian context.Discusion: This review uses social cognition theory to emphasize the importance of nutrition education, the development of nutritional products with biologically active compounds, and practical guidelines that influence individual dietary behavior. Nutritional interventions should take into account Indonesia’s existing food-based balanced nutrition diet guidelines and the dietary patterns of adults and the elderly. Indonesia has a large population, ethnic and cultural diversity, which together affect people’s daily consumption of various foods.Conclusions: Customized nutrition education programs and the development of functional foods are appropriate interventions that can be implemented in Indonesia.

Pharmacokinetic Interactions between Herbal Medicines and Drugs: Their Mechanisms and Clinical Relevance

The therapeutic efficacy of a drug or its unexpected unwanted side effects may depend on the concurrent use of a medicinal plant. In particular, constituents in the medicinal plant extracts may influence drug bioavailability, metabolism and half-life, leading to drug toxicity or failure to obtain a therapeutic response. This narrative review focuses on clinical studies improving knowledge on the ability of selected herbal medicines to influence the pharmacokinetics of co-administered drugs. Moreover, in vitro studies are useful to anticipate potential herbal medicine-drug interactions. In particular, they help to elucidate the cellular target (metabolic or transporter protein) and the mechanism (induction or inhibition) by which a single constituent of the herbal medicine acts. The authors highlight the difficulties in predicting herbal–drug interactions from in vitro data where high concentrations of extracts or their constituents are used and pharmacokinetics are missed. Moreover, the difficulty to compare results from human studies where different kinds of herbal extracts are used is discussed. The herbal medicines discussed are among the best sellers and they are reported in the “Herbal Medicines for Human Use” section of the European Medicinal Agency (EMA).

The Quality Determination of Selected Commercial Online Purchased Edible Pomegranate Seed Oils With New Argentometric Liquid Chromatography Method

The number of online-purchased dietary supplements of diversified origin is exponentially increasing. Pomegranate seed oils (PSOs)-the main dietary source of conjugated linolenic acids (CLnA)-are available as dietary supplements via the Internet. PSO samples (n = 24) were purchased from Internet shops in Poland and China. Chromatographic techniques (gas chromatography coupled with mass spectroscopy [GC-MS] for fatty acids [FAs], liquid chromatography with fluorescence detection for tocopherols, and high-performance liquid chromatography with photodiode array detection for conjugated FAs) were used. The GC-MS method enabled the quantification of 45 FAs, which indicates its superiority to previously used methods. Argentometric liquid chromatography with pre-column mild alkaline hydrolysis for analysis of structural isomers of CLnA does not need preliminary derivatization into volatile compounds, which ensures the absence of artifacts and enables the analysis of the entire conjugated FA profile. PSO differed with tocopherols and FA profile. Some PSOs contained negligible amounts of CLnA, and because of that they did not meet the criteria of valuable, unadulterated nutraceuticals. Obtained results indicate that online purchased PSO shipped from distant places of origin could have been stored in inadequate conditions (temperature, humidity), which caused i.a. deterioration of oxidative quality. Unregulated online availability of dietary supplements of low oxidative quality and nutritive value as well as their intake may be a risk rather than a benefit for consumers. Argentometric liquid chromatography can be a simple, selective, and sensitive tool for screening of dietary supplements containing conjugated FAs and should be considered as an essential way of quality assurance.

Bromelain Enhances the Anti-tumor Effects of Cisplatin on 4T1 Breast Tumor Model In Vivo

Background: This study aimed to evaluate the antitumor enhancing effect of bromelain consumption on 4T1-challenged mice treated with cisplatin. Methods: Mice challenged with 4T1 triple-negative breast cancer cells received water, bromelain, cisplatin, or bromelain + cisplatin treatment for 28 days. Tumor size was measured, and lung metastasis was evaluated by clonogenic assay. Expression of tumor inflammatory genes of the harvested tumor was quantified by polymerase chain reaction array and ELISA (enzyme-linked immunosorbent assay). Results: All treatments significantly reduced the size of tumor and lung metastasis, with combination treatment showing the best effect. Also, bromelain alone and combination treatment showed downregulation of the expression of tumor inflammatory genes (Gremlin [GREM1], interleukin 1β [IL-1β], interleukin-4 [IL-4], nuclear factor κB subunit 1 [NFκB1], and prostaglandin-endoperoxide synthase 2 [PTGS2]), tumor nitric oxide level, and serum IL-1β, and IL-4 levels. On the other hand, cisplatin treatment increased the expression of selected inflammatory markers. Conclusion: This study suggests that bromelain treatment could potentiate the antitumor effect of cisplatin on triple-negative breast cancer 4T1 cells through modulating the tumor environmental inflammation.

Interactions of clinical relevance associated with concurrent administration of prescription drug and food or medicinal plants: a systematic review protocol

BACKGROUND

An inadequate combination of prescription drugs with food or medicinal plants could cause adverse effects in patients or produce negative therapeutic results. Therefore, this generic systematic review protocol aims to identify and synthesize the literature on clinical characteristics and safety issues of these types of pharmacological interactions occurring in children, adolescents, adults, pregnant/lactating women, and older adults.

METHODS/DESIGN

This generic protocol follows the stated guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement. A literature search will be performed in PubMed, Scopus, and Virtual Health Library (VHL) electronic databases from 1960 till present for studies reporting clinical characteristics and safety issues associated with pharmacological interactions occurring between prescription drugs and food or medicinal plants in participants from birth-age to ≥ 65-year-old, including pregnant/lactating women. Lateral searching will be carried out in PubMed via related citation. Two reviewers will carry out an independent evaluation of eligible studies as well as the corresponding data extraction of the selected ones. Subsequently, the methodological quality evaluation of the selected articles will be completed using the corresponding Joanna Briggs Institute Checklists. Moreover, the quality of evidence will be graded according to the criteria of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group. Quantitative research in humans comprising clinical trials and clinical, comparative and, observational studies will be included. The main outcomes of this protocol involve reported potential food-drug and herb-drug interactions, associated safety issues, and adverse reactions along with the generic name of the prescribed drug and the scientific name of the food and medicinal plants involved in these types of pharmacological interactions. Finally, findings extracted from the selected studies will be summarized in a narrative synthesis.

DISCUSSION

This generic systematic review protocol seeks to synthesize and critically evaluate current knowledge besides to identify any comprehension gaps in the concurrent administration of prescription drugs with food and herbs. By achieving a better understanding of this topic, this information will allow healthcare professionals to develop useful strategies to recognize, manage, and prevent these types of pharmacological interactions at different age stages, including pregnant/lactating women.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018117308.

Ginsenoside Rg1 activates ligand-independent estrogenic effects via rapid estrogen receptor signaling pathway

Background

Ginsenoside Rg1 was shown to exert ligand-independent activation of estrogen receptor (ER) via mitogen-activated protein kinase–mediated pathway. Our study aimed to delineate the mechanisms by which Rg1 activates the rapid ER signaling pathways.

Methods

ER-positive human breast cancer MCF-7 cells and ER-negative human embryonic kidney HEK293 cells were treated with Rg1 (10⁻¹²M, 10⁻⁸M), 17ß-estradiol (10⁻⁸M), or vehicle. Immunoprecipitation was conducted to investigate the interactions between signaling protein and ER in MCF-7 cells. To determine the roles of these signaling proteins in the actions of Rg1, small interfering RNA or their inhibitors were applied.

Results

Rg1 rapidly induced ERα translocation to plasma membrane via caveolin-1 and the formation of signaling complex involving linker protein (Shc), insulin-like growth factor-I receptor, modulator of nongenomic activity of ER (MNAR), ERα, and cellular nonreceptor tyrosine kinase (c-Src) in MCF-7 cells. The induction of extracellular signal-regulated protein kinase and mitogen-activated protein kinase kinase (MEK) phosphorylation in MCF-7 cells by Rg1 was suppressed by cotreatment with small interfering RNA against these signaling proteins. The stimulatory effects of Rg1 on MEK phosphorylation in these cells were suppressed by both PP2 (Src kinase inhibitor) and AG1478 [epidermal growth factor receptor (EGFR) inhibitor]. In addition, Rg1-induced estrogenic activities, EGFR and MEK phosphorylation in MCF-7 cells were abolished by cotreatment with G15 (G protein-coupled estrogen receptor-1 antagonist). The increase in intracellular cyclic AMP accumulation, but not Ca mobilization, in MCF-7 cells by Rg1 could be abolished by G15.

Conclusion

Ginsenoside Rg1 exerted estrogenic actions by rapidly inducing the formation of ER containing signalosome in MCF-7 cells. Additionally, Rg1 could activate EGFR and c-Src ER-independently and exert estrogenic effects via rapid activation of membrane-associated ER and G protein-coupled estrogen receptor.

The Effect of Acute L-carnitine and Carbohydrate Intake on Cycling Performance

Chronic supplementation of L-carnitine and carbohydrate has been reported to increase L-carnitine content in skeletal muscle and have positive influences on exercise variables and performance. This study investigated the acute intake of L-carnitine and carbohydrate on the exercise parameters of cycling. A total of 10 males (27.0 ± 4 years) completed two exercise sessions consisting of 40 min of cycling at 65% of VO_2peak, followed by cycling to exhaustion at 85% of VO_2peak. L-carnitine or a placebo was consumed 3 hours prior to exercise, and beverages consisting of 94 g of carbohydrate were consumed at both 2 hours, and 30 minutes prior to exercise. Repeated measures ANOVAs were used to compare respiratory exchange ratio (RER), blood lactate, and power output across experimental trials and time. A repeated measures t-test was used to analyze differences between conditions and time to exhaustion. RER was significantly lower (p=0.01) at baseline with L-carnitine ingestion (.83 ± .05) compared to the placebo ingestion (.86 ± .06). Blood lactate was significantly lower (p=0.02) after 10 minutes of cycling at 65% of VO_2peak with ingestion of L-carnitine (35% change from baseline) compared to placebo ingestion (53% change from baseline). No differences were found for power output or time to exhaustion at 85% of VO_2peak. Despite mentioned differences, acute intake of L-carnitine and carbohydrate does not appear to influence exercise parameters, likely due to a lack of sufficient change in the content of L-carnitine in skeletal muscle.

Trends in botanical dietary supplement use among US adults by cancer status: The National Health and Nutrition Examination Survey, 1999 to 2014

BACKGROUND

Patients with cancer may use botanical dietary supplements (BDS) in an attempt to manage the side effects of chemotherapy, yet evidence about BDS use among patients with cancer is limited. The authors examined trends in BDS use among US adults according to cancer status and patient characteristics.

METHODS

A serial, cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey from 1999 through 2014 (n = 43,644). Self-reported cancer diagnosis history and any BDS use in the preceding 30 days were determined. The prevalence of BDS use was calculated in each cycle for respondents with and without cancer, both overall and by patient characteristics. Simple linear regression models were applied to test for trends in BDS use at a 2-sided P value < .05. Multiple logistic regression models were performed to identify the patient factors associated with BDS use. The results were weighted to represent national estimates.

RESULTS

The prevalence of BDS use was greater among participants who had cancer compared with participants who did not have cancer, but trends remained stable during 1999 through 2014 for both groups. Trends in BDS use declined in patients with cancer who were older (P_trend  = .047), had a low annual family income (P_trend  = .028), and had a lower education level (P_trend  = .004). Among the respondents without cancer, trends in BDS use declined in those who were middle-aged (P_trend  = .025), non-Hispanic whites (P_trend  = .025), those with a lower education level (P_trend  = .011), and those who were not receiving prescription medication (P_trend  = .036). Patient age, sex, race/ethnicity, income, education, and health conditions were associated with BDS use.

CONCLUSIONS

The overall use of BDS remained stable during 1999 through 2014 for US adults with and without cancer, but it varied by individual characteristics. Cancer 2018;124:1207-15. © 2017 American Cancer Society.

Probiotic Survey in Cancer Patients Treated in the Outpatient Department in a Comprehensive Cancer Center

Purpose. Availability without prescription restriction, low cost, and simple oral administration allow cancer patients to use probiotics without knowledge of potential risks. We present a survey of probiotic use and the association with patient tumor characteristics in cancer patients treated at the outpatient department of the National Cancer Institute in Slovakia. Patients and Methods. Between March and December 2014, 499 patients were asked to evaluate their overall experience with probiotics by questionnaire form, including the length and method of use relative to anticancer therapy, expectations, side-effect experiences, understanding of the possible risks, dietary supplement use, and others. The relevant data were statistically evaluated. Results. The cohort consisted of 323 women (64.7%) and 176 men (35.3%); 91.6% were undergoing chemotherapy (2.6% together with radiotherapy) and 8.4% had no anticancer therapy. The prevalence of probiotic use was 28.5% and only 12 patients using probiotics (8.5%) described negative side effects. Most patients declared consideration of probiotic use based on recommendation from a physician (37.3%) or a pharmacist (14.8%). Nevertheless, up to 86.6% of patients declared no knowledge of possible risks. Statistically significant correlation was found between probiotic use and age of patients (P < .008), gender (P < .023), and taking other dietary supplements (P < .000002). Conclusions. In this prospective study, we present for the first time the prevalence, side-effect experience, and aspects that most likely influence probiotic use in cancer patients. Minimal knowledge of risks underlines the importance of an active approach by oncologists to inform patients about probiotic safety.

Perception of naturopathy for female patients with metastatic gynecological cancer: A qualitative study

Objective:

Women with gynecological cancer have been reported as very high users of complementary medicine. The goal of our study was to explore the perceptions of patients with an advanced gynecological cancer who use naturopathy as complementary medicine. We were looking more specifically at patients' opinions on the effect of naturopathy on their quality of life and its relation to conventional oncological treatments.

Method:

This pilot qualitative study used semistructured interviews, and data were analyzed using grounded theory and qualitative methods. The main criterion for inclusion in the study was the use of naturopathy as a treatment complementary to conventional cancer treatment for gynecological metastatic cancer on the oncology day care unit.

Results:

Six patients were included until data saturation. They express the physical and psychological impact of treatments and disease. Usually, chemotherapy is perceived as something that may be curative or may at least lead to remission. Unlike conventional treatments, naturopathy is not perceived as drugs, and it is seen as a way to relieve symptoms, improve well-being, and as a way of enabling them to take an active decision-making role in their care journey. Patients want to have more information about naturopathy.

Significance of Results:

This study suggests that patients are aware of the benefits of a specific cancer treatment as chemotherapy, but they resort to naturopathy for symptom control, and also to take a more active role during treatment.

The personal nutrition-related attitudes and behaviors of Australian optometrists: is there evidence for an evidence-based approach?

OBJECTIVE

The aim of this study was to investigate the personal nutrition-related attitudes and behaviors of Australian optometrists and, in particular, their understanding of the evidence relating to the merit of specific dietary supplements, as applicable to their own health.

METHODS

An online survey was distributed to optometrists registered in Australia (N = 4242). Respondents anonymously provided information regarding their demographic characteristics (age, sex, practice location and modality), diet and lifestyle behaviors (assessment of self-perceived diet quality, smoking status), and nutritional supplement intake (including the rationale for consumption).

RESULTS

Completed surveys were received from 283 practitioners. Although most respondents considered themselves to eat a healthy, balanced diet, approximately 75% indicated taking nutritional supplements in the preceding year. The four most common supplements were fish oil/ω-3 (62%), multivitamins (54%), vitamin C (30%), and vitamin D (29%). In addition to vitamin D, which was typically recommended by a general medical practitioner for an established deficiency, the other three supplement categories were consumed on the basis of the respondents' self-assessment and decision. Analyses of the motivations for taking these supplements highlighted a significant misunderstanding of the evidence; furthermore, these practitioners appeared to base their personal behaviors on this misinterpretation.

CONCLUSIONS

These findings demonstrate scope for optometrists to enhance their critical thinking and/or understanding of the available evidence relating to the merit, or otherwise, of nutritional supplementation in managing their own health, and more broadly, improving their understanding of what a healthy diet is and its role in eye health.

Antihypertensive potential of combined extracts of olive leaf, green coffee bean and beetroot: a randomized, double-blind, placebo-controlled crossover trial

Extracts of olive leaf, green coffee bean and beetroot may deliver cardiovascular benefits. This study sought to evaluate the effects of regularly consuming a combination of these extracts on blood pressure (BP), arterial compliance, blood lipids, blood glucose and insulin sensitivity. A double-blind randomised placebo-controlled crossover trial was conducted in adults with untreated high normal or borderline elevated BP. They were randomised to take an active supplement, comprising 500 mg olive leaf extract, 100 mg green coffee bean extract and 150 mg beet powder, or a matching placebo twice daily for six weeks, followed by the alternate supplement for a further six weeks. Assessments of 24-h ambulatory BP (ABP), clinic BP arterial compliance (pulse-wave analysis), blood lipids, blood glucose and insulin were obtained at baseline and at the end of each treatment phase. Baseline clinic BP in 37 overweight middle-aged men and women who completed the trial averaged 145/84 mmHg. There was no significant effect of treatment on ABP or any other outcome measure. The failure to confirm prior evidence of the antihypertensive benefits of these extracts emphasises the importance of placebo control and the value of ABP monitoring. Further dose-response evaluation of olive leaf, green coffee bean or beetroot extracts is required to confirm or refute the purported benefits.

Dietary supplement use among participants of a databank and biorepository at a comprehensive cancer centre

OBJECTIVE

We assessed the prevalence, patterns and predictors of dietary supplement use among participants of the databank and biorepository (DBBR) at a comprehensive cancer centre in western New York.

DESIGN

Archived epidemiological questionnaire data were obtained from the DBBR at Roswell Park Cancer Institute. Descriptive statistics and logistic regression explored the prevalence, patterns and predictors of lifetime use of four common supplements (multivitamins, vitamin C, vitamin E and calcium) and use of multivitamins, sixteen single vitamins/minerals and eighteen herbal/specialty supplements within the previous 10 years.

SETTING

Western New York, USA.

SUBJECTS

DBBR participants (n 8096) enrolled between December 2003 and July 2012 were included in these analyses: 66.9 % (n 5418) with cancer, 65.6 % (n 5309) women, mean age for patients v. cancer-free controls 59.9 (SD 12.6) years and 50.7 (SD 15.4) years, respectively.

RESULTS

Overall, 54.4 % of DBBR participants reported lifetime use of one or more supplements and 63.1 % reported use of one or more supplements within the previous 10 years (excluding multivitamins). Multivitamin use was high in this sample (lifetime: 64.1 %; 10 years: 71.3 %; current: 51.8 %). Supplementation was higher among cancer-free controls than cancer patients. Vitamin C, calcium and fish oil were the most common single vitamin, mineral and specialty product, respectively.

CONCLUSIONS

A consistently high and increasing proportion of dietary supplement use over time remains clear. Supplementation is prevalent among cancer patients and may even be higher than predicted in cancer-free individuals. Further studies should assess the safety and efficacy of specific supplements in reducing disease risk.

Developing and implementing core competencies for integrative medicine fellowships

The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as "the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing." Over the past three decades, the U.S. public increasingly has sought integrative medicine approaches. In an effort to train medical professionals to adequately counsel patients on the safe and appropriate use of these approaches, medical schools and residencies have developed curricula on integrative medicine for their trainees. In addition, integrative medicine clinical fellowships for postresidency physicians have emerged to provide training for practitioners interested in gaining greater expertise in this emerging field. Currently, 13 clinical fellowships in integrative medicine exist in the United States, and they are predominantly connected to academic medical centers or teaching affiliate hospitals. In 2010, the Consortium of Academic Health Centers for Integrative Medicine, represented by 56 member academic health care institutions with a shared commitment to advance the principles and practices of integrative medicine, convened a two-year task force to draft integrative medicine fellowship core competencies. These competencies would guide fellowship curriculum development and ensure that graduates possessed a common body of knowledge, skills, and attitudes. In this article, the authors discuss the competencies and the task force's process to develop them, as well as associated teaching and assessment methods, faculty development, potential barriers, and future directions.

Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors

Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored.

Stable binding of alternative protein-enriched food matrices with concentrated cranberry bioflavonoids for functional food applications

Defatted soy flour (DSF), soy protein isolate (SPI), hemp protein isolate (HPI), medium-roast peanut flour (MPF), and pea protein isolate (PPI) stably bind and concentrate cranberry (CB) polyphenols, creating protein/polyphenol-enriched matrices. Proanthocyanidins (PAC) in the enriched matrices ranged from 20.75 mg/g (CB-HPI) to 10.68 mg/g (CB-SPI). Anthocyanins (ANC) ranged from 3.19 mg/g (CB-DSF) to 1.68 mg/g (CB-SPI), whereas total phenolics (TP) ranged from 37.61 mg/g (CB-HPI) to 21.29 mg/g (CB-SPI). LC-MS indicated that the enriched matrices contained all identifiable ANC, PAC, and flavonols present in CB juice. Complexation with SPI stabilized and preserved the integrity of the CB polyphenolic components for at least 15 weeks at 37 °C. PAC isolated from enriched matrices demonstrated comparable antiadhesion bioactivity to PAC isolated directly from CB juice (MIC 0.4-0.16 mg/mL), indicating their potential utility for maintenance of urinary tract health. Approximately 1.0 g of polyphenol-enriched matrix delivered the same amount of PAC available in 1 cup (300 mL) of commercial CB juice cocktail, which has been shown clinically to be the prophylactic dose for reducing recurring urinary tract infections. CB-SPI inhibited Gram-positive and Gram-negative bacterial growth. Nutritional and sensory analyses indicated that the targeted CB-matrix combinations have high potential for incorporation in functional food formulations.

Research and development for botanical products in medicinals and food supplements market

Botanical products sold in the health area are generally intended as drugs, medicinal products, food supplements or substances for therapeutic use. Use of botanicals for improving or to care human health has evolved independently in different countries worldwide. Regulatory issues regarding botanical products designed for the food supplements or medicinal market and their influence on research and development are discussed. European Union (EU) and United States (US) policies regulating these products are focused with comments on the legislations delivered during the last ten years and differences existing in rules between these countries are emphasized. Research and development on botanical products nowdays strongly influenced by the product destination in the market. Addressed and differentiated research for either food supplements or medicinal markets is necessary to purchase data really useful for assessment of safe and effective use for both the categories. The main objective is to catalyze interest of academic and companies' researchers on crucial aspects to be taken into account in the research for the development of botanical products.

Knowledge, Attitude and Practice of Vitamin Supplementation among Patients visiting Out-Patient Physicians in a Teaching Hospital in Karachi

OBJECTIVE

To determine the knowledge, attitude and practices regarding the use of vitamin supplements among patients visiting Out-Patient clinics of a teaching hospital.

METHODS

Four hundred patients were interviewed during the period of July to September 2008, at the Out-patient clinics, Aga Khan University hospital, Karachi. A pre-tested and structured questionnaire was used to collect information. It consisted of questions regarding demographics, awareness of vitamin supplements and its consumption, reasons for usage and its effects. The purpose of the study was explained and assurance of confidentiality was given. After obtaining written consent, eligible individuals were interviewed. Statistical Package for the Social Sciences version 19.0 was used to analyze the data.

RESULTS

The results revealed that 98% of the respondents were aware of vitamin supplements. The most known vitamin was found to be Vitamin C (16.9%) with Vitamin K being the least well-known (0.4%); while 51.8% of the respondents were unaware of the harmful effects of vitamin supplements. The results also showed that 84.8% of the study population had taken vitamin supplements, and 79% of the participants considered that vitamin supplements to be helpful. Taking vitamin supplements as a compensation for the deficiencies in the body was the most frequently chosen answer (17.7%) as the reason for use of vitamin supplements. On the other hand, a majority of the population was unaware of the indications for use of vitamin supplements.

CONCLUSION

This study highlights a very significant yet ignored issue of vitamin supplementation in Pakistan. A need exists to inform the general population about the use of vitamin supplementation. The media and the medical community are required to play their role in this regard. Short/ refresher training courses are needed for doctors to update and disseminate adequate knowledge of vitamin supplementation to their patients.

Association of distress symptoms and use of complementary medicine among patients with cancer

AIMS AND OBJECTIVES

The aim of this study was to investigate the association between distress symptoms and the types of complementary and alternative medicine use in patients with cancer.

BACKGROUND

Patients diagnosed with cancer have increasingly turned to the use of complementary and alternative medicine to manage its symptoms and cope with the side effects of conventional treatment.

DESIGN

A descriptive cross-sectional study.

METHODS

A face-to-face interview using a structured questionnaire was conducted with 208 outpatients at a medical centre in central Taiwan. The questionnaire included questions on socio-demographic information, disease specifics, distress symptoms and complementary and alternative medicine usage in the past 12 months. Logistic regression analysis was used to assess the association between distress symptoms and the use of different complementary and alternative medicine modalities.

RESULTS

A total of 165 (79·3%) patients reported use of at least one complementary and alternative medicine modality during the past 12 months. Complementary and alternative medicine users and non-users were not significantly different in age, sex, marital status, education level, religious affiliation and disease-related variables. Fatigue (66·8%) was the most frequently reported symptoms and was significantly associated with complementary and alternative medicine use (OR = 14·11, p = 0·001). Regarding specific complementary and alternative medicine modalities, chanting and enzyme therapy were found to be associated with 13 (68·4%) of the 19 distress symptoms.

CONCLUSIONS

There was no association between complementary and alternative medicine use and demographic or disease-related variables. Complementary and alternative medicine was widely used by patients with cancer, and symptom of fatigue was most strongly associated with complementary and alternative medicine use. Chanting and enzyme therapy were the two most frequently used complementary and alternative medicine modalities that were significantly associated with the 19 distress symptoms.

RELEVANCE TO CLINICAL PRACTICE

Health care providers should ask their patients about their complementary and alternative medicine use to avoid possible adverse interactions between conventional treatment and complementary and alternative medicine interventions, in particular, those remedies that are likely to interact with cancer medications.

Nutraceutical use in late-stage cancer

Access to a wealth of information on the internet has led many cancer patients to use complementary methods as an adjunct to traditional therapy for cancer, with, and more often, without informing their primary caregiver. Of the common complementary modalities, the use of dietary supplements appears to be highly prevalent in patients in active treatment for cancer, and later in cancer survivors. Emerging research suggests that some plant-based agents may, indeed, impact late-stage cancer, influencing molecular processes corrupted by tumor cells to evade detection, expand clonally, and invade surrounding tissues. The intent of this article is to review some of the current science underpinning the use of nutraceuticals in the latter stages of cancer.

Flavonoids and age-related disease: risk, benefits and critical windows

Plant derived products are consumed by a large percentage of the population to prevent, delay and ameliorate disease burden; however, relatively little is known about the efficacy, safety and underlying mechanisms of these traditional health products, especially when taken in concert with pharmaceutical agents. The flavonoids are a group of plant metabolites that are common in the diet and appear to provide some health benefits. While flavonoids are primarily derived from soy, many are found in fruits, nuts and more exotic sources, e.g., kudzu. Perhaps the strongest evidence for the benefits of flavonoids in diseases of aging relates to their effect on components of the metabolic syndrome. Flavonoids from soy, grape seed, kudzu and other sources all lower arterial pressure in hypertensive animal models and in a limited number of tests in humans. They also decrease the plasma concentration of lipids and buffer plasma glucose. The underlying mechanisms appear to include antioxidant actions, central nervous system effects, gut transport alterations, fatty acid sequestration and processing, PPAR activation and increases in insulin sensitivity. In animal models of disease, dietary flavonoids also demonstrate a protective effect against cognitive decline, cancer and metabolic disease. However, research also indicates that the flavonoids can be detrimental in some settings and, therefore, are not universally safe. Thus, as the population ages, it is important to determine the impact of these agents on prevention/attenuation of disease, including optimal exposure (intake, timing/duration) and potential contraindications.