herbal supplements, which ones work? jim painter phd, rd professor, eastern illinois university
TRANSCRIPT
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Herbal Supplements,
which ones work?
Jim Painter PhD, RDProfessor, Eastern Illinois University
Herbal Supplements,
which ones work?
Jim Painter PhD, RDProfessor, Eastern Illinois University
![Page 2: Herbal Supplements, which ones work? Jim Painter PhD, RD Professor, Eastern Illinois University](https://reader036.vdocuments.us/reader036/viewer/2022062716/56649dc85503460f94abdd21/html5/thumbnails/2.jpg)
Cavaliere, C., et al.(2008).Herbal Supplement Sales in United States
Top 10 Herbal Supplements By Sales
Supplement Sales
1 Soy $25,600,000
2 Cranberry $24,000,000
3 Garlic $20,500,000
4 Ginkgo $18,000,000
5 Saw Palmetto $17,000,000
6 Echinacea $14,400,00
7 Black Cohosh $8,600,000
8 Milk Thistle $8,600,000
9 Ginseng $8,400,000
19 St. John’s Wort $8,000,000
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Basic Four Food Groups
Everything that is bad for you tastes good
Everything that is good for you tastes bad
Was good for you but not any more
If you eat that it you will kill you
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Popular Herbal Supplements
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I. GingerZingiber officinale
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Ginger• Contains powerful
antioxidants– Gingerols, Shogaols,
zingerones
• Use - prevent or ease nausea
- Reduce motion sickness- Reduce morning
sickness- Reduce post surgery
nausea
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N/V in Motion Sickness
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N/V in Pregnancy
Study by Ozgoli, Goli & Simbar, 2009
Nausea Intensity
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N/V Post-surgery
Percentage reporting POV
symptoms
0
10
20
30
40
50
60
70
80
Ginger Placebo
Study by Bone, et al., 1990.
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II. Soy/ legumes
• Low in saturated fat
• Contains protein and other compounds that help lower blood cholesterol
Effect = reduced risk of heart disease
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Effects: Meta-analysis of Soy protein on Serum Lipids
• 38 clinical studies; 730 people over 2
decades:
- 20 studies used soy protein isolate
- 15 used textured vegetable protein
• Lowering of serum cholesterol in 34/38
studies
• No effect in 4 studies
•In all studies, cholesterol averaged <185
mg./dl.
James W. Anderson, M.D., Bryan M. Johnstone, Ph.D., and Margaret E. Cook-Newell, M.S., R.D. N Engl J Med 1995; 333:276-282
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Reduction of Total Cholesterol by Soy
0 20 40 60
127-198
201-255
259-332
>335
Init
ial C
hole
ste
rol
(mg
/dl)
Average Total Cholesterol Reduction (mg/dl)
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05
1015202530
Red
ucti
on
in
Blo
od
C
hole
ste
rol m
g.
25 50 75
Soy Intake (grams)
Reduction of Blood Cholesterol
with Soy Consumption
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Sources: Soy Protein
Soy Food Amount Soy Protein
Soy milk, plain 1 cup 8 g
Tofu ½ cup 10 g
Soy flour, defatted ¼ cup 8 g
Soybeans, cooked ½ cup 13 g
Roasted soynuts ¼ cup 12 g
Tempeh ½ cup 16 g
Source: United Soybean Board
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III. Garlic
• Garlic has been used in traditional and folk medicine for over 4,000 years
• Garlic contains sulfur compounds • Eating one clove of garlic per day may
help decrease blood cholesterol levels
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Effects: Garlic
• Prevents platelet “stickiness”• Inhibits constriction of arteries• Reduces LDL oxidation (leads to
clotting)• Prevents high blood pressure• Reduces blood lipids
Ackermann et al., 2001, Arch Intern Med, 161: 813-24.Butt et al., 2009, Crit Rev Food Sci Nutr, 49(6): 538-51
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Component Responsible for Lipid Lowering
• Allicin, a sulfur compound• Volatile sulfur compounds are not present in intact cells• Release by:
– chopping– steaming– crushing
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Garlic Compounds and the Effect on HMG-CoA Reductase
Liu & Yeh, 2002, J Nutr 132: 1129-1134
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Recommendations: Garlic
• Experts still researching optimal dose• Conservative estimate = 1-3 cloves per
day
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IV. Cinnamon
Cinnamon• Source of Manganese, iron,
calcium, and fiber– Cinnamaldehyde (Reduces stickiness
of platelets)– Cinnamyl acetate (Antioxidant)– Cinnamyl alcohol (Antioxidant)
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Cinnamon – True Ceylon Cinnamon
• Arthritis – Reduces uric acid production
• Heart Health – reduce lipids/platelet adhesion
• Type 2 Diabetes – lower blood glucose
• Blood Pressure – Reduced blood pressure
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Meta-analysis: Cinnamon & A1C
Allen, R. W., Schwartzman, E., Baker, W. L., Coleman, C. I., & Phung, O. J. (2013). Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis. Annals Of Family Medicine, 11(5), 452-459. doi:10.1370/afm.1517
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V. Black CohoshActaea racemosa L.
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Fast Facts• Main use: ease
menopausal symptoms like hot flashes or night sweats
• Most popular brand is Remifemin- it is a standardized extract– Commonly given in 20 mg
pills, twice a day
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Effect of Black Cohosh on Menopausal Symptoms
Study by Vermes et al., 2005
Average Kupperman Menopausal Index (KMI)
Score
KMI score is out of 51 points and scores the following symptoms: hot flushes, paraesthesia, insomnia, nervousness, melancholia, vertigo, weakness, arthralgia or myalgia, headache, palpitations, and formication.
0
10
20
30
40
50
Week 0 Week 4 Week 8 Week12
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Pilot Test of BC for hot flashes
Study by Pockaj et al., 2004.
Daily hot flash scores (mean of all participants)
0102030405060708090
100
Baseline Week 1 Week 2 Week 3 Week 4
Hot flash score is frequency of hot flashes X severity
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Summary:
• Black cohosh is probably effective but may not work for everyone- try it for a few months to see if it works for you!
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VI. Turmeric:• Long used as a yellow food coloring
and spice.• A principal ingredient in curry
powder(28%).• Contains three major curcuminoids,
which are responsible for the yellow color of the herb.
• Curcumin (diferuloylmethane) is the most significant curcuminoid.
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Effect of Turmeric on lung cancer in MicePercentage that developed cancer
0 20 40 60 80 100
Placebo
Taxol
Curcumin
Curcumin& Taxol
MD Anderson Study
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VII. Saw Palmetto
Main use: relief from urinary symptoms associated with
BPH
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BPH Prevalence in Males
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Does it work?- Peak Urinary Flow Rate
Pea
k U
rin
ary
Flo
w R
ate
(mL
/min
)
11
11.2
11.4
11.6
11.8
12
12.2
12.4
Month 3 Month 6 Month 9 Month 12
Saw Palmetto
Placebo
Study by Bent et al., 2006.
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SP effect on DHT
Pg/g
0
1000
2000
3000
4000
5000
6000
Untreated Permixon
Testosterone
DHT (dihydrostes tosterone)
Study by Di Silverio, et al., 1998.
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Maximal Urinary Flow Rate
Maximal Urinary Flow
Rate
(mL/sec)
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VIII. Kava KavaPiper Methysticum
Witte, D. Loew, D. & Gaus, W. (2005). Meta-analysis of the efficacy of the acetonic kava-kava extract WS 1490 in patients with non-psychotic anxiety disorders. Phytotherapy Research. 19, p. 183-188.
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Drug Interactions-Effective Uses
• Sedative• Anxiolytic• Muscle Relaxant• Mood stabilization• Reduce mild nervous anxiety• Restlessness & Agitation• Tension & Stress• Mild anti-inflammatory actions
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Dosage
• Oral Use• Supplied by:
– Capsules: 100 -500mg
– Liquid: 1:1, 1:2– Tea
• Daily Dosage:– Capsules: Root extract:
150mg-300mg twice daily, with a daily dosage of Kava pyrones 50mg-240mg.
– Tincture: Taken as 30 drops with water 3 times daily
– Infusion: Take ½ cup twice daily
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Results
Geier [3]
Kinzler [4]
Lehrl [5]
Malsch [7]
Volz [11]
Warnecke [12]
-15 -10 -5 0 5 10 15 20 25 30
Study by Witte, D. Loew, D. & Gaus, W. (2005).
HAMA Difference
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Results
Younger
Older
Male
Female
All
0 -10 -5 0 5 10 15 20 25 30
Study by Witte, D. Loew, D. & Gaus, W. (2005).
HAMA Difference
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IX. Valerian RootValeriana Officinalis
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Dosage
• Daily dosage: 100mg-1800mg• Total internal daily dose: 15g root
powder, for restlessness 220mg three times daily, & for sleep aid 400mg-900mg of extract
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YEAR NUMBER OF PARTICIPANT
DOSE DURATION SLEEP QUALITY INPROVEMENT
LEATHWOOD 1997 128 400 mg qhs 1 Day YES
BALDERER 1985 10 450 mg qhs 1 Day NO
LEATHWOOD 1985 8 450 mg qhs 1 Day NO
DIAPER 2004 16 300 mg qhs 1 Day NO
FARAG 2003 25 320 mg 4 Days NR
SCHULTZ 1994 14 405 mg tid 8 Days NO
KAMM-KOHL 1984 80 90 mg tid 14 days YES
KUHLMANN 1999 91 600 mg qhs 14 Days NO
DONATH 2000 16 600 mg qhs 14 Days NO
FRANCIS 2002 5 20 mg/kg 14 Days NO
DELSIGNORE 1992 51 100 mg tid 21 Days NR
COXETER 2003 21 225 mg qhs 21 Days NO
JACOBS 2005 270 600 mg qhs 28 Days NO
VORBACH 1996 121 600 mg qhs 28 Days YES
CERNY 1999 98 360 mg qhs 30 Days YES
JASEN 1977 150 100 mg tid 30 Day YES
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Dichotomous Outcomes for Sleep Quality (Sleep improved or not)
0.1 1.0 10.0 100.0
Jacobs
Kamm-Kohl
Cerny
Vorbach
Leathwood (1982)
Jansen
Study by Bent. S. et. Al. (2006).
Relative Risk
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X. St John’s Wort
Hypericum Perforatum
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Quick Facts • Main Use: treatment for
mild to moderate depression,
• Extract is standardized to
0.3% hypericin; 300-600mg 3x/day
• Treatment of depression requires 2-6 weeks of treatment, and for full therapeutic dose use up to 6months
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SJW & Mild to Moderate Depression
Kasper,S. et al, 2006
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SJW vs. Standardized Depression Medication
Phillip,M. et al, 1999
To
tal S
core
HA
M-D
(m
ean
)
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XI. Ginkgo Biloba
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What is Ginkgo biloba?• Dietary Supplement• Composition
– Extract, flavonoid glycosides (composition?), terpene lactones and ginkgolic acid
– Main Uses: Improves cognitive function, anti-inflammatory effects, and vascular effects
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Speed of Attention (total Msec)
TimeKennedy, DO, Scholey, AB, Wesnes, KA. Psychopharmacology. 2000
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Kennedy, DO, Scholey, AB, Wesnes, KA. Physiol Behav. 2002. Based on Bond-Lader Visual Analog Scales.
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Summary of effectiveness of Ginkgo and Ginkgo/Ginseng combination on cognition
• Enhanced speed of attention at 240 and 360 mg but not at 120 mg
• Quality of memory was enhanced at 120 mg and 240 mg of Ginkgo
• Working memory was enhanced with Ginkgo/Ginseng combo vs. Ginkgo alone
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XII. Glucosamine & XII. Glucosamine & ChondroitinChondroitin
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• Meta-analysis found that supplements used together narrowed joint space.
• Improved pain and mobility• More than 500 studies were
evaluated• 1,775 patients
Richy, F., & Bruyere O., 200355
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• Largest clinical trial: Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)
• GAIT has produced two sets of negative results.
• Glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain more than a placebo.
56
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• Glucosamine & chondroitin may reverse osteoarthritis and decrease inflammation
• Both may relieve arthritis pain and stiffness with fewer side effects than conventional drugs.
• Although positive reports outnumbered negative ones, the negative ones have been larger and better designed.
57
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• Do not use with: – Warfarin – Asthma – Allergic reactions– Constipation– Ulcers– Liver disease – Inflammatory bowl
disease
58
• Only for use with moderate-to-severe arthritis
• Give supplement three months to work
• Buy from researched supplier
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XIII. Chocolate
• Cocoa processed with alkali is not beneficial
• High fat chocolate is not beneficial• High sugar chocolate is not beneficial• Cocoa is beneficial
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Effects: CocoaComparison of Antioxidant Content
• Black tea (2gm bag) 1000 C for 2 min.• Green tea (2gm bag) 1000 C for 2 min.• Wine 140 ml. California Merlot.• 2 tbs. commercial Cocoa pwd. 200 ml
H20
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Gallic acid equivalents (GAE), phenolicEpicatechin equivalents (ECE), flavonoidLee et al. (2003). Cocoa Has More Phenolic Phytochemicals and Higher Antioxidant Capacity the Teas and Red Wine.Journal of Agriculture and Food Chemistry, 51, 7292-7295.
Total Flavonoid and Phenolic Content of Tea, Wine and Cocoa
(per serving)
0100200300400500600700
Black Tea Green Tea Wine cocoa
mgGAEECE
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Cocoa Inhibits Blood flow and Vessel Dilation
• Subjects 20 individuals at risk of CHD• Consumed a cocoa drink• 2 groups high and low flavanol• Brachial artery flow and dilation were
measured
Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.
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Vaso-dilation with Cocoa Flavanols
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Low flavanolcocoa
High flavanolcocoa
% FMDBefore2 hr After
FMD (Flow-mediated Dilation)Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.
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