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

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'.

Chinese herbal medicine has been practiced pre 0 AD.

In countries of the EU some herbal remedies are covered/

prescribed by government health plans.

… 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 - UnderstandHerbalist - 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

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……

Complementary Physician often Family Medicine(MD) (bachelor + 4yrs + 1yr resid.

+ 2yrs specialization);

- many 'not on lists‘.!

Qualified Advice - Seek It

Canadian Natural Health Assoc., 439 Wellington St., Suite 5, www.natural-health.org

Toronto, ON, M5V 1E7 (416) 977-2642

Dietitians of Canada, 480 University Av, Suite 604, www.dietitians.ca

Toronto, ON, M5G 1V2 (416) 596-0857

Canadian College of Naturopathic Medicine, 1255 Sheppard Av.,(East) www.ccnm.edu North York, ON, M2K 1E2 1-866-241-2266

For all types of info’ see:

www.canadian-health-network.ca

More …

Canadian Naturopathic Assoc., (see: Can. Coll. of Natur. Med.), 1-800-551-4381

www.naturopathicassoc.ca

National Institute of Nutrition, 408 Queen St.(3rd floor), www.nin.ca Ottawa, ON, K1R 5A7 (613) 235-3355Canadian Complementary Medicine Assoc., 8621 104th St., Edmonton, AB, T6E 4G6 (403) 433-7401

Canadian Assoc. of Herbal Practitioners, 1228 Kensington Rd., Apt. 400, Calgary, AB, T2N 4P9 (403) 270-0936

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

Plus: a 'function' claim; address / telephone #

Directions

Other Ingredients

DIN

Expiry date

Unit weight

Active Ingredients

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!

Independent testing often indicates up to 30% of products contain little(or no) 'active' ingredients, especially in USA.

Clinically Proven Quality Extract Guaranteed Potency Essential Naturally Occurring Pure Highly Concentrated Maximum Absorption Special Extract Scientifically Standardized Nutritionally Comprehensive

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

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

Dihydroepiandrosterone - conc'n drops to ~10% by

age 70

Melatonin - the 'Fountain of Youth'?

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.

From pineal gland;

regulates body 'biorhythms'; conc’n.

with age.

Ponce de Leon ?

Glucosamine - it's 'Natural'!

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'

Produced in joints as 'precursor' for cartilage

repair

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

• 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

• can't cure; only alleviate chronic conditions; NB. frequent use of 'minor effect' and 'may help'

'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

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

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!)

Purple Coneflower

Echinacea - only 3(of 9)

species ………..angustifolia .……….pallida ………. purpurea

the Top Ten– (continued)

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 - 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

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

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

Anticoagulants : avoid before surgery : gingko biloba !!!

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 anti- oxidant(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 low-

medium; 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 20-200x 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