Colostrum Supplements For Boosting Gastrointestinal Immunity

Colostrum is the clear or cloudy "premilk female mammals secrete after giving birth and before producing milk. Colostrum for dietary supplements is usually derived from bovine sources and contains various immunoglobulins (also called antibodies) and antimicrobial factors (i.e., lactoferrin, lactoperoxidase, lysozyme) as well as insulin-like growth factors such as IGF-I and IGF-M. The concentration of IGF-I in bovine colostrum is 200-2,000 mg/L, whereas normal milk contains less than 10 mg/L. In normal, healthy adults, IGF-1 occurs at a concentration of approximately 200 mg/L in serum. In terms of immunoglobulins, colostrum generally provides concentrations of IGF, IgM, and IgA that are 100-fold higher than in normal milk. The most prevalent claims for dietary supplements containing colostrum are in the area of generalized immune function as well as the specific areas of diarrhea prevention and treatment, overall gastrointestinal support, and improved recovery from intense exercise.



The amino acid sequences of human and bovine IGF-I are identical. The increase in serum ICF-I observed in several human studies is most likely a result of an enhanced stimulation of endogenous IGF-I synthesis rather than a direct absorption of the growth factor from the adult gastrointestinal tract. It is likely that the natural target of colostrum-derived growth factors is the gastrointestinal tract, whereby the increased growth and turnover of the intestine provides for a healthier gut and an increased uptake of dietary components that may enhance growth, immune competence, and athletic performance generally.



Bovine colostrum contains the same disease-resistance factors (immunoglobins) found in human breast milk and unpasteurized cow's milk. Among the many immune factors that may be effective against various viruses, bacteria, yeast, and other invaders are immunoglobins (IgA, JgG, IgM) lactoferrin, laclalbum'm, glycoprote'ins, cytokines (such as interleukin 1, interleukin 6, and interferon Y) and various polypeptides, growth factors, vitamins, and minerals. The antibodies present in colostrum are thought to combine with disease-causing microorganisms in the gastrointestinal tract. By adhering to pathogens, colostrum antibodies may be able to reduce the adhesive properties of bacteria and decrease their ability to attach to the intestinal wall (which could prevent their entrance into the body). Ii is unlikely that the "full" antimicrobial benefits of colostrum can be realized unless the user happens to be a baby cow, because the immunoglobulins are largely digested in the adult gut and cannot be absorbed intact (Mero et al,, 2002). It may be possible, however, for partially digested immunoglobulin fragments to retain a small portion of their functional properties and deliver these immune benefits on absorption.



Numerous studies have been conducted in adults and children to show the benefits of ingesting colostrum in neutralizing the activity of several strains of bacteria and parasites that cause diarrhea (Ashraf et al., 2001; Bolke et al., 2002; Huppertz et al., 1999; Mitra et al., 1995; Nord et al., 1990; Okhuysen et al., 1998; Plettenberg et al., 1993; Rump etal., 1992; Sarkeretal., 2001; Tacketetal., 1988; Tawfeek et al., 2003). Both the prophylactic and treatment effects of colostrum feeding against bacterial and parasitic infections of the gastrointestinal tract may be the result of the direct antimicrobial effects of colostrum-derived immune factors and/or a generalized stabilization of gut barrier function (Bolke et al., 2002; Playford et al., 2001). In studies of chronic gastritis, symptoms were improved and inflammation was reduced, but there was no evidence that colostrum was directly effective against Helicobacter pylori (the bacteria that cause stomach ulcers).



In terms of sports performance, several studies have investigated athletes who consumed colostrum (up to 60 g/day) compared with a placebo or whey protein. These studies found variable effects on IGF-I levels. In terms of overall athletic performance and exercise recover)', they found no differences in plasma IGF-1 concentrations in either group during the study period but they did find that the colostrum group ran further and did more work than the placebo group (equal to a 2% increase in performance; Antonio et al., 2001; Brinkworth et al., 2002; Buckley et al., 2002, 2003; Coombes et al., 2002; Hofman et al., 2002). One study examined rowing performance in a group of elite female rowers. Eight rowers completed a 9-week training program while consuming either colostrum (60 g/day) or whey protein. By week 9, rowers consuming colostrum had greater increases in the distance covered and work done compared to the whey protein group (Brinkworth ct al., 2002).



Additional studies on bovine colostrum consumption suggest that it can also deliver some generalized anti-inflammatory benefits (Bolke et al., 2002; Playford et al., 2001) and help prevent and treat the gastric injury associated with nonsteroidal anti-inflammatory drugs. Such effects may also be of value for the treatment of ulcerative conditions of the bowel, such as colitis and irritable bowel syndrome (Khan et al., 2002).



Taken together, the available evidence for bovine colostrum is supportive of its benefits as an effective immune-supporting supplement, particularly when interactions with pathogens in the intestinal tract are possible. It is unlikely; however, that colostrum would provide immune benefits against airborne pathogens and upper respiratory tract infections such as cold and influenza or against pollen-related allergic responses (Leifer-man et al., 1975).



No adverse side effects are expected up to doses of 60 g/day, but people with milk allergies should avoid bovine colostrum. Doses of 10 g and up have been used in most human studies; it is unknown if lower doses provide any meaningful immune or gastrointestinal benefits. Many capsule-form products provide no more than 1 g of colostrum per serving, but powder forms may deliver levels associated with clinical effectiveness (10 g and higher).

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Garlic Supplements

Garlic has been used for centuries for its reported benefits in promoting heart health and preventing infection. For more than 5,000 years, humans have been cultivating garlic for use as a spice and a medicine, and records document its medicinal use by Egyptian pharaohs, Chinese emperors, and soldiers from the middle Ages to World War II; among the latter, garlic juice was known as "Russian penicillin" for its antibiotic effects in wound healing.



Modern-day use of garlic as a dietary supplement generally centers on promotion of heart health by reducing scrum lipid levels (total cholesterol, LDL, triglycerides), lowering blood pressure, and inhibiting blood clotting. The cardio protective benefits associated with garlic are generally attributed to the various sulfur compounds that can be isolated from the raw clove. These compounds, which include allicin, allicin, S-allyl-cysteine, and S-methyl-cysleine, are found in varying concentrations.



in garlic, chives, leeks, shallots, and onions, but the chemical composition may vary considerably depending on processing methods and are generally highest in garlic compared with, other plants in the allium family. The chemical responsible for the pungent smell of garlic, allicin, is produced from allicin (an odorless amino acid derivative) through the action of allicin and is thought to contribute to many of the health effects associated with garlic supplements.



A major concern with all garlic supplements is the total level of sulfur-containing compounds or the total allicin potential of commercial products. Raw garlic is more potent than cooked garlic, and fresh garlic is more potent old garlic. Deodorized and aged garlic supplements typically contain only a fraction of the allicin found in fresh garlic.



Because allicin is converted to the active allicin form (the source of garlic's unique odor) in the body, and because the precise mechanism by which garlic helps lower cholesterol is unknown, it is prudent to select a product with high allicin potential. General considerations for dosing are that each milligram of allicin yields approximately 50% of that amount as allicin; thus, 500 mg of a garlic extract standardized to 1% allicin would yield approximately 2,500 jig allicin (compared with a clove of fresh garlic, approximately 4 g, with 1% allicin yielding about 20,000 u.g allicin). Owing to differences in strength and preparations of various commercial garlic supplements, consumers should pay attention to die allicin potential of a particular product.



Garlic is mostly used for its antihyperlipidemic and antihypertensive effects. It also has been reported to possess antibacterial, antiviral, and antifungal effects, but these are generally confined to topical applications. In patients with hyperlipidemia, garlic might lower cholesterol levels by acting as a mild HMG-CoA reeducates inhibitor. Garlic is thought to protect vascular endothelial cells from injury by reducing oxidative stress and inhibiting LDL oxidation. Garlic has also been shown to have antithrombotic activity by increasing fibrinolytic activity and decreasing platelet aggregation. For hypertension, garlic is thought to reduce blood pressure by causing cell relaxation and vasodilation by activating production of nitric oxide.



The benefits of garlic supplements are controversial. Although quite a large number of studies appear to indicate a beneficial cardiovascular effect of garlic supplements, die most well-controlled studies generally suggest a lack of any beneficial effects or suggest benefits only at high doses. For example, in a study of children with elevated blood cholesterol and triglycerid.es, 8 weeks of garlic supplementation (900 mg/day) produced no significant effect on total cholesterol triglycerides, LDL, or HDL (Jepson et al., 2000). It is possible that these children, who had severe cases of familial hyperlipidemia, did not respond to the garlic supplements because their medical conditions were too advanced for treatment with a mild approach such as dietary supplementation. In support of this "non effect," however, a multicenter study carried out over 12 weeks (also using 900 mg/day) showed no significant lipid or lipoprotein changes following garlic supplementation (Jepson et al., 2000). The FDA has gone so far as to issue a ruling to prohibit claims on dietary supplements promoting a relationship between garlic, decreased serum cholesterol, and the risk in adults of cardiovascular disease.



The lack of effects in the above-mentioned studies may have been the results of the dose used, with 900 mg/day being too low. Larger doses of garlic (4-10 g/day) have been more consistently associated with beneficial effects. For example, in a study of 30 patients with coronary artery disease (Simons et al., 1995), garlic supplements (4 capsules per day equivalent to 4 g of raw garlic) showed a significant reduction in serum cholesterol and triglyceride levels as well as an inhibition of platelet aggregation (reduced blood clotting). Further supporting the cardiovascular benefits in humans is a well-controlled study that compared the effect of aged garlic extract on blood lipids in a group of 41 men with moderately elevated cholesterol levels. Each subject received about 7 g of garlic extract per day over the course of 6 months. The major findings were a reduction in total serum cholesterol of approximately 7%, a drop in LDL of 4-5%, a 5.5% decrease in systolic blood pressure, and a modest reduction of diastolic blood pressure. The study concluded that "dietary supplementation with aged garlic extract has beneficial effects on the lipid profile and blood pressure of moderately hypercholesterolemic subjects, "but this dose of garlic would certainly pose numerous practical issues such as compliance.



Adverse side effects associated with garlic supplements are rare. Occasionally, mild gastrointestinal symptoms such as heartburn and nausea may occur with high intakes. In some cases, high doses of garlic may potentiate the antithrombotic (blood-thinning) effects of anti-inflammatory medications such as aspirin and dietary supplements such as vitamin E and fish oil.

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Dong Qua, Damiana and Evening Primrose Oil Supplements

Dong qua! has a long history of use in both Traditional Chinese Medicine and Native American medicine, and it continues to he used for female conditions to balance the effects of menopause (hot flashes and night sweats) and PMS (cramping). The active components in dong quai are thought to be the coumarins, ferulic acid, and ligustilide. The coumarins are known to increase blood flow, and ferulic acid and ligustilide are known to have muscle-relaxing effects. Although there have been no known estrogenic compounds found in dong quai, it has been confirmed to have both esirogenic and antiestrogenic activity in vitro (Amato et al., 2002). Dong quai is sometimes used in "bust-enhancing" herbal products, but no clinical studies have been conducted on it for this purpose (Fugh-Berman, 2003). Dong quai has been shown to possess nonspecific immunomodulatory activity in vitro (Wilasrusmee et al., 2002a, 2002b).



Dong quai was included in a phytoestrogen combination that a clinical study found to be beneficial in treating migraines associated with the menstrual cycle, but how much dong quai contributed to its efficacy is unknown (Burke et al., 2002). After only one negative clinical study, dong quai was abandoned from clinical practice by many in the United States; however, considering its long history of use and reported success in alternative medicine settings, ilseems dong quai deserves more clinical research and more credit.



Hirata et al. (1997) examined the use of dong quai in postmenopausal women in a double-blind, randomized, placebo-control led clinical trial. Outcome parameters measured its effects on endometrial thickness (by ultrasonography), cellular maturation of vaginal cells, the Kupperman index (for determining menopausal symptoms), and frequenq' of hot flashes. Seventy-one women were included in the study and given either dong quai or a placebo for 24 weeks. No statistically significant differences were found between the treatment and placebo groups for any of the parameters measured. The authors concluded that dong quai does not produce estrogen-like responses in postmenopausal women for the parameters measured.



Generally, dong quai is administered in the dosage range of 250-1,000 mg/day (taken in divided doses) for the relief of menopausal or menstrual symptoms. There is no consensus on the standardization of dong quai because activity has been found in different fractions of the plant extracts. Dong quai is considered quite safe, but there is some concern of its potential to increase photosensitivity because of the coumanns it.

No clinical support on the single phytotherapeutic preparation is available.



Generally, damiana is recommended in the dosages of 400-800 mg 3 times daily if used singly. Not much is known about the long-term safety of damiana, but it has been noted to cause a euphoric and mild laxative effect at high dosages. Another concern is a potential drug interaction with aspirin because of dong quai's aniiplatelel activity (Abebe, 2002, 2003).



Evening primrose oil is made from the seeds of the herb Qtmothera biennis, which grows wild in arid environments like sand dunes. True to its name, the bright yellow evening primrose flowers open in the evening and fade in bright sunlight. First documented medicinally in England, evening primrose oil is most commonly used for relieving premenstrual syndrome, fibrocystic breasts, and menopausal symptoms such as hot flashes.

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Mastic From Pistacia Lentiscus to Treat Ulcers, Heartburn and Treatment and Prevention of Bad Breath and Slipperyelm Supplements For Digestive Health

Mastic is a resin, or gum, extracted from a tree grown in Mediterranean or Middle liastern regions. Long used as a chewing gum and a traditional medicine, mastic resin also has been developed for use in numerous industrial applications (Milovet al., 1998). Preliminary clinical evidence has confirmed that mastic resins are useful in the treatment of ulcers. Further, mastic has been shown to exhibit antibacterial activity against Helicobacter pylori, explaining its efficacy in ulcers. Mastic has also shown antibacterial, antiplaque, and autigirigival activity in the saliva and on the teeth (Takahashi et al., 2003).



Although mastic has not yet been well studied as an herbal medicine, preliminary clinical evidence is promising 10 confirm the efficacy of its historical use in treating ulcers (AI-Habbal, 1984; Huwez, 1986).



Al-Habbal et al. (1984) performed a double-blind, clinical study on mastic for treatment of duodenal ulcer. Twenty patients were given mastic (I g/day) and 18 received a placebo (lactose, 1 g/day) to for 2 weeks. Mastic treatment resulted in highly statistically significant improvements in both the symptomatic relief (80% of the treatment group versus 50% of the placebo group) and the clinical manifestation of disease as proven by endoscopic examination {70% of the treatment group versus 22% of the placebo patients). Additionally, mastic was found to be well tolerated with no side effects.



Antiplaque, Antigingival, and Antibacterial Activity of Mastic Chewing Gum

A chewing gum of mastic resin was tested in two double-blind, randomized, placebo-controlled studies for the control of dental plaque. In the first study, saliva was collected from the mouths of participants after mechanical brushing and chewing gum and examined for its antibacterial activity by mastic or placebo gum. The mastic chewing gum group showed statistically significant reductions in bacterial growth compared with the placebo group during the 4 hours of chewing gum. In the second study, mastic and placebo gum chewing (and no brushing) were tested over 7 days for their ability to control new plaque formation on tooth surfaces and on gingival inflammation. The mastic group showed significantly reduced plaque index measures and gingival index compared with the placebo group (Takahashi et al., 2003).



For treating ulcers and gastrointestinal discomfort, 1 g of mastic is used. Mastic is not known to produce any side effects and is thought to be safe (Al-Habbal et al., 1984).



Slippery elm contains mucilaginous compounds that are the reason why slipper}' is in its name and why it has herbal therapeutic uses. The mucilaginous effect of slippery elm has been used traditionally and safely for soothing irritated mucous membranes in the throat and sinuses during colds and sore throat, in the digestive system during digestive complaints (e.g., diarrhea, constipation, Crohn disease), and on the skin during minor irritations (e.g., poison oak and wound healing).



Although slippery elm lacks clinical support, the soothing effect of the mucilaginous components is well known. Additionally, related elm species have shown evidence of antimicrobial activity and promise for inflammation and diseases of the mucous membranes (Jun et al., 1998; Song et al., 2003; Ye el al., 1990; Youn et al., 2003).

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Glucosamine Amino Acid Supplements

Glucosamine is an amino polysaccharide (a combination of an amino acid glutamine and sugar glucose). Glucosamine is concentrated in joint cartilage where it is incorporated into longer chains known as glycosaminoglycans and finally into very large structures known as proteoglycans. The proteoglycans function to attract water into the joint space for lubrication of the cartilage during movement. Glucosamine is available in supplements as glucosamine sulfste, glucosamine hydro-chloride, and N-acetylglucosamine. Chondroitin sulfate (also covered in this chapter) is often combined with glucosamine. These supplements are generally promoted with claims for protecting joints and joint cartilage from injury, alleviating the stiffness and pain of osteoarthritis, and reducing inflammation.



Glucosamine supplements typically take 1-3 months to exert noticeable effects (reduced pain and stiffness) in people with mi Id-to-moderate degrees of osteoarthritis. Because arthritis pain is one of the most debilitating conditions, most people dealing with such pain would gladly invest a dollar or two per day in a supplement that relieved their discomfort and helped repair their damaged cartilage tissue. For people with existing chronic joint pain, glucosamine supplements (whether or not combined with chondroitin sulfate) are worth the modest dollar investment for the benefits they deliver.



The major principle behind glucosamine supplementation is that the glucosamine is delivered to the joint space and incorporated into proteoglycans of joint cartilage to maintain structure and repair damage. Glucosamine may also stimulate chondrocytes (cartilage cells) to begin produ-ng healthy new cartilage matrix (both collagen and proteoglycans). Numerous European studies and a handful of North American reports low a clear benefit of glucosamine supplements for relief of joint pain and stiffness associated with arthritis. One Australian udy has even suggested a pain-relieving effect in osteoarthritis of topic-ly applied glucosamme/chondroitin (Cohen et al., 2003), but that "feet may have been the result of camphor in the topical formulation. rhile glucosamine supplements have been reported to modify disease ctivity in studies of rheumatoid arthritis (Lard etal., 2001), the majority Fglucosamine studies have examined osteoarthritis of mild-to-moder-te severity. Most studies examine patients with osteoarthritis of the nee and hip, but examples of glucosamine's pain-relieving effects can e found in studies of osteoarthritis of die fingers and temporomandibu-ar joint (Nguyen et al., 2001; Thie et al., 2001). Several studies have ompared the pain-relieving effects of glucosamine (1,500 mg/day) to ISAIDs such as ibuprofen (1,200 mg/day). These studies generally find



that although NSAIDs tend to exert their pain-relieving effects faster (within the first week of treatment; Muller-Fassbender et al., 1994), the difference between treatments lessens with time (similar benefits at 2-4 weeks), with fewer side effects reported among glucosamine users (6% versus 35% on ibuprofen). When followed post treatment, glucosamine shows a carryover effect, whereby pain and use of pain relievers is reduced for 3-4 months following cessation of supplementation (Qiu ei al., 1998; Thieetal., 2001).



Many of the existing studies have been criticized for lack of scientific control, short duration, and small size (Towheed et al., 2000), and indeed not all studies of glucosamine supplementation show benefits in terms of relief of pain or stiffness (Houpt etal., 1999; Rindone et al., 2000).



Mela-analyses of several smaller studies, however, have supported the beneficial role of glucosamine supplements as a safe and effective approach to treating osteoarthritis (McAlindon et al., 2000a, 2000b; Towheed et al., 2000). In general, 1-3 months of glucosamine supplementation seems to be as effective as many analgesics and NSAIDs, like acetaminophen and ibuprofen, in reducing the joint pain of osteoarthritis. In perhaps the longest-duration trial to date (Reginster et al., 2001), 3 years of glucosamine supplementation (1,500 mg/day) improved pain scores (while symptoms with placebo worsened) and maintained radiographic joint space of the knee (while placebo users experienced significant losses). At least two studies have shown that glucosamine may even slow or stop the destruction of cartilage in the knee joints of people with osteoarthritis (Bruyere et al., 2003; Pavelka et al., 2002); this effect may be especially dramatic in patients with less severe radiographic knee damage in whom intervention is started early (Bruyere et al., 2003). In these studies, oral glucosamine supplements (1,500 mg/ day for 3 years) were shown to virtually halt the progressive joint space narrowing observed in the placebo group, suggesting a retardation of osteoarthritis progression. Studies of glucosamine supplementation in more severe forms of osteoarthritis are less positive than studies of mild to-moderate forms of the disease (Das and Hammad, 2000).



Occasional symptoms of gastrointestinal discomfort have been noted but no significant adverse effects are associated with glucosamine supple mentation. Although no long-term safety studies have been conduclec in humans, animal studies on glucosamine have found it to be nontoxic (Towheed et al., 2005). Diabetics have been cautioned about using glucosamine supplements, based on findings from several animal studies that have suggested an increase in blood sugar levels caused by glucosamine (Monauni et al., 2000). Most of the animal studies have used injections of glucosamine, and recent feeding studies in humans have shown no changes in plasma levels of glucose or insulin (Scroggie et al., 2003) insulin sensitivity (Pouwels et al., 2001), or glucose oxidation (Monauni et al., 2000), suggesting lhat glucosamine has no significant effect on blood sugar metabolism when used as directed.



No dose-response studies have been conducted with glucosamine supplements. Virtually all oral supplementation studies on glucosamine have used 1,500 mg/day, usually in 2-3 divided doses of 500-750 mg each, but some recent studies have used higher levels of glucosamine [2,000 mg/day; Braham et al., 2003) or higher levels combined with chondroitin and other ingredients (Das and 1 lammad, 2000). Although higher doses appear to be effective, there is no information to suggest that a higher dose works better or faster or that a lower dose is less effective.



Glucosamine is also routinely combined with chondroitin sulfate, but no information currently exists to suggest lhat sucli a combined formulation is superior lo either agent consumed alone at the proper dosage. There appear to be few, if any, differences among the various forms of glucosamine (sulfate, hydrochloride, N-acetyl), and each form has been shown to reduce pain and stiffness in studies of mild-to-moderate osteoarthritis (Talent and Cracy, 1996).

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Devil's Claw (Harpagophytum Procumbens)Supplements

This herb's name definitely stimulates the imagination, but imagination may not be far from reality: devil's claw produces a hard fruit with large claw like appendages that lie waiting for a passerby on which to grip and hitch a ride for dispersal, only to eventually work its way into or tear out of the skin of its host. It is native to South Africa {though unrelated "devil's claws" are found in Noith America) and traditional healers have used it to reduce pain and inflammation. Today, its anti-inflammatory attributes are being confirmed by science, and it is primarily used as an herb for the pain and inflammation of arthritis and back pain. The German Commission E has approved its claims for "degenerative disorders of the locomotor system" (Bltimenthal et al., 11J98).



Preclinical and clinical studies showed mixed results, indicating that perhaps only certain types of inflammatory disease benefit from devil's claw (Chrubasik el al., 2003). More recent clinical data, however, have indicated a benefit for back pain and osteoarthritis of die knee and hip (Chantre el al., 2000).



In a randomized, double-blind, double-placebo clinical study involving patients with low back pain, Chrubasik et al. (2003) compared a devil's claw extract (Dolotcffin) totheCOX-2 inhibitor rofecoxib. Fifty eight patients were split into two groups and given either devil's claw extract (60 mg/day) or rofecoxib (12.5 mg/day) for 6 weeks. Rescue medication of'100 mg/day of tramadol was allowed all participants. No significant differences between outcome measures were observed, but there was a trend toward greater pain reduction and fewer side effects from the devil's claw group.



A postmarketing survey was performed to assess die safety and efficacy of a proprietary devil's claw extract (Doloteffin) in 227 people suffering from back pain or osteoarthritis pain of the knee or hip. The parameters measured were several validated and unvalidated measures of pain and for joint, low back, and arthritis pain.



Symptoms. The authors concluded that 50-70% of the participants benefited from the treatment with Doloteffin, and that both the generic and disease-specific outcomes improved in all groups. Few adverse effects were reported, with 10% found to be possibly caused by Doloteffin (Ghrubasik et al., 2002a, 2000b).



Gobel et a!. (2001) examined the effect of devil's claw extract (480 mg of Rivoltan 2 times a day or placebo for 4 weeks) in a randomized, double-blind, placebo-controlled study on people with slight to moderate muscular tension or slight muscular pain of the back, shoulder, and neck. The treatment group showed clear improvement in clinical global scores and in patient and physician subjective ratings. Highly significant results were found in the test measures of the visual analogue scale, pressure algometry test, muscle stiffness test, and muscular ischemia test. The mechanism of action of the extract was reported to have an influence on sensor)' and vascular muscular response and to reduce muscle stiffness without affecting the central nervous system. No serious adverse effects were noted, and tolerability was good.



Patients suffering from nonradicular back pain were studied in an open, multicenter study of devil's claw extract (480 mg of Rivoltan 2 times a day for S weeks). Significant improvement of pain symptoms and mobility were found (using die multidimensional pain scale, Arhus back pain index, finger-floor distance, and Schober's sign). No serious side effects were found, and the authors reported that iL appeared to be an excellent herbal alternative for chronic back pain, though further studies were needed (Laudahn and Walper, 2001).



A double-blind, randomized, multicenter, comparison study was performed on a 4-month treatment of Harpadol (six 435-mg capsules per day) versus diacerhein (100 mg/day) in 122 patients with knee and hip osteoarthritis. Although there were no significant differences between the two groups in efficacy, by the end of the study, patients in the devil's claw treatment group were using significantly less of other pain medications and had fewer reported adverse effects. The authors concluded that Harpadol is safer than and equally as effective as diacerhein (Chantre et al., 2000; Ghrubasik et al., 2002a, 2002b). A similar study vas performed to compare the efficacy of devil's claw extract versus diacerhein, and after 4 months of treatment, the same overall results vere found. The devil's claw extract showed similar efficacy for knee and hip osteo arthritis and fewer side effects than diacerhein, and the need for other pain medications was reduced in the devil's claw group (Leblanetal., 2000).



In a randomized, double-blind study involving 197 patients with chronic back pain, two doses of devil's claw extract (1531, 600 and 1,200 mg containing 50 and 100 mg of the marker compound larpagoside, respectively) were compared with a placebo over 4 weeks of treatment. Using the principal outcome measure of die number of patients free from pain without using the rescue medication (tramadol), the results were 3 for the placebo group, 6 for the 600-mg group, and 10 for the 1,200-mg group. Using analysis based on the Arhus back pain index, however, the 600-mg group showed more benefits. The only minor reported side effects were mild and infrequent gastrointestinal upset (Chrubasik et al, 1999).



The typical dosage of devil's claw extract is between 600 and 6,000 mg/day (standardized between 1% and 3% of iridoid glycosides, often calculated as harpagosidc), taken in divided doses. Only mild side effects of transitory gastrointestinal upset have been reported, if any. Because devil's claw extract is able to stimulate gastric acid secretion, it is not recommended for people with ulcers.

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Thiamin Supplements

Thiamin is a water-soluble vitamin. The active variety is a phosphorylated form called thlarnin pyrophosphate, which functions in carbohydrate metabolism to help convert pyruvate to acetyl coenzyme A for entry to the Krebs cycle and subsequent steps to generate ATP. Thiamin also functions in maintaining the health of the nervous system and the heart muscle. Food sources include nuts, liver, brewer's yeast, and pork. Dietary supplements containing thiamin are frequently marketed with claims of increased energy production, maintenance of memory, and improved carbohydrate tolerance.



Because exercise and stress can tax the metabolic pathways that depend on thiamin and riboflavin, it is logical that the requirements for these vitamins maybe increased in athletes, active people, and persons exposed to acute or chronic stressors. In these groups, marginally low intakes of thiarnin and riboflavin can be corrected easily and safely by supplements containing the recommended dietary allowance (RDA) of these nutrients; for such purposes, a balanced multivitamin is the best approach.



The term B complex simply refers to a mixture or combination of the eight essential B vitamins: thiamin (Bt), riboflavin (B2), niacin (B3), pyridoxine (B6), pantothenic acid, folic acid, cyanocobalamin (B12), and biotin. Most of the B vitamins play a critical role as cofactors in cellular energy metabolism. Cofactors can be thought of as "helper nutrients" that assist chemical reactions. For example, the process of glycolysis, which converts energy stored as glycogen into glucose molecules, requires vitamin B6 and biotin. The conversion of pyruvate (a metabolite of glucose) to acetyl coenzyme A (the first step in the Krebs cycle in energy metabolism) requires pantothenic acid, and further metabolism requires biotin, riboflavin, and niacin. Lack of any of the B vitamins can cause fatigue and lethargy, which is why B-complex supplements are often promoted as "energy boosters" and "stress formulas."



Because of thiamin's role in carbohydrate metabolism and nerve function, supplements have been promoted for increasing energy and maintaining memory. It is well known that thiamin deficiency (beriberi) is associated with generalized muscle weakness and mental confusion. Although beriberi is rare in industrialized countries, there continue to be reports of the condition in the medical literature. For example, thiamin insufficiency has been reported in Chinese prisoners (Chen et al., 2003), surgical patients (Nakasaki et al,, 1997), rural Cubans (Marcais-Matos et al., 1995), Gambian children (Bates et al., 1987), alcoholics (Walden-lind et al., 1981), and older women (Wouters-Wesseling et al., 2002). In addition to these populations, which may be "expected" to have deficient thiamin intakes, other populations that have been shown to have marginal or suboptimal thiamin intake include female collegiate volleyball players (Papadopoulou et al., 2002), collegiate wrestlers (Williams, 1989), and other athletes who may be restricting energy and/or food intake (Manore, 2000; van der Beek et al., 1994). Luckily, inad-equate thiamin status is easily and rapidly corrected by thiamin supplements in the range of 50-100 mg/day (Descombesetal., 2000; Nakasaki et al., 1997; Powers et al., 1985; Waldenlind et al., 1981).



Thiamin appears to be involved in the release of acetylcholine, a neurotransmitter, from nerve cells a fact that may account for isolated studies showing thiamin supplementation to benefit cognitive functioning (Benton et al., 1995). As a coenzyme for carbohydrate and branched-chain amino acid metabolism, thiamin has been touted as both a performance and an energy supplement, but supplementation studies of subjects already at normal thiamin status have not shown a beneficial effect. Because dietary thiamin requirements are based on caloric intake, people who consume more calories, such as athletes, are likely to require higher-than-average intakes of thiamin to help process the extra carbohydrates into energy. In persons who consume "whole" forms of carbohydrates, intakes of thiamin and other B vitamins will increase along with carbohydrate intake.



During acute periods of stress, including exercise, thiamin needs may be temporarily elevated, but outright thiamin deficiencies are rare except in persons consuming a severely restricted diet. On the basis of metabolic studies (Manore, 2000), there is biochemical evidence that riboflavin and/or thiamin status is poorer in persons who exercise moderately (2~ 5 hours/week) and who diet (restrict their food intake for weight loss).



Suboptimal dietary intakes of thiamin, riboflavin, vitamin B6, and vitamin C are known to compromise physical performance with reductions in mitochondrial metabolism and aerobic power (van der Beek et al., 1994). In one study, subjects consuming a diet low in thiamin and riboflavin (55% of RDA for 11 weeks) showed 7-11% reductions in oxygen uptake and power output (van der Beek et al., 1994). Exercise has also been shown lo compromise riboflavin status an effect that may be compounded and more severely affect performance when dietary intake is marginal (Soares et al., 1993; Winters et al., 1992).



No adverse side effects are known with thiamin intakes at RDA levels or even at levels several times the RDA. The daily value (DV) for thiamin is 1.5 mg (RDA is 1.2 mg/day for men, LI mg/day for women). The Food and Nutrition Hoard (FNB) has not established an upper-limit intake level for thiamin, but a level of 50 mg has been established by the Council for Responsible Nutrition as the NOAF.L (no observed adverse effect level). Virtually every multivitamin contains thiamin at 100% DV levels (1.5 mg) or higher. Isolated supplements of thiamin are not necessary.



When it comes to defining optimal amounts of vitamins and minerals, confusion is more the rule than the exception. Before 1997, the benchmark of nutritional adequacy was the RDA, established by the I7NB, which is part of the National Academy of Sciences. In general, the RDAs have always been viewed (as judged by the FNB) "to be adequate to meet the known nutrient needs of practically all healthy persons." Because scientific knowledge regarding the roles of nutrients, and their role in health and disease, has expanded dramatically since the inception of the RDAs, a new set of terminology dietary reference intakes (DRIs) has been established. The DRIs are based on contemporary scientific studies related to the role of nutrients in reducing the risk of osteoporosis, cancer, cardiovascular disease, and other chronic conditions. DRI is a generic term used to refer to the following reference values:



Estimated average requirement (EAR): the intake value that meets the nutrient requirements of 50% of an age and gender-specific population.



Recommended dietary allowance (RDA): the intake value that meets the nutrient requirements of nearly all people in an age- and gender-specific group.



Upper intake (UL): maximum intake of a specific nutrient that is unlikely to pose health risks.



Adequate intake (Al): suggested levels of nutrient intake that are established when insufficient data exist to establish a true RDA.

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Georgiy Kharchenko - green tea caffeine, cheap phentermine, diet products

Vitamin B2 - Riboflavin Supplements

Vitamin B2, or riboflavin, is a water-soluble vitamin. It functions primarily as a coenzyme for many metabolic processes in the body, such as red blood cell formation and nervous system function. Riboflavin is involved in energy production as part of the electron transport chain that produces cellular energy. As a building block for flavin adenine dinucleotide (FAD), riboflavin is a crucial component in converting food into energy. FAD is required for electron transport and ATP production in the Krebs cycle. FAD is also the cofactor for methylenetetrahydrofolate reductase, the enzyme that catalyzes the formation of 5-methyltetrahy-drofolate and acts as a methyl donor for homocysteine remethylation. Through this methylation pathway, riboflavin supplementation, together with folate, may act to reduce plasma levels of homocysteine.



Liver, dairy products, dark green vegetables, and many seafoods are good sources of riboflavin. Dietary supplements containing riboflavin, in addition to being marketed as general nutrients, will frequently contain claims for increased energy levels, treatment of chronic fatigue, improved concentration and mood, reduced plasma homocysteine, and promotion of heart health.



The term B complex simply refers to a mixture or combination of the eight essential B vitamins: thiamin (B, riboflavin (B2), niacin (B3), pyridoxine (B6), pantothenic acid, folic acid, cyanocobalamin (B2)- and biotin. Most of the B vitamins play a critical role as cofactors in cellular energy metabolism. Cofactors can be thought of as "helper nutrients" that assist chemical reactions. For example, the process of glycolysis, which converts energy stored as glycogen into glucose molecules, requires vitamin B(l and biotin. The conversion of pyruvate (a metabolite of glucose) to acetyl coenzyme A (the first step in the Krebs cycle in energy metabolism) requires pantothenic acid, and further metabolism requires biotin, riboflavin, and niacin. Lack of any of the B vitamins can cause fatigue and lethargy, which is why B-complex supplements are often promoted as "energy boosters" and "stress formulas."



Virtually every multivitamin/mineral supplement available contains the full complement of B-complex vitamins at RDA or higher levels. It is often a better value to get B vitamins through a multivitamin supplement than as a separate B-complex supplement. This chapter on energy supplements contains information on vitamins BI and B2, while other B vitamins, such as niacin, folic acid, BG, and El2l are covered in the "B-Complex Vitamins (B, B12, Folic Acid, Niacin.



Requirements for riboflavin, like most B vitamins, are related to calorie intake; therefore, the more food consumed, the more riboflavin needed to support the metabolic processes that convert food into usable energy. Women should be aware that riboflavin needs are elevated during pregnancy and lactation as well as by the use of oral contraceptives (birth control pills). Athletes may require more riboflavin because of both increased caloric intake and increased needs of exercise.



In cases of subclinical (biochemically defined) riboflavin deficiency, daily supplementation of diets with riboflavin (with or without other B vitamins) resulted in an increase in physical work capacity (Suboticanec etal., 1990). In other studies, adding riboflavin to an antianemia regimen (dietary changes plus ferrous sulphate) resulted in a significant increase in circulating plasma iron and in iron stores (hemoglobin) compared with iron supplements alone (Powers et al., 1987). As expected, riboflavin supplements have no effect on physical performance when added to a riboflavin-adequate diet (Manore, 2000).



There is no strong support for the efficacy of isolated riboflavin supplements in promoting health besides correcting a nutrient deficiency. Despite the role of riboflavin in a variety of energy-generating processes, the role for a supplement in directly improving energy levels in a well-nourished person is unlikely.



Isolated riboflavin supplements are not necessary. Virtually all multivitamins and B-complex formulas contain riboflavin at RDA or higher levels. When it comes to supplementing with B-complex vitamins, isolated single-vitamin supplements are not recommended. A more balanced approach is to supplement with the entire B-complex spectrum simultaneously or at least with several of the B vitamins in the same supplement. High-dose supplementation with any single B-complex vitamin can interfere with the absorption of another. For example, a folic acid supplement of 400 ug/day (a common level) has been shown to exacerbate a riboflavin deficiency and elevate plasma homocysteine levels (Moat et al., 2003). Likewise, studies of combined B-vitamin supplementation (folate plus B6 plus riboflavin) generally show that this approach has a more pronounced effect on metabolic parameters, such as plasma homocyst-eine levels, than supplementing with any single B vitamin (Jacques et al., 2001).



No serious side effects have been reported for supplementation with riboflavin at levels several times above the DV of 1.7 mg. Because the body excretes excess riboflavin in the urine, high supplemental levels are likely to result in brightly colored urine (fluorescent yellow).



The DV for riboflavin is 1.7 mg (RDA is 1.3 mg/day for men, 1.1 mg/ day for women). The Food and Nutrition Board sets no LJL intake of riboflavin, but as much as 200 mg/day of riboflavin is considered safe (the NOAIiL set by the Council for Responsible Nutrition).



When it comes to defining optimal amounts of vitamins and minerals, confusion is more the rule than the exception. Before 1 997, the benchmark of nutritional adequacy was the RDA established by the FNB. In general, the RDAs have always been viewed (as judged by the I'NB) "to be adequate to meet the known nutrient needs of practically all healthy persons." Because scientific knowledge regarding the roles of nutrients, and their role in health and disease, has expanded dramatically since the inception of the RDAs, a new set of terminology ((he DRIs) has been established. The DRIs are based on contemporary scientific studies related to the role of nutrients in reducing the risk of osteoporosis, cancer, cardiovascular disease and other chronic conditions. DRl is a generic term used to refer to the following reference values:



Estimated average requirement (EAR): the intake value that meets the nutrient requirements of 50% of an age- and gender-specific population.



Recommended dietary allowance (RDA): the intake value that meets the nutrient requirements of nearly all people in an age- and gender-specific group.



Upper intake (UL): maximum intake of a specific nutrient that is unlikely to pose health risks.



Adequate intake (AI): suggested levels of nutrient intake that are established when insufficient data exist to establish a true RDA.

About the Author

Georgiy Kharchenko - lipodrene ephedrine online, phentramin d diet pills, with ephedra