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Transcript
21. Supplements &
Herbal Remedies
supplementary
ie. not in text
Working Definition
• A dietary supplement is “a product taken
by mouth that contains a dietary
ingredient” intended to supplement the
diet.
• Includes vitamins, minerals, herbs or other
botanicals, amino acids, enzymes, tissues
from animal organs or glands, or a
concentrate, metabolite or extract
Vitamin and mineral supplements
• Necessity or a waste of money??
• What do you think
• (i) absolutely necessary (ii) in some dcases
useful (iii) waste of my $
Herbal Remedies/Medicines - Food or Drugs?
"Been around for centuries with no reported problems.
Should be treated like foods, ie. don't need labels,
tests or restrictions on claims. Give me easy access
and keep the price down." say proponents(and the
producers).
"They contain many potent ingredients. Need lots of
tests, warning labels, no unproven claims" say some
pharmacists and medical professionals (and the drug
companies).
The Rest of the
World Knows
Chinese herbal medicine
has been practiced pre 0 AD.
In countries of the EU some
herbal remedies are covered/
prescribed by government
health plans.
Since '78, Germany's Commission E (scientists &
health pros) have researched 'herbals' (usefulness
& safety); ~200 of 300 have been OK'd.
Companies have 2-4 yrs to 'prove their claims'.
… and North America catches up
USA, 1994 - vitamins/minerals/supplements become
in between foods & drugs; many 'hormones' are
OTC; benefit claims are eased; little 'quality
control'; prices drop; users are happy; but …….
Canada, 1997- started 'thinking about it'; has Office
of Natural Health Products and advisory panel
to gov't Health Committee; 'promising' new and
comprehensive regulations since 2002
www.hc-sc.gc > A-Z index > Natural Health Products
Where do supplements fit in?
• Categorized within “foods” not drugs, thus
less rigorous regulation
• Manufacturers must demonstrate safety
• No rules re: amounts or daily values
• Must list all ingredients
• Some substantiation of benefits needed
The Practitioners - Understand
Herbalist - completely unregulated; can get referrals to
persons with some courses/experience
Nutritionist - regulated in QC, BC, NS; many are
registered dietitians(RD/RDN, with Dietitians of
Canada); bachelors degree in nutrition + intern
Naturopathic Doctor(ND) - use a variety of 'alternative
therapies'; regulated in BC, MB, ON, SK(AB&NB);
should have 4yr program after bachelors; check
credentials
Pharmacist - 4/5yrs B.Pharm. + experience(front line);
but only relevant courses since ~'95
Conventional + Alternative
= Complementary
Complementary Physician
often Family Medicine(MD)
(bachelor + 4yrs + 1yr resid.
+ 2yrs specialization);
- many 'not on lists‘.!
Don't self-diagnose! Many 'alternative practitioners'
also do not have much diagnostic training/experience.
Also a certain number of ‘conventional’ doctors are not
interested in/ knowledgeable about alternates, but……
Qualified Advice - Seek It
For all types of info’ see:
www.canadian-health-network.ca
Canadian College of Naturopathic Medicine,
1255 Sheppard Av.,(East)
www.ccnm.edu
North York, ON, M2K 1E2
1-866-241-2266
Dietitians of Canada,
480 University Av, Suite 604,
Toronto, ON, M5G 1V2
www.dietitians.ca
(416) 596-0857
Canadian Natural Health Assoc.,
439 Wellington St., Suite 5, www.natural-health.org
Toronto, ON, M5V 1E7
(416) 977-2642
More …
Canadian Naturopathic Assoc.,
(see: Can. Coll. of Natur. Med.),
1-800-551-4381
www.naturopathicassoc.ca
Canadian Assoc. of Herbal Practitioners,
1228 Kensington Rd., Apt. 400,
Calgary, AB, T2N 4P9
(403) 270-0936
National Institute of Nutrition,
408 Queen St.(3rd floor),
Ottawa, ON, K1R 5A7
www.nin.ca
(613) 235-3355
Canadian Complementary Medicine Assoc.,
8621 104th St., Edmonton,
AB, T6E 4G6
(403) 433-7401
The DIN = Drug Identification Number
In Canada all OTC and prescription drugs, including
vitamins & minerals, must show on the label:
a) expiry date, b) amt of active ingredient, c) DIN
which indicates approval by Health Canada based
upon extensive tests of effectiveness and safety.
Traditional herbal medicines(THMs) also can have a
DIN based on historical support by 2 recognized
herbal compendia and no requirement for proof of
safety or efficacy.
An Informative Label - or Ignore
Directions
Expiry date
Unit weight
Other
Ingredients
DIN
Active
Ingredients
Plus: a 'function' claim; address / telephone #
Active ingredient GLA
• Gamma Linolenic acid (an essential fatty
acid)
• Present in corn oil, olive oil
• A polyunsaturated C18 Fatty acid
Structure of GLA
• An omega-3 and an omega-6 PUFA (p.
369 text)
Would you buy evening primrose
oil?
• Yes, no , maybe?
What the Mayo Clinic says
• “high quality evidence for its use in most
conditions is still lacking”
Marketing Hype
- Beware!
Clinically Proven
Quality Extract
Guaranteed Potency
Essential
Naturally Occurring
Pure
Highly Concentrated
Maximum Absorption
Special Extract
Scientifically Standardized
Nutritionally Comprehensive
Independent testing
often indicates up to
30% of products contain
little(or no) 'active'
ingredients, especially
in USA.
Reliable Info - It's a Jungle out There!
The Healing Power of Vitamins, Minerals and Herbs'
by Reader's Digest('99); consult. ed. Joe Schwarcz
(ISBN 0-88850-678-3)
Some interesting health-related websites
with lots of archived info and useful web links:
1) www.wellnessletter.com(articles on >70 'herbs')
2) www.tvo.org/yourhealth
3) www.cbc.ca >television>newsworld>healthmatters
Also
4) www.canoe.ca/HealthHerbal
Supplements - a Growing Market
In Canada(2007) - $4 billion and growing at ~20%/yr;
40% vitamins, 20% minerals, 20% herbs, 20% others
Out-of-control in some areas, eg. see
KidzHerbs (for ages 4 and up)
Time Out/ Sweet Lullaby -"to sleep/relax naturally",
contains St. John's wort
Straight A's - "helps children think straight"
contains ginkgo/ginseng
Allergy Schmallergy - "to help with allergies"
contains echinacea
also available in lollipops for your lunch!
OTHERS not Vitamins,
Minerals, Herbs
Acidophilus, bee products(pollen, royal jelly),
carotenoids, coenzyme Q, creatine, DHEA & other
steroids, evening primrose & other lipoic acids, fish
oils, flaxseed, glucosamine, HGH(human growth
hormone), 5-HTP(hydroxy tryptophan) & other amino
acids, kelp, soy isoflavonoids, shark cartilage
DHEA - the
'Precursor' Hormone
Dihydroepiandrosterone conc'n drops to ~10% by
age 70
Ads: build muscle,  immune system,  cell damage,
relieve stress, reduce fat.
Known: rats don't have much and human trials very
inconclusive. Prescription only in Canada but OTC
in USA. No quality control. Side effects, especially
in women when used in excess.
Avoid
Melatonin - the
'Fountain of Youth'?
From pineal gland;
regulates body
'biorhythms';
conc’n. with age.
Ads: anti-aging, sleep control, boosts immune
system, reduces oxidative cell damage.
Known: seems to be effective for 'jet-lag', may
assist
drugs against cancer, vascular damage,
Parkinsons. No apparent side effects. OTC in
USA, prescription in Canada.
Ponce de Leon ?
Glucosamine it's 'Natural'!
Produced in joints as
'precursor' for cartilage
repair
Ads: move again without pain
Known: prescribed in Europe for arthritis relief; slows
cartilage deterioration; relieves joint pain; no
known serious side effects.
It may work for you, try it but inform your doctor; some
people need >1g (!) for 'relief'
Herbal Remedies
- Remember
These materials contain physiologically active
compounds not all of which are known. They are not
patentable so there is no incentive by the suppliers to
do research. Because of their great popularity there
will be good 'studies' over time mainly from medical
schools.
Meanwhile >>>
Herbal Remedies some Observations
• can't cure; only alleviate
chronic conditions;
NB. frequent use of
'minor effect' and 'may help'
• be aware of 'side effects‘
• avoid if there are 'special conditions', eg. pregnancy
• avoid excess dosages and long duration
• the species and parts of plant are important
• there are many serious interactions with
conventional medicines
• keep up-to-date
'Herbals' - Something
for Everyone
A cornucopia! 121 listings in:
Tyler's Honest Herbal: A Sensible Guide to the Use
of Herbs and Related Remedies (4th ed),
Steven Foster & Varro Tyler
Tyler's Herbs of Choice: The Therapeutic Use of
Phytomedicines,
J. Roberts & V. Tyler
~ the Top Ten(2000) in the USA
Aloe Vera(external) - exudate/
gel from leaves, great for
minor skin problems;
Aloe latex (internal) juice of crushed leaves,
possible 'digestive aid‘
(cramps for many!)
Cranberry - minor urinary tract infections, especially
women; recommended 16 oz/day of undiluted
juice(~3000 berries!)
Echinacea - immune booster  don't take constantly;
tincture loses potency more quickly
but is more effective
Echinacea only 3(of 9) species
………..angustifolia
.……….pallida
………. purpurea
Purple Coneflower
the Top Ten–
(continued)
Garlic - blood thinner; may
cholesterol; 'fights' minor
infections; it's the sulfur
compounds that do it so
raw is best ! Worshipped
by the Egyptians and used
by pyramid builders for strength/endurance.
Ephedra(Ma Huang) - contains ephedrine(adrenaline –
like)  for bronchial problems (used in China
since 3000BC); potent stimulant, blood
pressure(weight loss?); abused in US(28 deaths
in '98), illegally peddled in fitness centres. Avoid it!
Garlic in 4 thieves vinegar
• ~1720 Marseilles. Plague killed ~60% of
population
• 4 thieves robbed the dying, but did not get
ill (boosted immune system?)
• Rubbed their bodies with mixture of cider
vinegar and garlic
• “le vinaigre des quatre voleurs”
4 thieves vinegar
• Available in California
the Top Ten - more
Ginkgo - aids memory loss in elderly(increase blood
flow to the CNS); maybe helps general circulatory
disorders BUT doesn't make you smarter
Ginseng(panax) - immuno stimulant; affects pituitary/
adrenal glands  anti-stress(?); OTC 'tonics'
contain more alcohol than ginseng
Goldenseal - immuno stimulant + antibiotic qualities
(sinus infections, nausea, warts, cold sores/
shingles); 'single' applications not prolonged use
Saw palmetto - fatty acids/phytosterols; relieves
prostate enlargement and urinary problems.
Truth: does not solve prostate problems!
Supplements+
Drug=Complications
Anticoagulants : avoid before surgery :
gingko biloba !!!
Antidepressants - ephedra, ginseng, kava,
melatonin, St. John's wort
Antihypertensives - ephedra, garlic,
ginseng, goldenseal, hawthorn, licorice
Diuretics - aloe vera, dandelion, ephedra, ginseng,
glucosamine, hawthorn, licorice
The Latest trends:some dangerous))
Kava kava - ceremonial/social drink in S. Pacific;
trendy anti-stress remedy (sedative, muscle
relaxant, intoxicant); skin problems;
St. John's wort - for mild (NOT major) depression;
some side effects (sun sensitivity); many active
compounds; with care!
More 'New' Finds
Grape seed extract - popular in Europe;
potent antioxidant(proanthocyanidins/pycnogenols or PCOs);
potential against cardiovascular degeneration; also
rheumatoid arthritis, allergies; no side effects;
reduces computer eye-strain!
Soy isoflavones - phytoestrogens, ie. anti cancer
properties, LDL reducers; get 100mg/day flavones
in 3 'servings' of soy products. Tofu everyone!
Recent rulings/results
Kava/kava – banned in
Germany, Canada, Singapore.
Implicated in liver damage.
Ephedra – Banned in USA 2004
Increasing implications
for heart attacks/strokes. HC
issued ‘voluntary recall’ 2002 .
St. John’s wort – NIH(US) study(double blind) found
no more effective than placebo for major depression.
Ginkgo – study in JAMA(US) found no measurable
memory improvement.
Stay tuned !
2008 Warning
• More than 60 incidents including strokes,
heart attacks, irregular heart beat, seizures
in Canada last year from ephedra use
Miracle supplements!!
• “Can you imagine developing a compound
which actually addresses the core reason
why we gain weight, become diabetic, feel
exhausted or prematurely old? Leading
scientists at the U. of Toronto have made
what may be one of the greatest
discoveries of our time”
PGX (PolyglycopleX)
• You could feel good about eating again!
• Non habit forming!
• Stimulant free!
Globe & Mail Ad. March 22/08
•
•
•
•
PGX –will change your life!
A unique combination of natural fibres
Will prevent or correct “insulin resistence”
Once blood sugar is under control, no
messages sent out from the brain
How does this work?
• PGX “reduces the glycemic index of food”
• Brings erratic and uncontrolled blood
sugar levels back under control
Glycemic Index
• Measures the potential foods to raise blood
glucose levels, which in turn trigger a
release of insulin, which then may be
followed by a dramatic decrease in blood
glucose
• All carbohydrates are not created equal!!
Factors affecting the Glycemic
Index
• Type of carbohydrate (simple or complex)
• Method of preparation
• Fat and fibre content
Scale of Glycemic Index
•
•
•
•
55 or less (low)
55-70 (moderate)
Above 70 (high)
Sucrose is 65, white bread is 71
Some generalities
• All vegetables and beans are very low (~15)
• Bakery products such as donuts are high
• Breads vary greatly; multi-grain and high grain
are low, white bread baguette is high (95)
• Cereals such as bran, oat bran, muesli are lowmedium; rice krispies, corn flakes are high
• Pasta is low; rice is high
• Peanuts are low; dates are high
• Milk is low; ice cream is high
White bread vs. whole grain bread
• Same caloric value, but white has high GI
vs. low for whole wheat
• Difference: whole wheat contains more
soluble fibre!
What is important
• Consider the whole meal, rather than the
GI of individual foods (too complicated)
• Beans, lentils, fresh vegetables, whole
wheat bread are all good choices
• Imp. for diabetics
• Still controversial: concepts too “complex”
• Glycemic load= amount of carbohydrate x
GI
A balanced diet
• Use food with low or medium glycemic
index
• Eat regularly
• Lots of fruits, vegetables, grains and
legumes
Causes of Insulin resistance
• Poor eating habits!
• Genetic disposition
• Result: blood sugar levels spike and fall
• Type II diabetes looms
What is in PGX that makes it work?
• “Natural factors”-actually Soluble fibre:
swells up when water present: gives full
feeling
• Take at mealtime with plenty of water
• Soluble fibre long known to be beneficial
• “Gramma called it Roughage” Fibre facts
and Fallacies, Robert L.Orey (1991)ACS
Soluble fibre and glucose levels
• It is known that soluble fibre dissolves 20200x its weight in water and becomes a
viscous gel.
• Nutrients can be trapped inside the gel and
are “shielded from the digestive enzymes”
• Thus sugar is absorbed into the
bloodstream more slowly, preventing
spikes in glucose levels
Soluble fibre chemically
• Consists of pectins, hemicelluloses and
gums
• Highly viscous in water
Solid Science
• It appears that the science behind PGX is
solid
• Just a question of $ and convenience
Soluble fibre in common foods
• Apples! (1 per day!)
• Raisins, figs, prunes, blueberries, oats,
dried beans, peas, citrus fruits
Your choice
• PGX powder, tablets, granules to be
sprinkled on cereal ($31.99+ tax for 120
tablets), PGX “shakes”
• Fresh or dried fruit on a daily basis
Weight loss supplements
•
•
•
•
Who is most likely to use them?
Women vs men?
Age profile?
Are they dangerous?
The findings
•
•
•
•
~15 % of adults per year use them
Women are 2x as likely as men to try them
Highest use among ages 18-34
Some are definitely dangerous
Hydroxycut
• “burns fat, builds muscles,and dramatically
boost metabolism”
• Findings: it does none of the above
• 23 reports of serious illness in users-1 death,
seizures, hepatitis & other liver damage
• FDA warning out-manufacturer withdrew a
long list of weight loss products from the
market
Hydroxycut-withdrawn form
market June 2009
Weight loss aids
• Often herbal and include ephedra
• 1994 law in USA deregulated supplements
• No Canadian regulations either
• Public is asking for reforms to “protect”
consumers
Summary on Supplements
• Univ.California “Wellness letter” July
2009
• In general, be skeptical about claims
• Legitimate use of fish oils for those with
heart disease; Vit D for all; Calcium for
postmenopausal women; folic acid for
pregnant women-reduces risk of
spinabifida and neural tube disorders
(NTD’s) in newborns;
New Products on the market!
• Belllifestyle ad (Ottawa Citizen 22/6/09)
• “Master Herbalist” cures for just about
everything
• Anxiety, stress, chronic fatigue, depressed
moods, eating disorders –use #66
“Calming chronic Stress”
• Etc,etc….BEWARE..no documented proof
Other Belllife herbals
Also “cures” for
• Skin disorders, hearing loss, cancer,
chronic nerve pain, arthritis( use shark
cartilage), incontinence, loss of virility
(men), loss of desire (women), high
cholesterol, migraines, snoring, sleep
apnea, allergies, high blood pressure,
carpal tunnel syndrome
• WOW!!!
Use of Multivitamins
• As “insurance policy” for general
population
• Highly recommended for expectant
mothers-June 2009 study shows
multivitamins aid infant birth weight
10 foods to consume AOAP
•
•
•
•
•
•
•
•
•
•
Salmon
Yogurt (probiotic)
Skim milk
Spinach
Carrots
Whole grains (bran, oats)
Legumes (beans, chickpeas etc)
Blueberries
Almonds
Broccholi
Mayo Clinic’s list
• Almonds, Apples, blueberries, Broccoli,
red beans, salmon,spinach, sweet potatoes,
vegetable juices, wheat germ
Food safety
•
•
•
•
Bacterial contamination is most dangerous
Listeria outbreak-August 2008
Maple Leaf foods Toronto
Symptoms of Listeriosis: fever, chills,
nausea, diarrhea, headaches-can be lethal
in people with compromised immune
systems (elderly,pregnant women etc)
Minimizing risk from Listeria
Avoid: soft cheeses, smoked fish, all deli
meats, raw milk
Heating kills it-pasteurization of milk,
cooking meats thoroughly
Keep food out of the danger zone (4-60oC).
Sources of Listeria
• From uncooked fruits and vegetables
• Soil,water, sewage, silage,human and
animal feces
• Many people carry it without getting ill
• Onset of illness can be from 12 hours to 3
months after infection
• More dangerous than salmonella
Sept 6, 2008: source identified
2 Meat slicing machines in processing
plant
Typical of this bacteria-can hide in “nooks
and crannies” of equipment
19 deaths in Canada
Prime Minister orders “public inquiry”
Another case for food irradiation!
• Would kill Listeria !!
End of course!!!
• Review next class
• evaluations