Treatment of hypertension with nutraceuticals, vitamins, antioxidants and minerals

Nutraceuticals: Transformation of Conventional Foods into Health Promoters/Disease Preventers and Safety Considerations

Nutraceuticals are essential food constituents that provide nutritional benefits as well as medicinal effects. The benefits of these foods are due to the presence of active compounds such as carotenoids, collagen hydrolysate, and dietary fibers. Nutraceuticals have been found to positively affect cardiovascular and immune system health and have a role in infection and cancer prevention. Nutraceuticals can be categorized into different classes based on their nature and mode of action. In this review, different classifications of nutraceuticals and their potential therapeutic activity, such as anti-cancer, antioxidant, anti-inflammatory and anti-lipid activity in disease will be reviewed. Moreover, the different mechanisms of action of these products, applications, and safety upon consumers including current trends and future prospect of nutraceuticals will be included.

Antihypertensive peptides of animal origin: A review

Many bioactive peptides trigger certain useful antihypertensive activities in the living body system and there is a mounting worldwide interest in the therapeutic potential of these bioactive peptides for exploitation in vivo against the hypertension. Studies suggest the antihypertensive properties for many bioactive peptides of animal origin with underlying mechanisms ranging from inhibition of angiotensin-converting enzyme to additional mechanisms to lower blood pressure such as opioid-like activities and mineral-binding and antithrombotic properties. Antihypertensive peptides are the most extensively studied of all the bioactivities induced by food protein hydrolysates, highlighting their importance in human health and disease prevention and treatment. There exist enormous opportunities for the production of novel peptide-based products in biopharmaceutical manufacturing industries for the treatment, prevention, and mitigation of hypertension. Numerous products have already struck on the global market and many more are in process. This article focuses on antihypertensive peptides identified in the meat, fish, blood, milk, dairy products, and egg and their probable application as novel ingredients in the development of functional food products as dietary treatment of hypertension.

Efficacy and Interaction of Antioxidant Supplements as Adjuvant Therapy in Cancer Treatment: A Systematic Review

Oxidative stress is a key component in carcinogenesis. Although radiation produces reactive oxygen species, some anticancer agents such as alkylating agents, platinum and antitumor antibiotics exert cytotoxicity by generating free radicals. Nonenzymatic exogenous antioxidants such as vitamins, minerals, and polyphenols can quench ROS activity. However, whether antioxidants alter antitumor effects during radiotherapy and some types of chemotherapy remains unclear. In the present study, we reviewed antioxidants as an adjuvant therapy for cancer patients during chemotherapy or radiotherapy. Electronic literature searches were performed to select all randomized controlled clinical trials (RCTs) in which antioxidants were administered to cancer patients along with chemotherapy or radiotherapy. Articles or abstracts written in English were included. In total, 399 reports received primary screening. Duplicated articles and those meeting the exclusion criteria (not RCT, not human, and no oral administration) were excluded. Finally, 49 reports matching the inclusion criteria were included. It was difficult to determine whether antioxidants affect treatment outcomes or whether antioxidants ameliorate adverse effects induced by chemotherapy and radiotherapy. It is desirable to use an evidence-based method to select supplements best suited to cancer patients. Although there are many opinions about risks or benefits of antioxidant supplementation, we could mostly conclude that the harm caused by antioxidant supplementation remains unclear for patients during cancer therapy, except for smokers undergoing radiotherapy.

Probiotics and blood pressure: current insights

Gut microbiota play a significant role in host metabolic processes, and recent metagenomic surveys have revealed that they are involved in host immune modulation and influence host development and physiology (organ development). Initially, probiotics are identified as potential therapeutics to treat gastrointestinal disorders and to revitalize the disturbed gut ecosystem. Currently, studies are exploring the potential for expanded uses of probiotics for improving the health conditions in metabolic disorders that increase the risk of developing cardiovascular diseases such as hypertension. Further investigations are required to evaluate targeted and effective use of the wide variety of probiotic strains in various metabolic disorders to improve the overall health status of the host. This review addresses the causes of hypertension and the hypotensive effect of probiotics, with a focus on their mechanistic action.

Mamao Pomace Extract Alleviates Hypertension and Oxidative Stress in Nitric Oxide Deficient Rats

Reactive oxygen species (ROS)-induced oxidative stress plays a major role in pathogenesis of hypertension. Antidesma thwaitesianum (local name: Mamao) is a tropical plant distributed in the tropical/subtropical areas of the world, including Thailand. Mamao pomace (MP), a by-product generated from Mamao fruits, contains large amounts of antioxidant polyphenolic compounds. The aim of this study was to investigate the antihypertensive and antioxidative effects of MP using hypertensive rats. For this purpose, male Sprague-Dawley rats were given Nω-nitro-L-arginine methyl ester (L-NAME), an inhibitor of endothelial nitric oxide synthase (eNOS), in drinking water (50 mg/kg) for three weeks. MP extract was orally administered daily at doses of 100 and 300 mg/kg. L-NAME administration induced marked increase in blood pressure, peripheral vascular resistance, and oxidative stress. MP treatment significantly prevented the increase in blood pressure, hindlimb blood flow and hindlimb vascular resistance of L-NAME treated hypertensive rats (p < 0.05). The antihypertensive effect of MP treatment was associated with suppression of superoxide production from carotid strips and also with an increase in eNOS protein expression and nitric oxide bioavailability. The present results provide evidence for the antihypertensive effect of MP and suggest that MP might be useful as a dietary supplement against hypertension.

Metabolic syndrome, aging and involvement of oxidative stress

The prevalence of the metabolic syndrome, a cluster of cardiovascular risk factors associated with obesity and insulin resistance, is dramatically increasing in Western and developing countries. This disorder consists of a cluster of metabolic conditions, such as hypertriglyceridemia, hyper-low-density lipoproteins, hypo-high-density lipoproteins, insulin resistance, abnormal glucose tolerance and hypertension, that-in combination with genetic susceptibility and abdominal obesity-are risk factors for type 2 diabetes, vascular inflammation, atherosclerosis, and renal, liver and heart diseases. One of the defects in metabolic syndrome and its associated diseases is excess of reactive oxygen species. Reactive oxygen species generated by mitochondria, or from other sites within or outside the cell, cause damage to mitochondrial components and initiate degradative processes. Such toxic reactions contribute significantly to the aging process. In this article we review current understandings of oxidative stress in metabolic syndrome related disease and its possible contribution to accelerated senescence.

Effects of coenzyme q10 supplementation on serum lipoproteins, plasma fibrinogen, and blood pressure in patients with hyperlipidemia and myocardial infarction

BACKGROUND

Low plasma concentrations of coenzyme Q10 (CoQ10) have been associated with concentration of lipoproteins and other factors contributing to coronary heart diseases.

OBJECTIVES

The present investigation aimed to improve the blood pressure and serum lipoproteins concentration in patients with myocardial infarction (MI) by CoQ10 supplementation.

PATIENTS AND METHODS

In this randomized double-blinded controlled clinical trial, 52 Iranian patients with hyperlipidemia and MI were recruited to examine the effect of CoQ10 on serum total cholesterol (TC), LDL-C, HDL-C, triglyceride (TG), LDL-C/HDL-C ratio, TC/HDL-C ratio, fibrinogen, systolic blood pressure (SBP) and diastolic blood pressure (DBP). Individuals were randomly allocated to two groups for receiving either 200 mg/d of CoQ10 or placebo for 12 weeks.

RESULTS

There were not significant differences in serum LDL-C (2.70 ± 0.31 vs. 2.70 ± 0.35 mmol/L), TC (4.47 ± 0.33 vs. 4.93 ± 0.57 mmol/L), TG (2.48 ± 0.12 vs. 2.25 ± 0.69 mmol/L), and fibrinogen (2.08 ± 0.99 vs. 38.7 ± 0.64 mg/dL) between CoQ10 and placebo groups. After 12 weeks, a significant enhancement in serum HDL-C (1.44 ± 0.18 vs. 1.14 ± 0.18 mmol/L) level was observed between groups after the supplementation (P < 0.001). A significant reduction of TC, LDL-C, and fibrinogen and a significant increase in HDL-C concentration was observed in CoQ10 group after intervention (P < 0.001). Our assessment demonstrated statistically significant differences between the two groups in SBP and DBP after intervention (P < 0.001). ANCOVA also revealed significant differences in the ratio of LDL-C/HDL-C and TC/HDL-C between the two groups (1.89 ± 0.42 vs. 2.39 ± 0.38, P = 0.002; and 3.2 ± 0.5 vs. 4.24 ± 0.66, P = 0.01, respectively). A significant reduction of LDL-C/HDL-C and TC/HDL-C was observed in CoQ10 group (P < 0.001).

CONCLUSIONS

Twelve-week supplementation with CoQ10 in patients with hyperlipidemia and MI can improve blood pressure, serum HDL-C as well as LDL-C/HDL-C and TC/HDL-C ratios; therefore, it might decrease the risk of frequent MI.

Moderation of hematological and plasma biochemical indices of sub-chronic salt-loaded rats by aqueous extract of the sclerotia of Pleurotus tuberregium (Fr) Sing's: implications for the reduction of cardiovascular risk

ETHNOPHARMACOLOGICAL RELEVANCE

The sclerotia of Pleurotus tuberregium are used in Southern Nigeria for the management of diabetes and hypertension, yet there is scarcity of information in the literature regarding the evaluation of the biochemical basis of its antihypertensive property, as well as the biochemical impact of its administration to the hypertensive. Thus, in this study, the ability of an aqueous extract of the sclerotia of Pleurotus tuberregium to moderate biochemical and hematological indices was investigated in normal and sub-chronic salt-loaded rats.

MATERIALS AND METHODS

The normal and treatment control groups received a diet consisting 100% of the commercial feed, while the test control, reference and test treatment groups received an 8% salt-loaded diet. The extract was orally administered daily at 100 and 200 mg/kg body weight; while the moduretics was administered at 1 mg/kg. The normal and test control groups received appropriate volumes of water by the same route.

RESULTS

On gas chromatographic analysis of the crude aqueous extract, 29 known flavonoids (mainly 47.71% kaempferol and 37.36% quercetin), four saponins (mainly 72.93% avenacin B1 and 26.80% avenacin A1), six hydroxycinnamic acid derivatives (mainly 57.57% p-coumaric and 42.10% caffeic acid), ten carotenoids (mainly 58.44% carotene and 28.16% lycopene) and seven phytosterols (mainly 98.16% sitosterol) were detected. Also detected were nine benzoic acid derivatives (mainly 44.19% ferulic acid and 25.92% rosmarinic acid), six lignans (mainly 70.88% galgravin and 22.69% retusin), three allicins (mainly 71.92% diallyl thiosulphinate and 23.68% methyl allyl thiosulphinate), seven glycosides (mainly 84.86% arbutin and 12.01% ouabain), 31 alkaloids (mainly 48.82% lupanine, 32.26% augustamine) and 24 terpenes (mainly 60.66% limonene and 6.52% geranyl acetate). Compared to test control, the treatment significantly, dose-dependently lowered (P < 0.05) the mean cell volume, atherogenic indices (cardiac risk ratio, atherogenic coefficient and atherogenic index of plasma), plasma alanine and aspartate transaminase activities, mean cell hemoglobin, sodium, bicarbonate, urea, blood urea nitrogen, triglyceride, total-, non-high density lipoprotein-, low density lipoprotein- and very low density lipoprotein cholesterol concentrations, and neutrophils, monocytes and platelets counts of the treated animals. However, it significantly, dose-dependently increased (P < 0.05) the hemoglobin concentration, mean cell hemoglobin, red cells and lymphocytes counts, plasma high density lipoprotein cholesterol, calcium, potassium, chloride, creatinine, albumin and total protein concentrations of the treated animals.

CONCLUSIONS

All these results support the use of the plant in traditional health care, for the management of hypertension, and highlight the cardio-protective potential of the sclerotia, whilst suggesting that its antihypertensive activity may be mediated through alteration of plasma levels of sodium and potassium, or increases in muscle tone brought about by changes in plasma calcium levels.

Nutrition and nutraceutical supplements for the treatment of hypertension: part I

Vascular biology, endothelial and vascular smooth muscle, and cardiac dysfunction play a primary role in the initiation and perpetuation of hypertension, cardiovascular disease, and target organ damage. Nutrient-gene interactions and epigenetics are predominant factors in promoting beneficial or detrimental effects in cardiovascular health and hypertension. Macronutrients and micronutrients may be able to prevent, control, or treat hypertension through numerous mechanisms related to vascular biology or other mechanisms. Oxidative stress, inflammation, and autoimmune dysfunction are some of the primary factors that initiate and propagate hypertension and cardiovascular disease. The literature suggests that there may be a complementary role of single and component nutraceutical supplements, vitamins, antioxidants, and minerals in the treatment of hypertension when combined with optimal nutrition and other lifestyle modifications. However, many of these studies are small and do not have long-term follow-up for efficacy and safety. The role of these nutrition and nutraceutical supplements will require careful review and additional studies to determine their exact role in the management of hypertension.

The essentials of essential fatty acids

All fats, including saturated fatty acids, have important roles in the body. However, the most important fats are those that the body cannot make and thus must come from the food we eat. These essential fatty acids (EFAs) are based on linoleic acid (omega-6 group) and alpha-linolenic acid (omega-3 group). We need both groups of essential fatty acids to survive. For various reasons EFA deficiency is common in the general population, as is a disproportionate intake of omega-6 fatty acids over omega-3 fatty acids. As such, it is important to eat the right foods to make sure that you're taking in enough and the right kinds of the essential fatty acids. However, there is much more to the story. Studies have shown that increasing the intake of certain essential fatty acids, either alone or in combination with other fats and compounds, can increase health, help in treating certain diseases, and even improve body composition, mental and physical performance.

Effect of aqueous extract of the leaves of Acalypha wilkesiana 'Godseffiana' Muell Arg (Euphorbiaceae) on the hematology, plasma biochemistry and ocular indices of oxidative stress in alloxan induced diabetic rats

ETHNOPHARMACOLOGICAL RELEVANCE

The leaves of Acalypha wilkesiana are used in Southern Nigeria for the management of hypertension and diabetes mellitus. In this study, the effect of aqueous extract of the leaves of Acalypha wilkesiana on the hematology, plasma biochemistry and ocular indices of oxidative stress was investigated in alloxan induced diabetic rats.

METHODOLOGY

Diabetes mellitus was induced by injection of alloxan (80 mg/kg body weight), via the tail vein. The extract was administered orally at 100, 200 and 300 mg/kg (both to normal and diabetic rats), and metformin at 50mg/kg.

RESULTS

On gas chromatographic analysis of the extract, twenty nine known flavonoids were detected, consisting mainly of 29.77% apigenin, 14.97% quercetin, 11.12% naringenin, 10.62% kaempferol, 9.05% (-)-epicatechin and 4.04% (+)-catechin. Tannic acid and β-sitosterol were also detected. Compared to test control, the treatment lowered (significantly, P < 0.05) plasma glucose, triglyceride, conjugated bilirubin levels, atherogenic index of plasma, plasma alanine transaminase activity, total protein and total bilirubin, aspartate transaminase activity and unconjugated bilirubin, plasma urea, blood urea nitrogen and ocular malondialdehyde contents, lymphocyte and monocyte counts, and not significantly, plasma very low density lipoprotein cholesterol, but increased (significantly, P < 0.05) plasma calcium contents, total white cell and platelet counts, mean cell volume and ocular ascorbic acid content, and (though not significantly) plasma high density lipoprotein cholesterol level, red cell and neutrophil counts.

CONCLUSIONS

This study showed that the extract was hypoglycemic, positively affected the hemopoietic system and integrity and function (dose dependently) of the liver and kidney of the diabetic rats; improved the lipid profile and had no deleterious effect on red cell morphology. It also protected against oxidative stress in ocular tissues. This study also revealed the presence of pharmacologically active compounds in the leaf extract. All of these highlights the cardioprotective potential of the leaves of Acalypha wilkesiana and support its use in traditional health practices for the management of diabetes mellitus.

IPP-rich milk protein hydrolysate lowers blood pressure in subjects with stage 1 hypertension, a randomized controlled trial

BACKGROUND

Milk derived peptides have been identified as potential antihypertensive agents. The primary objective was to investigate the effectiveness of IPP-rich milk protein hydrolysates (MPH) on reducing blood pressure (BP) as well as to investigate safety parameters and tolerability. The secondary objective was to confirm or falsify ACE inhibition as the mechanism underlying BP reductions by measuring plasma renin activity and angiotensin I and II.

METHODS

We conducted a randomized, placebo-controlled, double blind, crossover study including 70 Caucasian subjects with prehypertension or stage 1 hypertension. Study treatments consisted of daily consumption of two capsules MPH1 (each containing 7.5 mg Isoleucine-Proline-Proline; IPP), MPH2 (each containing 6.6 mg Methionine-Alanine-Proline, 2.3 mg Leucine-Proline-Proline, 1.8 mg IPP), or placebo (containing cellulose) for 4 weeks.

RESULTS

In subjects with stage 1 hypertension, MPH1 lowered systolic BP by 3.8 mm Hg (P = 0.0080) and diastolic BP by 2.3 mm Hg (P = 0.0065) compared with placebo. In prehypertensive subjects, the differences in BP between MPH1 and placebo were not significant. MPH2 did not change BP significantly compared with placebo in stage I hypertensive or prehypertensive subjects. Intake of MPHs was well tolerated and safe. No treatment differences in hematology, clinical laboratory parameters or adverse effects were observed. No significant differences between MPHs and placebo were found in plasma renin activity, or angiotensin I and II.

CONCLUSIONS

MPH1, containing IPP and no minerals, exerts clinically relevant BP lowering effects in subjects with stage 1 hypertension. It may be included in lifestyle changes aiming to prevent or reduce high BP.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00471263.

Nutrition and nutraceutical supplements in the treatment of hypertension

Macronutrient and micronutrient deficiencies are very common in the general population, and may be even more common in patients with hypertension and cardiovascular disease due to genetic and environmental causes, and prescription drug use. Vascular biology assumes a pivotal role in the initiation and perpetuation of hypertension and target organ damage sequelae. Endothelial activation, oxidative stress and vascular smooth muscle dysfunction (hypertrophy, hyperplasia and remodeling) are initial events that initiate hypertension. Nutrient-gene interactions determine a broad array of phenotypic consequences such as vascular problems and hypertension. Optimal nutrition, nutraceuticals, vitamins, antioxidants, minerals, weight loss, exercise, smoking cessation, and moderate restriction of alcohol and caffeine, in addition to other lifestyle modifications, can prevent, delay the onset, reduce the severity, treat and control hypertension in many patients. An integrative approach combining these lifestyle suggestions with the correct pharmacologic treatment will best achieve new goal blood pressure levels, reduce cardiovascular risk factors, improve vascular health, reduce target organ damage, including coronary heart disease, stroke, congestive heart failure and renal disease, and reduce healthcare expenditure. The expanded scientific roles for nutraceutical supplements will be discussed in relation to the prevention and treatment of essential hypertension and cardiovascular diseases.

The role of cellular micronutrient analysis, nutraceuticals, vitamins, antioxidants and minerals in the prevention and treatment of hypertension and cardiovascular disease

Macronutrient and micronutrient deficiencies are very common in the general population and may be even more common in patients with hypertension and cardiovascular disease due to genetic, environmental causes and prescription drug use. The Hypertension Institute in Nashville, TN, has evaluated micronutrient deficiencies and oxidation status, in a group of hypertensive versus normotensive patients. There are significant differences in numerous intracellular micronutrients and oxidation status between these two groups. Replacement of the micronutrient deficiencies, as well as high-dose therapy of selected nutraceuticals in combination with optimal diet, exercise and weight management resulted in control of blood pressure to goal levels in 62% of the hypertensive population (as defined by JNC 7) over a period of 6 months with complete tapering and discontinuation of antihypertensive drugs. These deficiencies will have an enormous impact on present and future cardiovascular health and outcomes such as hypertension, myocardial infarction, stroke and renal disease and overall health costs. It is estimated that the annual savings in drug costs alone for the treatment of hypertension could be as much as US$10 billion. Diagnosis and treatment of these nutrient deficiencies and improvement in oxidation status using functional intracellular assessments will reduce blood pressure, improve vascular health, endothelial dysfunction, vascular biology and cardiovascular events. Vascular biology assumes a pivotal role in the initiation and perpetuation of hypertension and target organ damage sequelae. Endothelial activation, oxidative stress, inflammation and vascular smooth muscle dysfunction are initial events that start hypertension. Nutrient-gene interactions determine a broad array of phenotypic consequences such as vascular problems and hypertension. Optimal nutrition, nutraceuticals, vitamins, antioxidants, minerals, weight loss, exercise, smoking cessation and moderate restriction of alcohol and caffeine in addition to other lifestyle modifications can prevent and control hypertension in many patients. An integrative approach combining these lifestyle suggestions with the correct pharmacologic treatment will best achieve new goal blood pressure levels, reduce cardiovascular risk factors, improve vascular biology and vascular health, reduce cardiovascular target organ damage and reduce healthcare expenditure. The expanded scientific roles for nutraceutical supplements are discussed in relation to the prevention and treatment of essential hypertension and cardiovascular diseases with emphasis on mechanisms of action and clinical integration with drug therapy with hypertension guidelines. It is the purpose of this paper to review only the hypertension clinical trials that have evaluated the clinical use and efficacy of nutrition, weight loss, exercise and selected nutritional supplements, vitamins, minerals and antioxidants. Numerous clinical trials have evaluated the use of nutritional supplements such as beta carotene, selenium, vitamin C and vitamin E in the prevention of coronary heart disease and stroke yielding conflicting results (positive, neutral and negative). In many of these clinical trials there are enormous clinical design problems, methodologic flaws, varied patient population, variable dose and type of vitamin use, improper selection of vitamin used and many other issues that make the studies difficult to interpret. It is beyond the scope of this paper to review these trials. The reader is referred to the vast literature on this subject.

Hypertensive status and lipoprotein oxidation in an elderly population at high cardiovascular risk

BACKGROUND

In elderly individuals, hypertension is a main risk factor for cardiovascular disease and oxidative damage is increased. Our aim was to assess the relationship between the degree of in vivo low-density lipoprotein (oxLDL) oxidation and the hypertensive status in a elderly population at high cardiovascular risk.

METHODS

Cross-sectional study with baseline data from the PREDIMED (PREvención con DIeta MEDiterránea) trial, an intervention study directed at testing the efficacy of the Mediterranean diet on the primary prevention of cardiovascular disease. Participants were 1,130 subjects at high cardiovascular risk aged 55-80. At baseline, in vivo circulating oxLDL was measured, and stages of hypertension determined according to the USA Joint National Committee guidelines.

RESULTS

A positive relationship between in vivo oxLDL and systolic and diastolic blood pressure (DBP) was observed after adjusting for confounding factors (P < 0.05). OxLDL concentrations increased in a linear manner from low to high hypertensive stages (P < 0.05).

CONCLUSIONS

Elderly individuals at high cardiovascular risk showed higher levels of circulating oxLDL when their hypertensive status increased. This fact identifies the hypertensive elderly population as a target for antioxidant preventive measures.

Lactotripeptides and antihypertensive effects: a critical review

Hypertension or high blood pressure is a significant health problem worldwide. Typically, lifestyle changes, including adopting a healthy diet, are recommended for people with an elevated blood pressure. Lactotripeptides are bioactive milk peptides with potential antihypertensive properties in man. These peptides, as part of a food product or as nutraceutical, may contribute to the prevention and treatment of hypertension. This paper reviews the current evidence of the blood pressure control properties of lactotripeptides in man. Blood pressure-lowering effects of lactotripeptides are typically measured after 4-6 weeks of treatment. However, in some cases, a blood pressure response has been observed after 1-2 weeks. Maximum blood pressure reductions approximate 13 mmHg (systolic blood pressure) and 8 mmHg (diastolic blood pressure) after active treatment compared with placebo, and are likely reached after 8-12 weeks of treatment. Effective dosages of lactotripeptides range from 3.07 to 52.5 mg/d. Evidence indicates that lactotripeptides are only effective at elevated blood pressure; no further lowering of normal blood pressure has been observed. Concomitant intake of antihypertensive medication does not seem to influence the potency of lactotripeptides to lower blood pressure. Similarly, ethnicity has not been found to influence the extent of lactotripeptide-induced blood pressure lowering. Based on the currently available data, lactotripeptides appear to be safe and effective. Thus, they can be part of a healthy diet and lifestyle to prevent or reduce high blood pressure.

Preparation of botanical samples for biomedical research

Plants are chemical storehouses, a fact which has driven countless multidisciplinary quests for bioactive compounds. As the very first step of botanical research, the whole desire is to find "hit" plants with specific bioactivities. It is logical to use some strategies that can maximize the chances of finding these "hits" with limited time and resources. In addition to selecting the right plants for screening, how the plant extracts are prepared can also influence the bioactivity screening outcomes. An extract from the same plant material can be quite different in chemical composition having different preparations. Because of the complex mixture nature of plant extracts, it is possible artifact activities may be observed. Thus confirmatory activity tests are often necessary to warrant the next laborious isolation step. A bioassay directed isolation approach may be the most efficient in identifying the bioactive compounds because of the narrowed focus at each isolation step, but a phytochemistry isolation approach is appropriate to characterize a purified bioactive extract. In fact, these two approaches can be taken intermittently whenever efficiency can be improved. Finally, use of the identified active compounds is now broader. In addition to determining a lead compound to continue a drug development path, there is an increasing interest in support for the use of botanical extracts as botanical drugs. Instead of dropping the extract after extracting the lead compound, the natural analogues representing the purified extract now have a chance to become leading compounds in the pursuit of novel therapies for metabolic syndrome and other diseases.