18/03/25-Nutraceuticals and herbal remedies

what is an alternative therapy

• Used instead of conventional treatment

what is a Complementary therapies

• Used together with conventional treatment

what is Integrative medicine

• Combination of conventional medicine and alternative

• Where safety and effectiveness are supported by high quality evidence

what are the Reasons to use alternative /complementary therapies

• Symptoms not adequately addressed by conventional practitioners

• Preference for natural products

• Not necessarily a safe option

• Misled by dramatic claims

• Terminally ill people

what are characteristics of people using CAM?

• female

• University educated

• Suffering with anxiety or depression

• Poorer mental health

• Lower levels of perceived social support

• People consuming >5 portions of F=V a day

• Hunt 2010

what is the revelance of nutraceuticals and herbal remedies to dietetics

• Some may be harmful

• Interact with other treatments

• Be able to know the evidence base

• Particularly popular in areas with chronic conditions

what is the potential for harm with nutraceuticals

• Elimination diets recommended with our deeper understanding of nutrition

• Deficiency risk

• Stopping conventional treatments

• Chinese herbs can have drug interactions

what are nutritional supplements

• Essential nutrients

• Established functions in the body

• Plant extracts

what does EU food supplementation directive say about supplementation

• Vitamin and mineral suplements must be safe and appropriately labelled

• Sports supplements in UK are regulated as foods and subject to food law

• Manufacturers responsibility to ensure food supplements are safe for consumption

when is vitamin and mineral supplementation appropriate

• Identified deficiency

• Increased physiological needs

• Increased nutrient losses

• Poor appetite

• Swallowing difficulties due to illness

• Prescribed or self imposed restricted diets

• Pt at risk of osteoporosis or rickets

what are nutraceuticals

• Characterised as specially designed preparations

• Fulfilling specific dietary requirements and/or preventative health care

• Preventative treatment of some diseases, in addition to a supplement diet

what is creatine

• Methyl guanidine-acetic acid

• Naturally occurring in most muscle tissue

how is creatine synthesised

• Mainly liver and kidney

• Transported via blood to muscle

how is creatine metabolised

to creatinine

how is creatine excreted

as creatinine in urine

what does creatine supplementation do

• Increases maximum strength

• Increases FFM (by increasing water)

• Associated with poorer performance for long term sports

• Assocaitions with potential better performance for shorter term sports

dietary recommendations of creatine

• Taking with carbohydrate or a protein source can help uptake

• Safety in children and adolescents not established

what are the safety concerns of creatine

• No studies of determinetal health effects

• Anecdotal reports

• GI disturbances

• CV and muscular problems

• Nausea

• Vomitting

• Diarrhoea

• Kidney and liver function

• Alterations

• Muscle cramps

• Elevated bp

what is bicarbonate

most important extracellular buffer

what does bicarbonate do

• Stops the build up of acid so you can exercise for longer

• Buffers H+ and increases diffusion of H+ out of cells

what are the benefits of bicarbonate supplementation

• Performance benefits in events less than 8 mins

what are the dietary recommendations bicarbonate

take with carbohydrate rich meal

what is b-alanine

• Rate limiting precursor to carnosine

• Intracellular buffer

what does b-alanine supplementation do?

• Immediate defence against protein accumulation in contracting muscle

• Carnisone higher in fast twitch muscle and in sprinters

what may antioxidant supplementation do?

increase oxidative stress

what has research found about contamination of supplements

• 10% of supplements found to be contaminated with steroids or stimulants

• Seems to be that this is due to poor manufacturing practices

• Weight management products had theist findings

what are the rules around licensing of herbal remedies

• Some have to be licensed

• Some over the counter don’t have to be licensed

• Traditional herbal medicines registration schemes to show safety to buyers

• Do not need to have proven efficacy

• Suspected adverse reactions can be reported using yellow card system

what is St Johns wort herbal remedy used for

to treat depression

how does St Johns wort herbal remedy interact with medicines

• Potentially by

• By inducing cytochrome P450

• Up relating multi drug transporter p-glycoprotein

why does St Johns wort herbal remedy interact with medicines

• Plasma concentrations of drug reduced

• Reduced therapeutic effect of drug

which drugs to St Johns Wort herbal remedy reduce the therapeutic effect of?

• Antidepressants

• Antiretrovirals

• Anticonvulsants

• Digoxin

• Theophylline

• Warfarin

• SSRIs

what is gingko Bilbo herbal remedy used for

• improving memory, anxiety and stress

what does gingko Biloba herbal remedy interact with

• Warfarin

• Aspirin

how does ginkgo Biloba herbal remedy interact with drugs

increases risk of bleeding

what is Ginseng herbal remedy used for

• improve wellbeing energy and stress reduction

what does ginseng herbal remedy interact with

warfarin

how does ginseng herbal remedy interact with drugs

increased risk of bleeding

what is dong qual herbal remedy used to treat

• reproductive problems in women

• Painful menstruation

• Improve blood flow

what does dong qual herbal remedy interact with

warfarin

what does dong qual herbal remedy do when on warfarin

increase bleeding risk

what is echinacea herbal remedy used for

• improve immune function

• Reduce inflammation

• Pain relief

what is the unwanted interaction of herbal remedy echinacea

• Counteracts the activity of immunosuppressants

• Results in possible immune stimulation when not wanted

what is the herbal remedy saw palmetto used for

treatment of enlarged prostate in men

what drug does herbal remedy saw palmetto interact with

warfarin

what does saw palmetto herbal remedy do to warfarin

results in altered anticoagulation

what is turmeric used for as a herbal remedy

• Moderate quality evidence that turmeric / cur cumin supplements may relieve pain and improve physical symptoms of osteoarthritis

• Low quality evidence that turmeric may be helpful in metabolic disorders and other inflammatory conditions

• Turmeric was safe to use and associated with minor adverse events

what is curcumin

• Derived from tumeric

what had curcumin been found to do

• Anti-inflammatory activity in mice

• Better muscle regeneration in mice

what are the benefits of Manuka honey

• Antibacterial

• Antioxidant

• Anti- inflammatory

• Prebiotic

• No change in IgE or altered gut microbial gut profiles during trial

• Safe for healthy individuals to consume

• Anecdotal evidence suggesting good for digestive health

what is echinacea herbal remedy

• Extracts of echinacea can be efficacious immunomodulators

what is unclear in evidence about echinacea herbal remedy

• Which preparation to use

• Which dose to employ for a specific indication

what have studies shown about the effectiveness of St Johns wort in treating depression

• Similar changes to antidepressants

• One study found no difference between st johns wort and placebo

what have studies shown about the effectiveness of ashwaganda

• Small but significant effect on overall sleep

• More prominent in

• Adults with insomnia

• Treatment dosage >600mg/day

• Treatment duration >8 weeks

• Also found to improve

• mental alterness

• Anxiety

• No significant effect on quality of life

what has research found about ginseng

• Meta analysis found no compelling evidence for ginseng root extract to be effective for physical performance, psychomotor performance and cognitive function, immunomodulation, diabetes mellitus and herpes simplex type-II infections

• No high quality evidence about efficacy in pt eight dementia

• Can significantly reduce hot flushes, menopausal symptoms and QOL in menopausal women

what has research found about ginseng in cancer

• With fluoropyrimidine based chemotherapy and ginseng compared to just FBC

• Had better objective response

• Disease control rates

• Better QoL

• Higher proportions of CD3+ T cells, CD4+ T cells, and natural killer cells, CD4+/CD8+

• T-cell ratio.

• Reduced incidence of adverse drug reactions during chemotherapy

what is the Possible adverse effects of beta carotene

• Long term intake >7mg/ day

• May increase risk of lung cancer

• Should not be taken by people who smoke

what is the Possible adverse effects of vitamin A

• Excessive doses can

• be teratogenic

• Cause irreversible bone and liver damage

• Avoid supplements in pregnancy, order adults at risk of osteopososirs, high intakes of liver

• Do not exceed RNI

• 700 men

• 600 women

what is the Possible adverse effects of nicotinic acid

• EFSA state 5.5mg/1000 kcal

• Prolonged high dose intakes can lead to liver dysfunction

• In doses of >50mg

• Niacin flush

• Red patchy skin

• GI disturbances

• Limit supplemental intakes to <17mg/day

what is the Possible adverse effects of vitamin c

• Abdominal pain and diarrhoea at >1000mg/day

• Do not exceed RNI

• 90 men

• 80 women

what is the Possible adverse effects of vitamin b6

• May cause irreversible neurological damage >200mg/day

• Supplement at <10mg/day

what is the Possible adverse effects of calcium

• >1500mg/day

• abdominal pain and diarrhoea

what is the Possible adverse effects of iron

• >17mg/day

• Constipation

• Nausea

• Abdominal pain

what is the Possible adverse effects of magnesium

• >400mg/day

• Osmotic diarrhoea

what is the practical advice to give pt about herbal remedies and supplements

• If no danger with interactions

• Buy from reputable source

• Chemist

• Pharmacy

• Supermarker

• Not from the internet

• Check the dosage

• Amount in dose

• Expiry date

• Is it really needed?

how much salt in a tablet of fizzy vitamin supplement

1g

what kind of supplement would you recommend for a pt needing a salt restriction

non fixzzing vitamin supplement

what may natural botanical products do?

damage liver