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Tessele I, Dal Molin TR, Dognini J, Noremberg S, de Carvalho LM. Investigation of thallium as a contaminant in dietary supplements marketed for weight loss and physical fitness. Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2024; 41:800-810. [PMID: 38781478 DOI: 10.1080/19440049.2024.2354494] [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: 01/29/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Dietary supplements are drastically growing as a category of consumer products all over the world. The abuse of supplements marketed for slimming purposes and physical fitness has been observed worldwide in recent years, which raises concerns in terms of public health. In this study, different types of dietary supplements marketed and delivered through the e-commerce were studied for the determination of thallium as a hazardous inorganic contaminant. The total content of thallium was determined by a sensitive voltammetric method after a microwave-assisted oxidative digestion of the sample. In addition, a comparative spectrometric method was applied for validation of the results in the samples. The maximum concentration found for thallium was found to be 2.89 mg kg-1, which well agree with the comparative measurement. Considering the 32 studied formulations, it can be pointed out that ∼24% of the of dietary supplements presented Tl concentrations at concentrations higher than 1 mg kg-1. The results permitted the assessment of the health risk related to thallium from contaminated samples, based on the calculation of the estimated daily intake (EDI) and the risk quotient (HQ). The highest daily intake of thallium was calculated as 82.0 µg day-1 in a protein-based supplement, which is equivalent to an EDI of 1.17 µg kg-1 day-1. This work highlights the need to develop regulations on the limits of toxic elements such as thallium in widely consumed dietary supplements, as well as an in-depth look at the adverse effects caused by this element in the human body.
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Affiliation(s)
- Igor Tessele
- Department of Chemistry, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Thaís R Dal Molin
- Graduate Program of Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | | | - Simone Noremberg
- Department of Chemistry, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Leandro M de Carvalho
- Department of Chemistry, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
- Graduate Program of Pharmaceutical Sciences, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
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2
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Gyamfi ET, Ackah M, Gore DB. Bioaccessibility, exposure and risk assessment of potentially toxic elements and essential micronutrients in ayurvedic, traditional Chinese and Ghanaian medicines. Biometals 2023; 36:943-960. [PMID: 36749495 DOI: 10.1007/s10534-023-00495-9] [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: 12/12/2022] [Accepted: 02/01/2023] [Indexed: 02/08/2023]
Abstract
Potentially toxic constituents in traditional medicines remain a concern due to health risks posed to consumers. Thirty-six traditional medicines (TM) consisting of 14 Indian Ayurvedic Medicines, 11 Chinese Traditional Medicines and eleven Ghanaian Traditional Medicines were evaluated using Total Reflection X-ray Fluorescence Spectrometer (T-XRF) after microwave assisted acid digestion. Physiologically Based Extraction Test (PBET) was used to obtain bioaccessible elemental concentrations. Merck XVI multi-element standard were used to evaluate the accuracy of the analytical method. The concentrations of the elements were quantified in (mg kg-1): Cr (0.01-698), Mn (0.01-1140), Fe (15-73300), Ni (1-1340), Cu (3-8160), Zn (0.01-224). The greatest bioaccessible concentrations of arsenic was 0.80 mg kg-1 and 0.44 mg kg-1 in the gastric and intestinal phases respectively. In order to evaluate the human health risks from ingesting these TM, the Acceptable Daily Intake (ADI) was calculated for each medicine based on element-specific bioaccessibility-adjusted concentrations and results compared with the United States Environmental Protection Agency (USEPA) Reference Dose (RfD) limits. The Acceptable Daily Intake (ADI) values for risks were within the USEPA RfD. Hazard quotients (HQ) of TM were < 1, meaning elemental concentrations do not pose non-carcinogenic risks to adult consumers. In summary the methods applied in the study gives a new insight on human health risks of potentially toxic and essential micronutrients elements in TM.
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Affiliation(s)
- Eva T Gyamfi
- Nuclear and Applied Chemistry Research Centre, National Nuclear Research Institute Ghana Atomic Energy Commission, Legon, P. O. BOX LG 80, Accra, Ghana.
| | - Michael Ackah
- Nuclear and Applied Chemistry Research Centre, National Nuclear Research Institute Ghana Atomic Energy Commission, Legon, P. O. BOX LG 80, Accra, Ghana
| | - Damian B Gore
- School of Natural Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
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3
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Brodziak-Dopierała B, Fischer A, Chrzanowska M, Ahnert B. Mercury Exposure from the Consumption of Dietary Supplements Containing Vegetable, Cod Liver, and Shark Liver Oils. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2129. [PMID: 36767496 PMCID: PMC9915034 DOI: 10.3390/ijerph20032129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
Vegetable and fish oils constitute a significant part of all dietary supplements. Due to increasing environmental pollution, the raw materials used for their production may be contaminated with toxic substances, including metals. The aim of the present study was to determine the mercury (Hg) content in vegetable oils, shark liver oils, and cod liver oils. The tests conducted were to help determine the level of mercury contamination of the tested preparations and the related potential threat to human health. The amount of Hg in the tested dietary supplements was compared, and the amount of the metal consumed at various times of use was determined. A total of 36 preparations of dietary supplements available on the Polish market were used for the study. The method of atomic absorption spectrometry using the amalgamation technique was used for the determinations (AMA 254, Altec, Czech Republic). Among the sample of all of the tested preparations, the Hg concentration ranged from 0.023 to 0.427 µg/kg, with an average of 0.165 µg/kg. Differences in Hg content in the various tested preparations (shark liver oil, cod liver oil, and vegetable oils) were statistically significant. The average concentration of Hg in the vegetable oils (0.218 µg/kg) was more than twice that of the cod liver oils (0.106 µg/kg) and shark liver oils (0.065 µg/kg). In none of the tested preparations did the amount of Hg exceed the acceptable standard for dietary supplements (0.10 mg/kg). The analysis showed that the Hg content in vegetable oils, shark liver oils, and fish oils from the Polish market is at a low level, guaranteeing the safety of their use, and as such, they do not pose a threat to health.
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Affiliation(s)
- Barbara Brodziak-Dopierała
- Department of Toxicology and Bioanalysis, Faculty of Pharmaceutical Science, Medical University of Silesia, 30 Ostrogórska Str., 41-200 Sosnowiec, Poland
| | - Agnieszka Fischer
- Department of Toxicology and Bioanalysis, Faculty of Pharmaceutical Science, Medical University of Silesia, 30 Ostrogórska Str., 41-200 Sosnowiec, Poland
| | | | - Bożena Ahnert
- Department of Toxicology and Bioanalysis, Faculty of Pharmaceutical Science, Medical University of Silesia, 30 Ostrogórska Str., 41-200 Sosnowiec, Poland
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4
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Xu X, Li L, Zhou H, Fan M, Wang H, Wang L, Hu Q, Cai Q, Zhu Y, Ji S. MRTCM: A comprehensive dataset for probabilistic risk assessment of metals and metalloids in traditional Chinese medicine. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 249:114395. [PMID: 36508783 DOI: 10.1016/j.ecoenv.2022.114395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/24/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Traditional Chinese medicine (TCM) is still considered a global complementary or alternative medical system, but exogenous hazardous contaminants remain in TCM even after decocting. Besides, it is time-consuming to conduct a risk assessment of trace elements in TCMs with a non-automatic approach due to the wide variety of TCMs. Here, we present MRTCM, a cloud-computing infrastructure for automating the probabilistic risk assessment of metals and metalloids in TCM. MRTCM includes a consumption database and a pollutant database involving forty million rows of consumption data and fourteen types of TCM potentially toxic elements concentrations. The algorithm of probabilistic risk assessment was also packaged in MRTCM to assess the risks of eight elements with Monte Carlo simulation. The results demonstrated that 96.64% and 99.46% had no non-carcinogenic risk (hazard indices (HI) were < 1.0) for animal and herbal medicines consumers, respectively. After twenty years of exposure, less than 1% of the total carcinogenic risk (CRt) was > 10-4 for TCM consumers, indicating that they are at potential risk for carcinogenicity. Sensitivity analysis revealed that annual consumption and concentration were the main variables affecting the assessment results. Ultimately, a priority management list of TCMs was also generated, indicating that more attention should be paid to the non-carcinogenic risks of As, Mn, and Hg and the carcinogenic risks of As and Cr in Pheretima and Cr in Arcae Conch. In general, MRTCM could significantly enhance the efficiency of risk assessment in TCM and provide reasonable guidance for policymakers to optimize risk management.
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Affiliation(s)
- Xiaohui Xu
- Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China
| | - Limin Li
- Shanghai Institute for Food and Drug Control, NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai 201203, China
| | - Heng Zhou
- Shanghai Institute for Food and Drug Control, NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai 201203, China
| | - Mingcong Fan
- Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China
| | - Hongliang Wang
- Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China
| | - Lingling Wang
- Shandong Academy of Chinese Medicine, Jinan 250014, China
| | - Qing Hu
- Shanghai Institute for Food and Drug Control, NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai 201203, China
| | - Qiang Cai
- Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China
| | - Yin Zhu
- Yangtze Delta Region Institute of Tsinghua University, Zhejiang 314006, China.
| | - Shen Ji
- Shanghai Institute for Food and Drug Control, NMPA Key Laboratory for Quality Control of Traditional Chinese Medicine, Shanghai 201203, China.
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5
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Dietary supplement use and recommendations for discontinuation in an integrative oncology clinic. Support Care Cancer 2023; 31:40. [DOI: 10.1007/s00520-022-07504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022]
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6
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Madassery GP, M V, Panja S, P H, Dey R. Metal‐Free Synthesis of S‐Aryldithiocarbamates: Aryl C−S Bond Formation at Room Temperature†. ChemistrySelect 2022. [DOI: 10.1002/slct.202202136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Geo Paul Madassery
- Department of Chemistry National Institute of Technology Calicut Kozhikode 673601 India
| | - Vageesh M
- Department of Chemistry National Institute of Technology Calicut Kozhikode 673601 India
| | - Subir Panja
- Indian Association for the Cultivation of Science School of Chemical Sciences Jadavpur Kolkata 700032 India
| | - Hima P
- Department of Chemistry National Institute of Technology Calicut Kozhikode 673601 India
| | - Raju Dey
- Department of Chemistry National Institute of Technology Calicut Kozhikode 673601 India
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7
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Peters J, Staff NP. Update on Toxic Neuropathies. Curr Treat Options Neurol 2022; 24:203-216. [PMID: 36186669 PMCID: PMC9518699 DOI: 10.1007/s11940-022-00716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review Toxic neuropathies are an important preventable and treatable form of peripheral neuropathy. While many forms of toxic neuropathies have been recognized for decades, an updated review is provided to increase vigilant in this area of neurology. A literature review was conducted to gather recent information about toxic neuropathies, which included the causes, clinical findings, and treatment options in these conditions. Recent Findings Toxic neuropathies continue to cause significant morbidity throughout the world and the causative agents, particularly with regards to medications, do not appear to be diminishing. A wide variety of causes of toxic neuropathies exist, which include alcohol, industrial chemicals, biotoxins, and medications. Unfortunately, no breakthrough treatments have been developed and prevention and symptom management remain the standard of care. Summary A detailed medication, occupational and hobby exposure history is critical to identifying toxic neuropathies. Increased research is warranted to identify mechanisms of neurotoxic susceptibility and potential common pathomechanistic pathways for treatment across diverse toxic neuropathies.
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Affiliation(s)
- Jannik Peters
- Department of Neurology, Mayo Clinic Rochester, MN USA
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8
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St John AW, Aebischer JH, Friend R, Jones KD. Fibromyalgia: A clinical update. Nurse Pract 2022; 47:20-30. [PMID: 35349514 DOI: 10.1097/01.npr.0000822536.18719.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Fibromyalgia (FM) is a chronic pain disorder commonly encountered by advanced practice registered nurses in primary and specialty care. Knowing how to recognize FM and its multiple pain and nonpain symptoms facilitates diagnosis. We propose a four-step approach to diagnosis that can reduce costly referrals and treatment delays, and describe evidence-based interventions.
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9
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ur Rehman A, Yasmeen K, Saeed I, Zubair Khan M. Estimations of potential risk of carcinogenic arsenic in smokeless tobacco products. NEW J CHEM 2022. [DOI: 10.1039/d2nj01240e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Moderate arsenic exposure may lead to health problems, and thus, measuring arsenic (As) and inorganic arsenic (iAs) exposure from smokeless tobacco products (SLTs) for different population groups is important.
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Affiliation(s)
- Atta ur Rehman
- Department of Chemistry, Khushal Khan Khattak University, Karak 27200-Karak, Khyber Pakhtunkhwa, Pakistan
| | - Kousar Yasmeen
- Department of Chemistry, Federal Urdu University of Arts, Science and Technology, Gulshan-e-Iqbal Campus, Karachi-75300, Pakistan
| | - Iftekhar Saeed
- Department of Chemistry, Federal Urdu University of Arts, Science and Technology, Gulshan-e-Iqbal Campus, Karachi-75300, Pakistan
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10
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Chopra AS, Lordan R, Horbańczuk OK, Atanasov AG, Chopra I, Horbańczuk JO, Jóźwik A, Huang L, Pirgozliev V, Banach M, Battino M, Arkells N. The current use and evolving landscape of nutraceuticals. Pharmacol Res 2021; 175:106001. [PMID: 34826602 DOI: 10.1016/j.phrs.2021.106001] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022]
Abstract
The nutraceutical market is currently a high-impact multi-billion-dollar industry, and it is anticipated to grow rapidly over the next decade. Nutraceuticals comprise diverse food-derived product categories that have become widespread due to increased consumer awareness of potential health benefits and the need for improved wellness. This targeted review is designed to identify the current global trends, market opportunities, and regulations that drive the nutraceutical industry. Safety and efficacy concerns are also explored with a view to highlighting areas that necessitate further research and oversight. Key drivers of the nutraceutical market include aging populations, consumer awareness, consumer lifestyle, increasing cost of healthcare, and marketing channels. Although some nutraceuticals hold promising preventive and therapeutic opportunities, there is a lack of a universal definition and regulatory framework among countries. Moreover, there is a lack of adequate evidence for their efficacy, safety, and effectiveness, which was even further highlighted during the ongoing coronavirus pandemic. Future prospective epidemiological studies can delineate the health impact of nutraceuticals and help set the scientific basis and rationale foundation for clinical trials, reducing the time and cost of trials themselves. Together, an understanding of the key drivers of the nutraceutical market alongside a consistent and well-defined regulatory framework will provide further opportunities for growth, expansion, and segmentation of nutraceuticals applications.
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Affiliation(s)
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - Olaf K Horbańczuk
- Warsaw University of Life Sciences, Faculty of Human Nutrition, Nowoursynowska 159 C, 02-776 Warsaw, Poland.
| | - Atanas G Atanasov
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland; Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria.
| | | | - Jarosław O Horbańczuk
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
| | - Artur Jóźwik
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Jastrzebiec, Poland
| | - Linfang Huang
- Institute of Medicinal Plant Development (IMPLAD), Peking Union Medical College, Chinese Academy of Medical Sciences (CAMS), Beijing, PR China
| | - Vasil Pirgozliev
- National Institute of Poultry Husbandry, Harper Adams University, Shropshire TF10 8NB, UK
| | - Maciej Banach
- Department of Preventative Cardiology and Lipidology, Medical University of Lodz, Lodz, Poland
| | - Maurizio Battino
- Department of Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang, PR China
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11
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Daher J, El Khoury D, Dwyer JJM. Education Interventions to Improve Knowledge, Beliefs, Intentions and Practices with Respect to Dietary Supplements and Doping Substances: A Narrative Review. Nutrients 2021; 13:nu13113935. [PMID: 34836190 PMCID: PMC8618302 DOI: 10.3390/nu13113935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/24/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022] Open
Abstract
The misuse of dietary supplements and doping substances is commonly associated with toxicity, nutritional imbalances, and health and psychological consequences. This is alarming especially in light of the increasing prevalence of the use of dietary supplements and doping, particularly among young adults including athletes. There is evidence that education interventions can lead to improved knowledge, intentions, and practices. However, no review has summarized and evaluated the effectiveness of such interventions. The aim of this article is to review the characteristics, contents and effects of education interventions that were designed and implemented to improve knowledge, attitudes, beliefs and intentions with respect to the use of dietary supplements and doping agents in different populations. PubMed, Scopus, CINAHL, PsycInfo and Google Scholar were searched for English-language education interventions targeting dietary supplements and doping substances. A total of 20 articles were identified and have generally provided consistent findings. Most interventions reported a significant improvement in knowledge on dietary supplements and doping agents. Unfortunately, the heavy reliance on self-reported assessment tools limits the validity of these interventions, with almost all articles targeting athletes and adolescents.
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12
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Sparks E, Zorzela L, Necyk C, Hughes C, Vohra S. Study of natural product adverse events in adult HIV-infected patients in Canada. HIV Med 2021; 23:29-38. [PMID: 34432937 DOI: 10.1111/hiv.13155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/23/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Many individuals living with HIV use natural health products (NHPs) in an effort to decrease medication side effects and to enhance overall well-being. METHODS An active surveillance study of adult patients (≥ 18 years) with HIV was conducted between 2012 and 2014 to detect prescription drug and NHP use and associated adverse events (AEs) in the last month. RESULTS Of the 167 participants, 85 (50.9%) took prescription medications only, three (1.8%) took NHPs only, 75 (44.9%) took NHPs and prescription medications concurrently, and four (2.4%) took neither. Patients who used both prescription drugs and NHPs concurrently were more than three times more likely to experience an AE compared with those who used prescription drugs only (OR, P = 0.003, 95% CI: 1.47-6.91). CONCLUSIONS Increased AEs are reported in patients with HIV who combine NHPs and prescription medications, and no serious AEs were reported. Active surveillance was found to be feasible in this clinical setting.
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Affiliation(s)
- Emma Sparks
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Liliane Zorzela
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Candace Necyk
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Christine Hughes
- Department of Pediatrics, Medicine and Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Vohra
- Department of Pediatrics, Medicine and Psychiatry, University of Alberta, Edmonton, Alberta, Canada
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A Health Risk Assessment of Lead and Other Metals in Pharmaceutical Herbal Products and Dietary Supplements Containing Ginkgo biloba in the Mexico City Metropolitan Area. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168285. [PMID: 34444035 PMCID: PMC8391129 DOI: 10.3390/ijerph18168285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 11/17/2022]
Abstract
The use of the medicinal plant Ginkgo biloba has increased worldwide. However, G. biloba is capable of assimilating both essential and toxic metals, and the ingestion of contaminated products can cause damage to health. The aim of this study was to investigate the safety of manganese (Mn), copper (Cu), lead (Pb), arsenic (As), and cadmium (Cd) in 26 items containing Ginkgo biloba (pharmaceutical herbal products, dietary supplements, and traditional herbal remedies) purchased in the metropolitan area of Mexico City. Metal analysis was performed using a graphite furnace atomic absorption spectrometer. All of the products were contaminated with Pb, 54% of them with As, and 81% with Cd. The lowest values of Pb, As, and Cd were detected in pharmaceutical herbal products > dietary supplements > traditional herbal remedies. The daily intake dose (DID) of pharmaceutical herbal products was within the established limits for the five metals. Dietary supplements and traditional herbal remedies exceeded the DID limits for Pb. The hazard quotients estimation and non-carcinogenic cumulative hazard estimation index for Mn, As, and Cd indicated no human health risk. Our results suggest that products containing G. biloba for sale in Mexico are not a health risk.
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14
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Pinkhasova DV, Jameson LE, Conrow KD, Simeone MP, Davis AP, Wiegers TC, Mattingly CJ, Leung MCK. Regulatory Status of Pesticide Residues in Cannabis: Implications to Medical Use in Neurological Diseases. Curr Res Toxicol 2021; 2:140-148. [PMID: 34308371 PMCID: PMC8296824 DOI: 10.1016/j.crtox.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Movement disorders are the most common neurological category of qualifying conditions in the U.S. The number and action levels of regulated pesticides in cannabis differ vastly in 33 states and Washington, D.C. Network analysis reveals potential interactions of insecticides, cannabinoids, and seizure at a functional level.
Medical cannabis represents a potential route of pesticide exposure to susceptible populations. We compared the qualifying conditions for medical use and pesticide testing requirements of cannabis in 33 states and Washington, D.C. Movement disorders were the most common neurological category of qualifying conditions, including epilepsy, certain symptoms of multiple sclerosis, Parkinson’s Disease, and any cause of symptoms leading to seizures or spasticity. Different approaches of pesticide regulation were implemented in cannabis and cannabis-derived products. Six states imposed the strictest U.S. EPA tolerances (i.e. maximum residue levels) for food commodities on up to 400 pesticidal active ingredients in cannabis, while pesticide testing was optional in three states. Dimethomorph showed the largest variation in action levels, ranging from 0.1 to 60 ppm in 5 states. We evaluated the potential connections between insecticides, cannabinoids, and seizure using the Comparative Toxicogenomics Database. Twenty-two insecticides, two cannabinoids, and 63 genes were associated with 674 computationally generated chemical-gene-phenotype-disease (CGPD) tetramer constructs. Notable functional clusters included oxidation-reduction process (183 CGPD-tetramers), synaptic signaling pathways (151), and neuropeptide hormone activity (46). Cholinergic, dopaminergic, and retrograde endocannabinoid signaling pathways were linked to 10 genetic variants of epilepsy patients. Further research is needed to assess human health risk of cannabinoids and pesticides in support of a national standard for cannabis pesticide regulations.
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Affiliation(s)
- Dorina V Pinkhasova
- School of Mathematical and Natural Sciences, Arizona State University - West Campus, Glendale, AZ 85306.,Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Laura E Jameson
- Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Kendra D Conrow
- Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
| | - Michael P Simeone
- ASU Library Data Science and Analytics, Arizona State University, Tempe, AZ 85281
| | - Allan Peter Davis
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695
| | - Thomas C Wiegers
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695
| | - Carolyn J Mattingly
- Department of Biological Sciences, North Carolina State University, Raleigh, NC 27695.,Center for Human Health and the Environment, North Carolina State University, Raleigh, NC 27695
| | - Maxwell C K Leung
- School of Mathematical and Natural Sciences, Arizona State University - West Campus, Glendale, AZ 85306.,Pharmacology and Toxicology Program, Arizona State University - West Campus, Glendale, AZ 85306
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15
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Demaegdt H, Waegeneers N, Cheyns K, Ruttens A. Does arsenic pose a health concern after consumption of clay products? Food Addit Contam Part A Chem Anal Control Expo Risk Assess 2020; 38:113-124. [PMID: 33300835 DOI: 10.1080/19440049.2020.1842515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clay products for oral use form a particular group of food supplements in relation to potential arsenic (As) toxicity, because - certainly in case of pure clay- all arsenic in these supplements is expected to be present in the most toxic inorganic form (Asi). In terms of risk, the most important questions to answer relate to the bioaccessibility and bioavailability of the inorganic arsenic present, rather than to the As species distribution, which often receives most attention in standard foodstuffs. In the present study, clay products for oral use were bought on the Belgian market and analysed for total arsenic (Astot), arsenic species (Asi, arsenobetaine, dimethylarsenate and monomethylarsenate)) and bioaccessible arsenic, in order to perform an exposure assessment and risk characterisation. Total As concentrations differed considerably between the samples and ranged from 0.20 to 6.4 mg Astot/kg. Bioaccessibility of Asi, determined via the Unified Barge Method (extraction making use of digestive enzymes) varied between 8% and 51%. The Asi concentration determined via HPLC-ICP-MS after extraction with diluted HNO3 + H2O2 (as in the CEN method for foodstuffs) was only a poor predictor of the bioaccessible Asi fraction, despite the significant relationship (R2 = 0.36; p < .05). The risk characterisation did not reveal acute risks related to Asi exposure. However, a potential concern with regard to chronic Asi intake was identified for the general population in 42% of the analysed food supplements, and for sensitive population groups in 67% of the samples, even after taking into account the bioaccessible fraction. The data presented illustrate that consumption of some of these clay products may contribute significantly to dietary Asi intake and that these should not be taken chronically.
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Affiliation(s)
- Heidi Demaegdt
- SD Chemical and Physical Health Risks, Service Trace Elements and Nanomaterials, Sciensano , Brussels, Belgium
| | - Nadia Waegeneers
- SD Chemical and Physical Health Risks, Service Trace Elements and Nanomaterials, Sciensano , Brussels, Belgium
| | - Karlien Cheyns
- SD Chemical and Physical Health Risks, Service Trace Elements and Nanomaterials, Sciensano , Brussels, Belgium
| | - Ann Ruttens
- SD Chemical and Physical Health Risks, Service Trace Elements and Nanomaterials, Sciensano , Brussels, Belgium
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16
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Jairoun AA, Shahwan M, Zyoud SH. Heavy Metal contamination of Dietary Supplements products available in the UAE markets and the associated risk. Sci Rep 2020; 10:18824. [PMID: 33139833 PMCID: PMC7606431 DOI: 10.1038/s41598-020-76000-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
A specific safety concern is the possibility that a dietary supplement could be contaminated with heavy metals. This research was undertaken to investigate the daily exposure levels of heavy metals in dietary supplements available in the UAE and to explore the factors associated with the contamination of dietary supplements with heavy metals. A total of 277 dietary supplement samples were collected from the UAE market and prepared for the analysis of selected heavy metal contamination. Inductively coupled plasma mass spectrometry (ICP-MS) was used to determine the presence of heavy metals. The average daily intake of cadmium was 0.73 μg [95% CI 0.61-0.85], compared to the acceptable daily intake (ADI) of 6 μg; the daily intake of lead was 0.85 μg [95% CI 0.62-1.07], compared to the acceptable daily intake (ADI) of 20 μg; and the daily intake of arsenic was 0.67 μg [95% CI 0.57-0.78], compared to the acceptable daily intake of 10 μg. Although the dietary supplements available in the UAE have low levels of heavy metal contamination, numerous individuals are consuming a number of different dietary supplements every day and thereby may experience a cumulative level of toxic exposure. Dietary supplements formulations (Categories), dosage forms and country of origin are strong determents of heavy metal contamination in dietary supplements products.
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Affiliation(s)
- Ammar Abdulrahman Jairoun
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town, Pulau Pinang, Malaysia.
| | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine
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17
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Johanson K, Stirnaman S, Rose TM. Top consumer uses of bestselling, single-ingredient vitamin and mineral supplements. Complement Ther Med 2020; 53:102540. [PMID: 33066866 DOI: 10.1016/j.ctim.2020.102540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Vitamin and mineral supplements are widely used for self-care of a variety of medical conditions, but little is known about the specific conditions for which they are used. This study mined consumer product reviews to determine specific ways vitamin and mineral supplements are being used therapeutically. DESIGN/SETTING A cross-sectional analysis of user reviews for top-selling, single-ingredient vitamin and mineral products from a popular online retailer was performed to identify the most frequently appearing words associated with medical conditions. Results of individual analyses were compared to achieve consensus on the top, relevant keywords for each supplement. The full text of the reviews was searched for these keywords to distinguish whether they referred to therapeutic uses or adverse effects. RESULTS A total of 14 vitamin and 11 mineral supplements were analyzed. The number of user reviews for the analyzed products varied from 41 for manganese to over 5000 for biotin and vitamin D (median = 547 reviews per product). Cohen's kappa test for investigator-selected keywords related to medical conditions was generally greater than 0.6, indicating good interrater reliability. From these lists, the top consumer self-care uses were identified for 24 supplements. Commonly reported adverse effects were also noted for several products. CONCLUSION This study used data mining to identify the top ways consumers use an array of bestselling, single-ingredient vitamin and mineral supplements. These results can provide healthcare and nutrition professionals with information to anticipate the supplement-related education needs of patients and provide researchers with priority areas for clinical studies.
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Affiliation(s)
- Kendra Johanson
- Roseman University of Health Sciences College of Pharmacy, 10920 S River Front Pkwy, South Jordan, UT 84095, United States
| | - Sara Stirnaman
- Roseman University of Health Sciences College of Pharmacy, 10920 S River Front Pkwy, South Jordan, UT 84095, United States
| | - Tyler M Rose
- Roseman University of Health Sciences College of Pharmacy, 10920 S River Front Pkwy, South Jordan, UT 84095, United States.
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18
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Staff NP. Peripheral Neuropathies Due to Vitamin and Mineral Deficiencies, Toxins, and Medications. Continuum (Minneap Minn) 2020; 26:1280-1298. [PMID: 33003002 DOI: 10.1212/con.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Vitamin and mineral deficiencies, neurotoxins, and, particularly, prescription medications, are some of the most common causes of peripheral neuropathy. Recognition and prompt treatment of these neuropathies require a high index of suspicion and an accompanied detailed history. This article provides a comprehensive approach and list of items that must be considered in the setting of new-onset neuropathy. RECENT FINDINGS Although many of the neuropathies described in this article have decreased in prevalence in developed countries because of public health interventions and occupational/environmental regulations, new causes for this class of neuropathy continue to be uncovered. SUMMARY The peripheral nervous system is susceptible to a broad array of metabolic and toxic abnormalities, which most often lead to a length-dependent sensory-predominant axonal peripheral neuropathy. A careful history accompanied by recognition of multisystem clues can increase recognition of these neuropathies, which is important as many have specific treatments that may either improve the neuropathy or halt its progression.
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Roy KA, El Khoury D, Dwyer JJM, Mountjoy M. Dietary Supplementation Practices among Varsity Athletes at a Canadian University. J Diet Suppl 2020; 18:614-629. [PMID: 32990098 DOI: 10.1080/19390211.2020.1826618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Given the risks of inadvertent doping associated with dietary supplement (DS) use, it is critical to explore the extent of dependence of varsity athletes on DS to improve performance and support recovery. The purpose of this study was to gain insight into dietary supplementation practices among varsity athletes in a university setting in Ontario, Canada. METHODS An online DS use questionnaire was completed by 302 varsity athletes (30.5% male, 69.5% female; 20.5 ± 1.8-year old) who were competing in intermittent, power and endurance-based sports at the University of Guelph. The data from supplement users were analyzed using a Chi-square analysis to investigate type of DS consumption, frequency of use and reasons for use. RESULTS Overall, 58.3% of athletes reported having used at least one type of DS in the past six months. Gender and age had significant associations with prevalence of DS use, with male athletes and athletes over 20-year old being more likely to be DS users. The most frequently reported reasons for consuming DS were to maintain good health, increase energy, promote recovery, correct or prevent micronutrient deficiencies and supply convenient forms of energy and/or macronutrients. Although, most athletes were using reliable sources of information, health care professionals, 58.6% still mentioned wanting to become more knowledgeable about DS. CONCLUSIONS Findings from this study may guide the development of educational materials needed to address knowledge gaps on DS among varsity athletes.
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Affiliation(s)
- Karol-Ann Roy
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Dalia El Khoury
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - John J M Dwyer
- Department of Family Relations and Applied Nutrition, College of Social and Applied Human Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Margo Mountjoy
- Health and Performance Center, John T. Powell Building, University of Guelph, Guelph, Ontario, Canada
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20
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Quan NV, Dang Xuan T, Teschke R. Potential Hepatotoxins Found in Herbal Medicinal Products: A Systematic Review. Int J Mol Sci 2020; 21:E5011. [PMID: 32708570 PMCID: PMC7404040 DOI: 10.3390/ijms21145011] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
The risk of liver injury associated with the use of herbal medicinal products (HMPs) is well known among physicians caring for patients under a HMP therapy, as documented in case reports or case series and evidenced by using the Roussel Uclaf Causality Assessment Method (RUCAM) to verify a causal relationship. In many cases, however, the quality of HMPs has rarely been considered regarding potential culprits such as contaminants and toxins possibly incriminated as causes for the liver injury. This review aims to comprehensively assemble details of tentative hepatotoxic contaminants and toxins found in HMPs. Based on the origin, harmful agents may be divided according two main sources, namely the phyto-hepatotoxin and the nonphyto-hepatotoxin groups. More specifically, phyto-hepatotoxins are phytochemicals or their metabolites naturally produced by plants or internally in response to plant stress conditions. In contrast, nonphyto-hepatotoxic elements may include contaminants or adulterants occurring during collection, processing and production, are the result of accumulation of toxic heavy metals by the plant itself due to soil pollutions, or represent mycotoxins, herbicidal and pesticidal residues. The phyto-hepatotoxins detected in HMPs are classified into eight major groups consisting of volatile compounds, phytotoxic proteins, glycosides, terpenoid lactones, terpenoids, alkaloids, anthraquinones, and phenolic acids. Nonphyto-hepatotoxins including metals, mycotoxins, and pesticidal and herbicidal residues and tentative mechanisms of toxicity are discussed. In conclusion, although a variety of potential toxic substances may enter the human body through HMP use, the ability of these toxins to trigger human liver injury remains largely unclear.
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Affiliation(s)
- Nguyen Van Quan
- Transdisciplinary Science and Engineering Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima 739-8529, Japan; (N.V.Q.); (T.D.X.)
| | - Tran Dang Xuan
- Transdisciplinary Science and Engineering Program, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima 739-8529, Japan; (N.V.Q.); (T.D.X.)
| | - Rolf Teschke
- Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Teaching Hospital of the Medical Faculty, Goethe University Frankfurt/Main, 63450 Hanau, Germany
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21
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Umegaki K, Yokotani K, Marumoto S, Miyazawa M. Identification of Compounds in Coleus forskohlii Extract Involved in the Induction of Hepatic CYP and Fatty Liver in Mice. J Oleo Sci 2020; 68:995-1002. [PMID: 31582668 DOI: 10.5650/jos.ess19124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Coleus forskohlii extract (CFE), a popular weight-loss herbal product, induces hepatic cytochrome P450 (CYP) and fatty liver in mice; however, its main bioactive ingredient, forskolin, does not show such effects. To ensure the safety of CFE as a dietary supplement, identification of the compounds implicated in the induction of hepatic CYP and fatty liver is required. In this study, we separated a crude CFE extract into 5 fractions (Fr.) by column chromatography and administered the fractions to mice for one week to assess their ability to induce CYP and fatty liver. CYP induction was detected for all fractions, indicating that many compounds may be involved in CYP induction, while fatty liver was only detected for Fr. 2. Further isolation and purification of Fr. 2 by column chromatography identified 14-deoxycoleon U as a major compound and crocetin dialdehyde as a pigment compound. An in vivo mouse study revealed that crocetin dialdehyde had no effect on the liver and, as 14-deoxycoleon U was the major compound in Fr. 2, it is likely that the active compound inducing fatty liver in CFE is 14-deoxycoleon U. These findings will facilitate the preparation of standardized safe CFE ingredients for dietary supplements.
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Affiliation(s)
- Keizo Umegaki
- Department of Food Safety and Management, Showa Women's University
| | - Kaori Yokotani
- Department of Food Safety and Management, Showa Women's University
| | | | - Mitsuo Miyazawa
- Department of Applied Chemistry, Kindai University.,Division of Materials Science, Graduate School of Science and Technology, Nara Institute of Science and Technology
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Tanner S, Sharma V, Jebakumar D, Narayanan M, Rao A. Mercury in natural health products as a cause of membranous nephropathy. Proc (Bayl Univ Med Cent) 2020; 33:243-245. [PMID: 32313474 DOI: 10.1080/08998280.2020.1719782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/15/2020] [Accepted: 01/20/2020] [Indexed: 10/25/2022] Open
Abstract
Membranous nephropathy is a glomerular disease characterized by diffuse subepithelial immune complex deposition along the glomerular basement membrane. It can be both primary and secondary to malignancy and various drugs. An emerging area of concern is heavy metal exposure from use of largely unregulated natural health products. Here we present a case of biopsy-proven membranous nephropathy due to natural health products contaminated with mercury.
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Affiliation(s)
- Stephen Tanner
- Department of Nephrology, Baylor Scott & WhiteTempleTexas
| | - Vivek Sharma
- Department of Nephrology, Baylor Scott & WhiteTempleTexas
| | | | | | - Arundhati Rao
- Department of Pathology, Baylor Scott & WhiteTempleTexas
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Abstract
The Dietary Supplement Health and Education Act led to a flood of poor-quality dietary supplements. The Food and Drug Administration’s (FDA’s) jurisdiction is limited to removing products proven unsafe, rather than prospectively assessing them for quality manufacturing. With so many products available, there is very little FDA oversight until reports of patient harm occur. Microbial and heavy metal contamination, adulteration with synthetic drugs (including drugs banned from the United States), substituting herbs, and fraudulently specifying ingredients on the label have all occurred. Clinicians should collectively advocate for legislative change, only recommend products tested by outside laboratories for quality, and educate consumers about the risks of using unverified products.
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24
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Abdulla NM, Adam B, Blair I, Oulhaj A. Heavy metal content of herbal health supplement products in Dubai - UAE: a cross-sectional study. Altern Ther Health Med 2019; 19:276. [PMID: 31638965 PMCID: PMC6805626 DOI: 10.1186/s12906-019-2693-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lead, mercury, cadmium, chromium, and arsenic intoxication have been associated with the use of health supplement (HS) products. The aim of this study is to estimate the concentration of heavy metals in HS products that are on sale in Dubai, United Arab Emirates, premises and to compare estimated daily metal intake with regulatory standards. METHODS Dubai-area premises selling HS products were identified by searching the Dubai Municipality database to identify all pharmacies, para-pharmacies and nutrition and healthcare shops. A total of 859 premises were identified in the Deira and Bur-Dubai areas. Data collection was performed between September 1 and December 12, 2016. During that period, all premises that had been identified within Dubai were visited and samples for laboratory testing were collected. RESULTS A total of 200 HS products were tested for lead, mercury, cadmium, chromium and arsenic. High proportion of samples were found to contain metals less than the limits of the detection (LOD) of the method. It was found that 93% of products contained Arsenic (As) < LOD, 94.5% of lead (Pb) < LOD, 100% of Cadmium (Cd) < LOD, 99% of Mercury (Hg) < LOD and 23.5% of Chromium (Cr) < LOD. Using the single imputation method to account for LOD, estimates for the average daily intake of lead was 0.88 μg compared to the tolerable daily intake (TDI) of 20 μg, daily intake of mercury was 0.09 μg (TDI = 20 μg), daily intake of cadmium was 0.83 μg (TDI = 6 μg) while for arsenic it was 0.92 μg compared to the tolerable daily intake of 10 μg. The average daily intake of chromium was 7.57 μg with no internationally established TDI. Assuming users followed the manufacturers' instructions, daily intake of arsenic, lead and mercury would not exceed TDI for any of the 200 products. However, the daily intake of cadmium exceeded or approximated the TDI for three products. CONCLUSIONS In this study we found low levels of metals in the products that were available for sale in Dubai. With few exceptions, if the products were used according to the suppliers' instructions, average daily intake of heavy metals will be well below the recommended tolerable daily intakes.
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25
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Lombardi N, Crescioli G, Bettiol A, Menniti-Ippolito F, Maggini V, Gallo E, Mugelli A, Vannacci A, Firenzuoli F. Safety of complementary and alternative medicine in children: A 16-years retrospective analysis of the Italian Phytovigilance system database. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 61:152856. [PMID: 31035051 DOI: 10.1016/j.phymed.2019.152856] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dietary supplements and homeopathic medicines are largely used in children as complementary and alternative medicine (CAM) to treat different health conditions. Safety of CAM is unknown when they are marketed. This study analysed suspected CAM-related adverse reaction (AR) in pediatric population. METHODS The Italian Phytovigilance system was searched for reports of suspected AR related to CAM use in children (0-18 years) from 2002 to 2018. AR reports were evaluated and information about patient's demographic characteristics, suspected CAM, conventional medications, and ARs were collected. In particular, we evaluated whether patient's and CAM characteristics, and concomitant drugs could be potential predictors of ARs seriousness. RESULTS We evaluated 206 pediatric CAM-related AR reports, of which 69 were serious. Patients were mostly treated with only one CAM (n = 193), and 39% of AR reports were related to products containing 2-5 components. Most reported ARs were related to dietary supplements (57.18%), and skin and subcutaneous tissue disorders (40.29%) were the most involved System Organ Class. CAM-related AR reported as serious were higher in subjects exposed to homeopathic medicines (ROR 3.13 [1.88-5.22]), to CAM in presence of concomitant medications (ROR 1.77 [1.01-3.10]), to CAM containing 2-4 components (ROR 2.18 [1.13-4.22]), and to more than three concomitant CAM (ROR 7.81 [1.97-32.69]). CONCLUSION We provide new insights on factors that might increase the risk of serious AR associated with CAM use in children: products containing more than two components and simultaneously administered with conventional medications can represent a potential risk in children.
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Affiliation(s)
- Niccolò Lombardi
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Giada Crescioli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | | | - Valentina Maggini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Eugenia Gallo
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy
| | - Alfredo Vannacci
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Viale G. Pieraccini, 6, 50139, Florence, Italy.
| | - Fabio Firenzuoli
- Referring Center for Phytotherapy, Tuscany Region, Careggi University Hospital, Florence, Italy
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Nadareishvili I, Pkhakadze G, Tskitishvili A, Bakuradze N, Lunze K. Georgia's healthcare system and integration of complementary medicine. Complement Ther Med 2019; 45:205-210. [PMID: 31331562 DOI: 10.1016/j.ctim.2019.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND An increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients' CAM use and their perspectives of CAM complementation of existing services in Georgia's health care system. METHODOLOGY We conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia. RESULTS Study participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration. CONCLUSION Patients favor an integration of CAM into Georgia's current healthcare systems to ensure CAM's broad availability as well as effective regulation and financing, including coverage by health insurance.
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Affiliation(s)
| | | | | | - Nata Bakuradze
- Eliava Institute of Bacteriophage, Microbiology & Virology and Georgian National University, Georgia.
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27
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Nishijima C, Chiba T, Sato Y, Yamada H, Umegaki K. [Nationwide Online Survey Method to Estimate Ongoing Adverse Events Caused by Supplement Use: Application to Diarrhea]. Food Hygiene and Safety Science (Shokuhin Eiseigaku Zasshi) 2019; 59:106-113. [PMID: 30033986 DOI: 10.3358/shokueishi.59.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current adverse event reporting systems are inadequate to prevent potential health damage caused by dietary supplement use, and a better case-collecting system is needed. The aim of this study was to examine whether online surveys would be a useful methodology for estimating ongoing adverse events, focusing on diarrhea as a model symptom. We used four online survey companies and requested that they administer the same questionnaire to their registrants regarding experiences of adverse events associated with supplement use and details of diarrhea symptoms, as well as the product and ingredient names of suspected supplements. Of 78,220 dietary supplement users, 9% to 25% reported experiencing adverse events in the previous year. A total of 723 participants who answered affirmatively about a putative causal relationship between supplement use and the onset of diarrhea and who clearly identified the product and/or ingredient were eligible for final analysis. Comparisons among the survey companies showed differences in the proportions of reported symptoms; however, the rank orders were consistent in the preliminary survey. Also, when analysis was limited to specific participants from a full-scale survey, even the numerical values of the proportions were consistent among the four companies. Herbal/botanical ingredients, specifically Coleus forskohlii, were the ingredients most frequently reported to be associated with diarrhea. These results indicate that online survey can be a useful method to complement the current system for estimating ongoing adverse events and identifying the responsible supplements.
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Affiliation(s)
- Chiharu Nishijima
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Graduate School of Nutrition Sciences, Kagawa Nutrition University
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Yoko Sato
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Hiroshi Yamada
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka
| | - Keizo Umegaki
- Department of Food Safety and Management, Showa Women's University
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28
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Gyamfi ET. Metals and metalloids in traditional medicines (Ayurvedic medicines, nutraceuticals and traditional Chinese medicines). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:15767-15778. [PMID: 31004267 DOI: 10.1007/s11356-019-05023-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 03/27/2019] [Indexed: 06/09/2023]
Abstract
Traditional medicine (TM) including Ayurvedic medicines, traditional Chinese medicines and nutraceuticals are popular across the globe as dietary supplements and traditional and alternative medicines. Health risks from these remedies continue to present serious concerns, with occurrences of poisoning by metals and metalloids present at concentrations above acceptable regulatory standards. This review overviews the prevalence of TM use, cases of metal and metalloid poisoning following TM consumption, and forms of TM contamination and adulteration. The review summarises regulations by the World Health Organization (WHO) and other relevant bodies. Finally, the review recommends how to protect consumers.
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Affiliation(s)
- Eva T Gyamfi
- Department of Environmental Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
- Nuclear Chemistry and Environmental Research Centre, Ghana Atomic Energy Commission, National Nuclear Research Institute, P.O. Box LG 80, Legon, Accra, Ghana.
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29
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Nationwide Online Survey Enables the Reevaluation of the Safety of Coleus forskohlii Extract Intake Based on the Adverse Event Frequencies. Nutrients 2019; 11:nu11040866. [PMID: 30999632 PMCID: PMC6521622 DOI: 10.3390/nu11040866] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/09/2019] [Accepted: 04/15/2019] [Indexed: 01/17/2023] Open
Abstract
The formulations of the functional ingredients of dietary supplements was studied with a small number of subjects, with a particular focus on their effectiveness, but not enough to evaluate their safety. In this regard, the reevaluation and estimation of the safe use of marketed products, with regards to their adverse event (AE) frequencies, are important. To address this issue, a post-marketing nationwide online survey was conducted for the herbal ingredient Coleus forskohlii extract (CFE), a popular weight-loss ingredient. The questionnaire included product names, adherence to the claimed amount, and AE experiences. The safe intake amount was estimated by the relationship between the claimed amount of CFE and the frequencies of AEs of each product. The number of users who experienced AEs was 75 (10.5% of all users). Gastrointestinal symptoms accounted for 92.0% (n = 69) of all AEs, and diarrhea alone accounted for 81.3% (n = 61). The amount of CFE was significantly associated with the occurrence of diarrhea (p = 0.005). The fitted curve showed that the safe intake amount of CFE was less than 250 mg/day; however, considering its effectiveness, 500 mg/day of CFE might be acceptable. In conclusion, nationwide online surveys of users enable us to confirm and reevaluate the safety of herbal supplements.
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Ganguli A, Rai P, Balachandran S, Gupta R, Sharma R, Neogi SB. Heavy Metals in Indigenous Preparations Used for Sex Selection During Pregnancy in India. Biol Trace Elem Res 2019; 188:239-244. [PMID: 29909490 DOI: 10.1007/s12011-018-1411-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/06/2018] [Indexed: 12/29/2022]
Abstract
Indigenous preparations (IPs) have evoked a considerable interest in alleviating infections and chronic diseases and improving wellbeing. While such formulations have been a part of traditional practice in several countries and many have been reviewed scientifically for their claims, several of them until date remain to be investigated. A class of IPs for sex selection by Indian pregnant women exists with an aim of begetting a male offspring. In view of the leads obtained from our previous studies on detrimental effects of the newborn, for instance stillbirths and congenital malformations, we attempted to investigate the samples for heavy metal toxicity. Three samples were chosen following phytochemical analysis and reproductive toxicity of such preparations under in vivo conditions. The selected samples were examined for heavy metals-lead, cadmium, arsenic, and mercury using Microwave-assisted atomic absorption spectroscopy. The upper limit level of lead, mercury, and cadmium was found to be 18.56, 0.11, and 0.84 mg/kg respectively whereas arsenic was not detected. The levels of lead and mercury were found to be manifolds high in the IP samples that were primarily contributed by its constituents. The results of our study indicate the potential risk conferred upon, to both the mother and fetus on account of high levels of lead, mercury, and cadmium.
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Affiliation(s)
| | - Pragya Rai
- Public Health Foundation of India, Indian Institute of Public Health, Delhi, India
| | | | | | - Rashmi Sharma
- Science for Equity, Empowerment and Development (SEED) Division, Department of Science and Technology, Delhi, India
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Jena M, Mishra A, Maiti R. Environmental pharmacology: source, impact and solution. REVIEWS ON ENVIRONMENTAL HEALTH 2019; 34:69-79. [PMID: 30854834 DOI: 10.1515/reveh-2018-0049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 12/02/2018] [Indexed: 06/09/2023]
Abstract
Environmental pharmacology is the knowledge, study and the methods implemented for amalgamating the presence of pharmaceutical products and their metabolites in the environment. Pharmaceutical and house care products and their metabolites gain access to the environment through various means and affect the flora and fauna and modulate the ecosystem. The effect on wildlife, biofilms and human are being studied to gain knowledge of sources and causations. Potential risks of development of acute and chronic toxicity, carcinogenicity, interference with hormone and immune systems and drug resistance are of major concern. They may alter the genome and can affect future generations leaving them vulnerable to disease. There are regulations in good manufacturing practices and disposal which take into account the environmental risks but the knowledge for stakeholders and their implementation is very restricted. Ecopharmacology and ecopharmacovigilance are propagators of green healthcare. A strategy towards human health risk assessment and ecotoxicological hazard evaluation must be developed and risk minimization measures to be sought for and applied.
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Affiliation(s)
- Monalisa Jena
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India
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McElroy JA, Hunter MI. Cadmium: a new risk factor for endometrial cancer? Expert Rev Anticancer Ther 2019; 19:355-358. [DOI: 10.1080/14737140.2019.1596029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jane A. McElroy
- Family and Community Medicine Department, University of Missouri, Columbia, MO, USA
- Missouri University Research Reactor, University of Missouri, Columbia, MO, USA
| | - Mark I. Hunter
- Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, Ellis Fischel Cancer Center, Columbia, MO, USA
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Mishra T, Dhaliwal HS, Singh K, Singh N. Shilajit (Mumie): Current Status of Biochemical, Therapeutic and Clinical Advances. CURRENT NUTRITION & FOOD SCIENCE 2019. [DOI: 10.2174/1573401313666170823160217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background: Shilajit (mumie), a natural multi-component herbomineral ethnomedicinal
food, is used as a traditional medicine for enhancing the quality of life and for management of health
ailments in many countries of the world. Use of Shilajit as an adaptogen, aphrodisiac, rejuvenator and
anti-aging substance is mentioned in many ancient texts. This review aims to provide comprehensive
insights into its biochemical aspects, microbial role in biosynthesis, bioactivities and to establish correlation
between traditional uses and scientifically validated research findings.
Methods:
Scientific literature and ethnopharmacological information were compiled from the published
peer-reviewed articles, unpublished materials, thesis, books, patent databases, clinical trial registries
and from the websites of research councils of traditional medicine. The scientific databases,
thesis repositories and books databases were searched with keywords Shilajit, mumie, mumijo,
salajeet, asphaltum, fulvic acid, dibenzo-alpha-pyrones etc.
Results:
Scientifically validated research and ancient texts suggest multifaceted benefits of Shilajit. It
is endowed with anti-stress, memory and energy enhancing, antioxidant, anti-inflammatory, antidiabetic,
spermatogenic, neuroprotective, antiulcer and wound healing activities. These pharmacological
effects are mainly attributed to the presence of humic acid, fulvic acid, dibenzo-α-pyrones, dibenzo-
α-pyrones chromoproteins and trace elements.
Conclusion:
This review summarizes the traditional importance of Shilajit for the treatment and prevention
of several acute and chronic diseases and health ailments. Despite numerous health claims,
there are still major gaps in our understanding of its mechanism of action, variability in efficacy and
toxicity profile. Therefore, a coordinated interdisciplinary approach is needed to establish the underlying
mechanisms of action, comprehensive toxicological profile, pharmacokinetics parameters and effects
on different organ systems. Regulatory and governmental impetus to basic and clinical research,
safety testing and formulations quality control is warranted.
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Affiliation(s)
- Tanuja Mishra
- Department of Biotechnology, Eternal University, Baru Sahib-173101, Himachal Pradesh, India
| | - Harcharan S. Dhaliwal
- Department of Biotechnology, Eternal University, Baru Sahib-173101, Himachal Pradesh, India
| | - Karan Singh
- Chemistry, Eternal University, Baru Sahib-173101, Himachal Pradesh, India
| | - Nasib Singh
- Department of Biotechnology, Eternal University, Baru Sahib-173101, Himachal Pradesh, India
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Baars EW, Zoen EBV, Breitkreuz T, Martin D, Matthes H, von Schoen-Angerer T, Soldner G, Vagedes J, van Wietmarschen H, Patijn O, Willcox M, von Flotow P, Teut M, von Ammon K, Thangavelu M, Wolf U, Hummelsberger J, Nicolai T, Hartemann P, Szőke H, McIntyre M, van der Werf ET, Huber R. The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:5365608. [PMID: 30854009 PMCID: PMC6378062 DOI: 10.1155/2019/5365608] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 12/23/2018] [Indexed: 12/18/2022]
Abstract
AIM The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use. METHODS We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence. CONCLUSIONS CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.
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Affiliation(s)
- Erik W. Baars
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Eefje Belt-van Zoen
- University of Applied Sciences Leiden, Faculty of Healthcare, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | | | - David Martin
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Harald Matthes
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | | | - Georg Soldner
- Medical section of the Goetheanum, Rüttiweg 45 4143 Dornach, Switzerland
| | - Jan Vagedes
- ARCIM institute, Im Haberschlai 7, 70794 Filderstadt, Germany
| | | | - Olga Patijn
- Louis Bolk Institute, Kosterijland 3-5, 3981 AJ Bunnik, Netherlands
| | - Merlin Willcox
- University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Paschen von Flotow
- Sustainable Business Institute, Zehnthofstr. 1, 65375 Oestrich-Winkel, Germany
| | - Michael Teut
- Charité Universitätsmedizin Berlin, Institute for Social Medicine, Epidemiology and Health Economics, Luisenstr. 57, 10117 Berlin, Germany
| | - Klaus von Ammon
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | - Madan Thangavelu
- European Ayurveda Association e.V., In den Forstwiesen 27, D- 56745 Bell, Germany
| | - Ursula Wolf
- University of Bern, Freiburgstrasse 46, 3010 Bern, Switzerland
| | | | - Ton Nicolai
- Eurocam, Rue du Trône 194, 1050 Brussels, Belgium
| | - Philippe Hartemann
- University of Lorraine, School of Medicine, 7 avenue de la Forêt de Haye, 54500 Vandoeuvre-Nancy, France
| | - Henrik Szőke
- University of Pécs, 7622 Pécs, Vasvári Pál str. 4., Hungary
| | - Michael McIntyre
- Midsummer Clinic, Church Westcote, Chipping Norton, Oxon, Ox7 6SF, UK
| | - Esther T. van der Werf
- Taylor's University, School of Medicine, 1, Jalan Taylor's, 47500 Subang Jaya, Selangor D.E., Malaysia
- University of Bristol, Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Roman Huber
- University of Freiburg, Faculty of Medicine, Breisacher Str. 115b, 79106 Freiburg, Germany
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Nishijima C, Sato Y, Chiba T, Umegaki K. Nationwide Online Survey to Complement the Current Voluntary Reporting System for Adverse Events Associated with Dietary Supplements: Application to the Case of Skin Manifestations. J Nutr Sci Vitaminol (Tokyo) 2019; 64:277-283. [PMID: 30175791 DOI: 10.3177/jnsv.64.277] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The current adverse event reporting system for dietary supplements lacks the ability to collect and analyze ongoing case reports in sufficient numbers to detect health issues. We conducted an online survey to collect data on skin manifestations due to supplement use in consumers and to identify the suspected products and ingredients. An online survey was conducted among 63,737 dietary supplement users in 2016. Those who self-reported experiences of skin anthema or itching caused by supplement use and recognized a causal relationship as almost certain (0.8%) were invited to provide further details of symptoms and products. Most of the users experienced mild symptoms with "itching and/or rash of body part." After the onset of skin manifestations, 69.3% ceased supplement use, while 26.6% continued supplement use, including those who reduced the amount or frequency of use. Respondents who visited the hospital in response to symptoms accounted for 26.0%, while 53.3% did not seek treatment. The products used were identified in 155 of 300 eligible respondents. Although those products were composed of multiple ingredients, the accumulated data suggested that cutaneous symptoms were related to the following constituents: "Peptides or animal by-products" (31.0%), "Herbal/Botanical" (23.2%) and "Fats and lipid" (13.5%). Conducting an online survey to elicit information directly from consumers identified components of supplements that are involved in skin manifestations that could lead to serious damage, and may fill a void in the current adverse event reporting system.
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Affiliation(s)
- Chiharu Nishijima
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Laboratory of Medical Chemistry, Graduate School of Nutrition Sciences, Kagawa Nutrition University
| | - Yoko Sato
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Tsuyoshi Chiba
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
| | - Keizo Umegaki
- Department of Food Function and Labeling, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition.,Department of Food Safety and Management, Showa Women's University
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Khalil AAI, Labib OA. RETRACTED ARTICLE: Levels of Toxic Elements in Tea Brands Commercialized in Egypt Using Optimized Dual-Pulsed Laser-Induced Spectral Analysis Spectrometer. Biol Trace Elem Res 2018; 186:294. [PMID: 29876796 DOI: 10.1007/s12011-018-1403-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/29/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Ahmed Asaad I Khalil
- Department of Laser Sciences and Interactions, National Institute of Laser Enhanced Sciences, (NILES), Cairo University, Giza, 12613, Egypt.
| | - Osama A Labib
- Department of Environmental Health, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Liu L, Zhang Y, Yun Z, He B, Zhang Q, Hu L, Jiang G. Speciation and bioaccessibility of arsenic in traditional Chinese medicines and assessment of its potential health risk. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 619-620:1088-1097. [PMID: 29734587 DOI: 10.1016/j.scitotenv.2017.11.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 06/08/2023]
Abstract
Arsenic in traditional Chinese medicines (TCMs) has caused public concerns about its health risk in recent years due to the high toxicity of arsenic and widespread use of those medicines throughout the world. However, in previous studies the arsenic toxicity was usually overestimated by considering the total arsenic concentration only. This work investigated the total concentration, speciation and bioaccessibility of arsenic in 84 commonly used traditional Chinese patent medicines (CPMs) and Chinese herbal medicines (CHMs) to evaluate arsenic's potential health risks to human. Arsenic was found in all the CPMs and 88% of CHMs at concentrations ranging from 0.033 to 91,000mgkg-1 and 0.012 to 6.6mgkg-1, respectively. The bioaccessibility of arsenic varied significantly and was in the range of 0.21%-90% in the CPMs and 15%-96% in the CHMs, with inorganic arsenic as the predominant species. The average daily intake dose (ADD) and hazard quotient (HQ) of arsenic in most of medicines were within the safe limits, while in certain medicines, they exceeded the safe threshold level. These excesses remind us that the potential health risk by consumption of several medicines may not be negligible and more control and monitoring of arsenic in medicines should be carried out.
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Affiliation(s)
- Lihong Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Yu Zhang
- Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing 100102, China
| | - Zhaojun Yun
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Bin He
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Qinghua Zhang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Ligang Hu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guibin Jiang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
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Schwalfenberg G, Rodushkin I, Genuis SJ. Heavy metal contamination of prenatal vitamins. Toxicol Rep 2018; 5:390-395. [PMID: 29854609 PMCID: PMC5978005 DOI: 10.1016/j.toxrep.2018.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/25/2018] [Accepted: 02/27/2018] [Indexed: 12/18/2022] Open
Abstract
Toxic elements are found in prenatal vitamins with lead at unacceptable levels in more than half of the products tested. Arsenic is also found in some products at unsafe levels. Thallium is present at levels in some products that are not acceptable. Some products have very low level, which are safer, and recommendations are made to have industry (self regulatory) and government oversight to have the least contamination of prenatal vitamins.
Prenatal vitamins are often consumed daily during gestation and postnatally for up to 18–24 months with the belief that supplementation achieves better outcomes. Detrimental effects of gestational exposure to adverse chemical agents are gathering increasing attention. This study was designed to assess toxic element contamination in prenatal supplements. Twenty-six commonly used prenatal vitamin brands including one prescription brand were collected from Canadian health-food outlets and pharmacies, and tested for toxic element contamination. Results were compared to established endpoints. All samples contained Lead with average amounts being (0.535 μgm), 20/51 samples exceeded established standards for lead toxicity (0.50 μgm/day), with one sample yielding 4. μgm/day. Three samples registered inorganic arsenic levels above acceptable limits. Cadmium levels did not exceed current standards. Toxic elements such as Aluminum, Nickel, Titanium and Thallium were detected in all samples. Cumulative intake of prenatal supplement over many months may constitute a significant source of toxic element exposure to the mother and offspring. With several samples exceeding known standards for gestational toxic element exposure, guidelines for routine monitoring and reporting are required. In keeping with recommendations from the International Federation of Obstetrics and Gynecology, industry regulation would be welcomed to protect expectant mothers and their vulnerable offspring.
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Affiliation(s)
| | - Ilia Rodushkin
- Scandinavia Division of A.L.S. Laboratory Group, Sweden.,Luleå University of Technology, Sweden
| | - Stephen J Genuis
- Department of Obstetrics and Gynecology, University of Alberta, Canada
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Heltai G, Győri Z, Fekete I, Halász G, Kovács K, Takács A, Boros N, Horváth M. Longterm study of transformation of potentially toxic element pollution in soil/water/sediment system by means of fractionation with sequential extraction procedures. Microchem J 2018. [DOI: 10.1016/j.microc.2017.01.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bolan S, Kunhikrishnan A, Seshadri B, Choppala G, Naidu R, Bolan NS, Ok YS, Zhang M, Li CG, Li F, Noller B, Kirkham MB. Sources, distribution, bioavailability, toxicity, and risk assessment of heavy metal(loid)s in complementary medicines. ENVIRONMENT INTERNATIONAL 2017; 108:103-118. [PMID: 28843139 DOI: 10.1016/j.envint.2017.08.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 08/05/2017] [Accepted: 08/09/2017] [Indexed: 05/27/2023]
Abstract
The last few decades have seen the rise of alternative medical approaches including the use of herbal supplements, natural products, and traditional medicines, which are collectively known as 'Complementary medicines'. However, there are increasing concerns on the safety and health benefits of these medicines. One of the main hazards with the use of complementary medicines is the presence of heavy metal(loid)s such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg). This review deals with the characteristics of complementary medicines in terms of heavy metal(loid)s sources, distribution, bioavailability, toxicity, and human risk assessment. The heavy metal(loid)s in these medicines are derived from uptake by medicinal plants, cross-contamination during processing, and therapeutic input of metal(loid)s. This paper discusses the distribution of heavy metal(loid)s in these medicines, in terms of their nature, concentration, and speciation. The importance of determining bioavailability towards human health risk assessment was emphasized by the need to estimate daily intake of heavy metal(loid)s in complementary medicines. The review ends with selected case studies of heavy metal(loid) toxicity from complementary medicines with specific reference to As, Cd, Pb, and Hg. The future research opportunities mentioned in the conclusion of review will help researchers to explore new avenues, methodologies, and approaches to the issue of heavy metal(loid)s in complementary medicines, thereby generating new regulations and proposing fresh approach towards safe use of these medicines.
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Affiliation(s)
- Shiv Bolan
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Anitha Kunhikrishnan
- Department of Agro-Food Safety, National Institute of Agricultural Science, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - Balaji Seshadri
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Girish Choppala
- Southern Cross GeoScience, Southern Cross University, Lismore, New South Wales 2480, Australia
| | - Ravi Naidu
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nanthi S Bolan
- Global Centre for Environmental Remediation, ATC Building, Faculty of Science and Information Technology, The University of Newcastle, Callaghan, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), The University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Yong Sik Ok
- O-Jeong Eco-Resilience Institute (OJERI) & Division of Environmental Science and Ecological Engineering, Korea University, Seoul, Republic of Korea
| | - Ming Zhang
- Department of Environmental Engineering, China Jiliang University, Hangzhou, China
| | - Chun-Guang Li
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Feng Li
- National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Barry Noller
- Sustainable Minerals Institute, University of Queensland, Brisbane, Australia
| | - Mary Beth Kirkham
- Department of Agronomy, Throckmorton Plant Sciences Center, Kansas State University, Manhattan, KS, USA
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Bolan S, Kunhikrishnan A, Chowdhury S, Seshadri B, Naidu R, Ok YS. Comparative analysis of speciation and bioaccessibility of arsenic in rice grains and complementary medicines. CHEMOSPHERE 2017; 182:433-440. [PMID: 28528310 DOI: 10.1016/j.chemosphere.2017.04.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/07/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
In many countries, rice grains and complementary medicines are important sources of arsenic (As) consumption. The objective of this study was to compare the speciation and bioaccessibility of As in selected rice grains and complementary medicines. A number of rice grain samples, and a range of herbal and ayurvedic medicines were analyzed for total As, speciation of As using sequential fractionation and extended x-ray absorption fine structure (EXAFS) techniques, and bioaccessibility of As using an in vitro extraction test. The daily intake of As through the uptake of these As sources was compared with the safety guidelines for As. The results demonstrated higher levels of As in ayurvedic medicines compared to herbal medicines and rice grains. The sequential fractionation showed the dominance of organic-bound As species in rice grains and herbal medicines, however, inorganic-bound As species dominated the ayurvedic medicines. This implies that As is derived from plant uptake in herbal medicines and rice grains, and from inorganic mineral input in ayurvedic medicines. Arsenic bioaccessibility was higher in ayurvedic than herbal medicines and rice grains, suggesting that inorganic As added as a mineral therapeutic input is more bioaccessible than organic As species derived from plant uptake. This study also showed a positive relationship between soluble As fractions and bioaccessibility indicating that solubility is an important factor controlling bioaccessibility. The daily intake values for As as estimated by total As content are likely to exceed the safe threshold level in rice grains that are enriched with As.
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Affiliation(s)
- S Bolan
- Global Centre for Environmental Remediation, University of Newcastle, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), University of Newcastle, NSW 2308, Australia
| | - A Kunhikrishnan
- Department of Agro-Food Safety, National Institute of Agricultural Science, Wanju, Jeollabuk-do 55365, Republic of Korea
| | - S Chowdhury
- Department of Soil Science, Sher-e-Bangla Agricultural University, Dhaka 1207, Bangladesh
| | - B Seshadri
- Global Centre for Environmental Remediation, University of Newcastle, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), University of Newcastle, NSW 2308, Australia.
| | - R Naidu
- Global Centre for Environmental Remediation, University of Newcastle, NSW 2308, Australia; Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE), University of Newcastle, NSW 2308, Australia
| | - Y S Ok
- O-Jeong Eco-Resilience Institute (OJERI), Division of Environmental Science and Ecological Engineering, Korea University, Seoul, Republic of Korea.
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Udousoro I, Ikem A, Akinbo OT. Content and daily intake of essential and potentially toxic elements from dietary supplements marketed in Nigeria. J Food Compost Anal 2017. [DOI: 10.1016/j.jfca.2017.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Baars EW, Hamre HJ. Whole Medical Systems versus the System of Conventional Biomedicine: A Critical, Narrative Review of Similarities, Differences, and Factors That Promote the Integration Process. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2017; 2017:4904930. [PMID: 28785290 PMCID: PMC5530407 DOI: 10.1155/2017/4904930] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is an increasing need for a worldwide professional integration of conventional medicine and traditional/complementary whole medical systems (WMSs). However, the integration is perceived by conventional medicine as problematic or unacceptable, because of a supposed lack of evidence for specific effects of WMSs therapies and supposed prescientific or unscientific paradigms of WMSs. OBJECTIVES To review the literature on the features of WMSs, similarities and differences between conventional medicine and WMSs, and scientific and clinical practice issues that should be dealt with in order to promote the integration process. METHODS A critical, narrative review of the literature on six WMSs. RESULTS AND CONCLUSIONS Key factors for the integration of WMSs and conventional medicine are as follows: legal frameworks, quality standards, high-quality research on safety and efficacy of WMS interventions, infrastructure, and financial resources. For scientific assessment of WMSs, there are unresolved ontological, epistemological, and methodological issues and issues of diagnostics, therapy delivery, and outcome assessment in clinical practice. Future research not only should be directed at quality assurance and generating the necessary data on safety and efficacy/effectiveness but also should address more fundamental (ontological, epistemological, and methodological) issues, in order to overcome the differences between WMSs and conventional medicine.
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Affiliation(s)
- Erik W. Baars
- European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP), Zechenweg 6, 79111 Freiburg, Germany
- Louis Bolk Institute, Hoofdstraat 24, 3972 LA Driebergen, Netherlands
- University of Applied Sciences Leiden, Zernikedreef 11, 2333 CK Leiden, Netherlands
| | - Harald J. Hamre
- European Scientific Cooperative on Anthroposophic Medicinal Products (ESCAMP), Zechenweg 6, 79111 Freiburg, Germany
- Institute for Applied Epistemology and Medical Methodology, Witten/Herdecke University, Zechenweg 6, 79111 Freiburg, Germany
- Witten/Herdecke University, Gerhard-Kienle-Weg 4, 58313 Herdecke, Germany
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Godinho AF, de Souza RP, Anselmo F, Silva NCC. Cadmium and Caffeine in Coexposure but Not Alone, in Low Doses, Modulate Aggression Behavior in Rats. JOURNAL OF CAFFEINE RESEARCH 2017. [DOI: 10.1089/jcr.2016.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Antonio Francisco Godinho
- Center of Toxicological Assistance (CEATOX), Bioscience Institute, Paulista State University (UNESP), Botucatu, Brasil
| | - Renan Pereira de Souza
- Center of Toxicological Assistance (CEATOX), Bioscience Institute, Paulista State University (UNESP), Botucatu, Brasil
| | - Fabio Anselmo
- Center of Toxicological Assistance (CEATOX), Bioscience Institute, Paulista State University (UNESP), Botucatu, Brasil
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Barrella MV, Heringer OA, Cardoso PMM, Pimentel EF, Scherer R, Lenz D, Endringer DC. Metals Content in Herbal Supplements. Biol Trace Elem Res 2017; 175:488-494. [PMID: 27344673 DOI: 10.1007/s12011-016-0776-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
Obesity has become an international epidemic. To evaluate the level of metals in extracts of plants prescribed as weight loss supplements, different brands containing Camellia sinensis (L.) Kuntze, Citrus aurantium L., Cordia ecalyculata Vell, Ilex paraguariensis A. St.-Hil, Cissus quadrangularis L., Senna alexandrina Mill were purchased in local market, hot acid digested, and analyzed while metal content by inductively coupled plasma optical emission spectrometry, ICP-OES. Quality assurance and quality control tests were carried out in order to monitor and control the reliability of the analytical method. For each metal evaluated, a calibration curve was prepared with certified reference material. The recovery test was performed for each batch of samples. Analyses were performed in triplicate. Quantification of aluminum, barium, cadmium, cobalt, chromium, copper, iron, lithium, manganese, molybdenum, nickel, lead, vanadium, and zinc were determined. The metals most frequently detected were manganese (15.3-329,60 mg kg-1) aluminum (11.76-342.4 mg kg-1), and iron (11.14-73.01 mg kg-1) with higher levels in products containing C. sinensis China origin, I. paraguariensis Brazilian origin, C. quadrangularis, and C. aurantium China origin, respectively. To ensure safety consumption, an adequacy of the certification of Brazilian suppliers for herbal weight loss products is indispensable.
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Affiliation(s)
- Michelle Vieira Barrella
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil
| | - Otavio Arruda Heringer
- Tommasi Analítica, Av. Luciano das Neves, 2016, Divino Espirito Santo, Vila Velha, ES, Brazil
| | - Priscylla Maria Martins Cardoso
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil
| | - Elisangela Flavia Pimentel
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil
| | - Rodrigo Scherer
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil
| | - Dominik Lenz
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil
| | - Denise C Endringer
- Pharmacy Postgraduate Program, Vila Velha Universitys, Av. Comissário José Dantas de Melo, n°21, 29102-920 - Boa Vista, Vila Velha, ES, Brazil.
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Budnik LT, Baur X, Harth V, Hahn A. Alternative drugs go global: possible lead and/ or mercury intoxication from imported natural health products and a need for scientifically evaluated poisoning monitoring from environmental exposures. J Occup Med Toxicol 2016; 11:49. [PMID: 27833648 PMCID: PMC5101689 DOI: 10.1186/s12995-016-0139-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND With increases in globalization, cultural remedies from Chinese, Ayurvedic, Arab and other traditions have become more available to international consumers, offering unfamiliar "Natural Health Products" (NHP), used as alternative medicine or supplementary medicine. Contamination with toxic ingredients including lead, mercury, arsenic, and other toxic elements has been documented in several of these products from various parts of the globe, particularly from some parts of Asia and the Orient. FINDINGS We have been following this development in the last 6 years and have analyzed n = 20 such products (60 analyses) from patients with intoxication symptoms in a pilot study, showing alarming high concentrations of mercury and/or lead (the first one in "therapeutic" doses). 82 % of the studied NHP contained lead concentrations above the EU limit for dietary supplements. 62 % of the samples exceeded the limit values for mercury. Elevated blood lead and mercury levels in patients along with clinical intoxication symptoms corroborate the causal assumption of intoxication (s). We present one detailed clinical case report of severe lead and mercury intoxications and give an overview about blood concentration related symptoms and signs of n = 41 case reports of mercury intoxications of the German monitoring BfR-DocCenter. CONCLUSIONS For NHP there is evidence on a distinct toxicological risk with alarming low awareness for a possible intoxication which prevents potentially life-saving diagnostic steps in affected cases. In many cases patients do not communicate the events to their physicians or the local health authority so that case reports (e.g. the BfR-DocCentre) are missing. Thus, there is an urgent need to raise awareness and to initiate more suitable monitory systems (e.g. National Monitoring of Poisonings) and control practice protecting the public.
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Affiliation(s)
- Lygia Therese Budnik
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany
- Occupational Toxicology and Immunology, Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Marckmannstrasse 129 B, 20539 Hamburg, Germany
| | - Xaver Baur
- Charite Institute for Occupational Medicine (CIOM), Charite-University Medicine, Berlin, Germany
- European Society for Environmental and Occupational Medicine (EOM), Berlin, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Hahn
- Federal Institute for Risk Assessment (BfR), Berlin, Germany
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Raab A, Stiboller M, Gajdosechova Z, Nelson J, Feldmann J. Element content and daily intake from dietary supplements (nutraceuticals) based on algae, garlic, yeast fish and krill oils—Should consumers be worried? J Food Compost Anal 2016. [DOI: 10.1016/j.jfca.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Community acquired respiratory virus infections in cancer patients-Guideline on diagnosis and management by the Infectious Diseases Working Party of the German Society for haematology and Medical Oncology. Eur J Cancer 2016; 67:200-212. [PMID: 27681877 PMCID: PMC7125955 DOI: 10.1016/j.ejca.2016.08.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 01/11/2023]
Abstract
Background Community acquired viruses (CRVs) may cause severe disease in cancer patients. Thus, efforts should be made to diagnose CRV rapidly and manage CRV infections accordingly. Methods A panel of 18 clinicians from the Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology have convened to assess the available literature and provide recommendations on the management of CRV infections including influenza, respiratory syncytial virus, parainfluenza virus, human metapneumovirus and adenovirus. Results CRV infections in cancer patients may lead to pneumonia in approximately 30% of the cases, with an associated mortality of around 25%. For diagnosis of a CRV infection, combined nasal/throat swabs or washes/aspirates give the best results and nucleic acid amplification based-techniques (NAT) should be used to detect the pathogen. Hand hygiene, contact isolation and face masks have been shown to be of benefit as general infection management. Causal treatment can be given for influenza, using a neuraminidase inhibitor, and respiratory syncytial virus, using ribavirin in addition to intravenous immunoglobulins. Ribavirin has also been used to treat parainfluenza virus and human metapneumovirus, but data are inconclusive in this setting. Cidofovir is used to treat adenovirus pneumonitis. Conclusions CRV infections may pose a vital threat to patients with underlying malignancy. This guideline provides information on diagnosis and treatment to improve the outcome. Community acquired viral respiratory tract infections can be life-threatening in cancer patients. Respiratory virus infections need early and appropriate management to improve outcome and avoid outbreaks. This guideline summarises recommendations by the AGIHO on community acquired respiratory viruses in cancer patients.
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Knapik JJ, T Jean R, Austin KG, Steelman RA, Gannon J, Farina EK, Lieberman HR. Temporal trends in dietary supplement prescriptions of United States military service members suggest a decrease in pyridoxine and increase in vitamin D supplements from 2005 to 2013. Nutr Res 2016; 36:1140-1152. [PMID: 27865356 DOI: 10.1016/j.nutres.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 08/18/2016] [Accepted: 09/01/2016] [Indexed: 01/26/2023]
Abstract
Dietary supplements (DSs) can be obtained over-the-counter but can also be prescribed by health-care providers for therapeutic reasons. Few studies have documented this later source despite the fact that 79% of physicians and 82% of nurses have recommended DSs to patients. This investigation assessed prevalence and temporal trends in oral DS prescriptions filled by all United States service members (SMs) from 2005 to 2013 (n = 1 427 080 ± 22 139, mean ± standard deviation (SD)/y). We hypothesize that there would be temporal variations in specific types of DSs. Data obtained from Department of Defense Pharmacy Data Transaction System were grouped by American Hospital Formulary System pharmacologic-therapeutic classifications and prevalence examined over time. About 11% of SMs filled one or more DS prescriptions of 235 180 ± 4926 (mean ± SD) prescriptions/y over the 9-year period. Curve-fitting techniques indicated significant linear declines over time for multivitamins (P = .004), iron preparations (P < .001), antacids (P < .001), and vitamin B and B complex vitamins (P < .001). There were significant quadratic trends indicating a rise in early years followed by a leveling off in later years for replacement preparations (P < .001) and vitamin C (P < .001). There were significant quadratic trends (P < .001) for vitamin E indicating a decline in early years and leveling off in later years, and vitamin D indicating little change in early years followed by a large rise subsequently (P < .001). This study identified temporal trends in specific DS categories that may be associated with changing perceptions of prescribers and/or patients of the appropriate roles of DSs in medicine and public health.
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Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; US Army Public Health Center, Aberdeen Proving Ground, MD, 21010, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Rosenie T Jean
- Office of the US Army Surgeon's General, Pharmacovigilance Center, Falls Church, VA, 22041, USA.
| | - Krista G Austin
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Ryan A Steelman
- US Army Public Health Center, Aberdeen Proving Ground, MD, 21010, USA.
| | - Julia Gannon
- Office of the US Army Surgeon's General, Pharmacovigilance Center, Falls Church, VA, 22041, USA.
| | - Emily K Farina
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA; Oak Ridge Institute for Science and Education, Belcamp, MD, 21017, USA.
| | - Harris R Lieberman
- US Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA.
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Preconception Care: A New Standard of Care within Maternal Health Services. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6150976. [PMID: 27314031 PMCID: PMC4903143 DOI: 10.1155/2016/6150976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/18/2016] [Indexed: 12/13/2022]
Abstract
Emerging research suggests that much pediatric affliction has origins in the vulnerable phase of fetal development. Prenatal factors including deficiency of various nutrients and exposure to assorted toxicants are major etiological determinants of myriad obstetrical complications, pediatric chronic diseases, and perhaps some genetic mutations. With recent recognition that modifiable environmental determinants, rather than genetic predestination, are the etiological source of most chronic illness, modification of environmental factors prior to conception offers the possibility of precluding various mental and physical health conditions. Environmental and lifestyle modification through informed patient choice is possible but evidence confirms that, with little to no training in clinical nutrition, toxicology, or environmental exposures, most clinicians are ill-equipped to counsel patients about this important area. With the totality of available scientific evidence that now exists on the potential to modify disease-causing gestational determinants, failure to take necessary precautionary action may render members of the medical community collectively and individually culpable for preventable illness in children. We advocate for environmental health education of maternity health professionals and the widespread adoption and implementation of preconception care. This will necessitate the translation of emerging knowledge from recent research literature, to health professionals, to reproductive-aged women, and to society at large.
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