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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Ribose Supplements

Ribose is a five-carbon simple sugar (a pentose) that forms the carbohydrate portion, or backbone, of RNA and DNA molecules. When combined with adenine, ribose produces adenosine, one of the components of the energy currency of the cell, ATP. Ribose is used in the body in several specific ways. It can be converted into pyruvate and enter into the pathways of energy metabolism, or it can be used to manufacture nucleotides, the primary building blocks for important structures in the body such as RNA, DNA, and ATP. As a result, ribose supplements are typically marketed for increasing energy levels, exercise endurance, and muscular power output.



Clearly, anybody concerned with managing diminished blood flow to the heart or muscle tissues would be interested in ribose supplementation. In particular, people who experience chest pain, shortness of breath, or leg pain during exercise may want to consider ribose as a daily dietary supplement. The casual or occasional exerciser is unlikely to benefit from ribose supplements except in the case of several back-to-back days of intense exercise. For the "weekend warrior," who probably has enough time between exercise sessions to fully recover ATP levels, supplemental ribose is not recommended. Competitive athletes, who may be training once or more per day, could notice very modest benefits such as increased power output and increased time to exhaustion with regular ribose supplementation (because of enhanced ATP resynthesis following exercise-induced depletion); required doses, however, are large (more than 10 g/day) and expensive.



Because ribose can serve as a precursor to adenosine (the A in ATP} and seems to stimulate the production of ATP (in laboratory studies), the theory behind ribose supplementation is that it maximizes ATP stores and therefore increases cellular energy stores for improved exercise performance and fatigue prevention.



In the cell, ATP loses its phosphate groups to generate energy. Losing one phosphate turns ATP (triphosphate) into ADP (diphosphate) and finally into AMP (monophosphate). Adenine or adenosine (no phosphates) can either be converted back to AMP or lost from the cell. The conversion back to AMP/ADP/ATP or the "salvage" of adenosine requires a ribose-containing molecule known as 5-phosphororibosyI-l-pyro-phosphate (PRPP). If this salvage does not take place, the adenosine is lost and must be converted "from scratch" a process known as de novo synthesis, which again requires the ribose-containing PRPP.



Ribose has been understudy as a therapy for cardiac ischemia (reduced blood flow to die heart) for a number of years (Pasque and Wechsler, 1984). The data from those studies clearly indicate that ribose can help improve heart function during and following periods of reduced blood flow and oxygen delivery (Erickson, 1990), Under conditions of constricted blood and oxygen flow to heart and muscle tissue, ATP levels have been shown to decrease by as much as 50%. This finding is not unexpected, but the fact that creatine phosphate levels recover relatively quickly while ATP levels may remain depressed for several days suggests that adenosine levels may not be adequately maintained. In animal studies, supplemental ribose permits recovery of approximately 85% of normal ATP levels within 24 hours following restricted circulation.



In patients with coronary artery disease, supplemental ribose allows subjects to exercise forsignificandy longer periods than they could before they consumed ribose and longer than subjects who consumed a placebo supplement (Pliml et al., 1992). During intense exercise, ATP levels are reduced 10-20%, which may be attributed to the loss of adenosine and inadequate resynthesis of ATP (Wagner et al., 1991). In some muscle fibers, complete resyndiesis of ATP may require 24-96 hours (1-4 days) to fully recover from exhaustive exercise. Supplemental ribose has the potential to increase the rate of adenosine production and ATP synthesis following exhaustive exercise by approximately 3-4 times, meaning that recovery of ATP stores can be reduced from 1-4 days to 6-24 hours (Wagner et al., 1991).



Because ribose is found in all cells of the body, it is generally recognized as a nontoxic substance. Supplemental doses of as much as 60 g/day have been given with no significant side effects (Erickson, 1990). At such high levels, die possible occurrence of gastrointestinal distress, diarrhea, and hypoglycemia are more likely. For purposes of maintaining elevated levels of ribose in the blood, smaller doses of 3-10 g/day of ribose are common in commercial dietary supplements, but as noted earlier, the clinical evidence for energy or endurance benefits of such doses in healthy subjects has been disappointing.

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Tribulus - Tribulus Terrestris

Tribulus is a traditional Chinese medicinal herb that has gained attention lately for its uses in enhancing sexual and athletic performance and treating painful urination and as a general tonic (Anand et ah, 1994).



The main active components in tribulus appear to be steroidal saponins and protodioscin. Tribulus has been proven to improve sexual desire and erectile function by converting protodioscin to DHEA. Both phyto-chernicals have been shown in preclinical tests to stimulate sexual desire and function .



Few well-designed studies have been conducted on Tribulus terrestris for its primary indications of sexual performance and athletic performance. Of the few human clinical studies involving treatment with only tribulus, the results were favorable. A few other studies exist in the areas of sexual performance and athletic performance, but they used tribulus in a mixture with other supplements, and it is not known how much the tribulus contributed to the clinical results. Of note, a heart drug made from Tribulus terrestris saponins is being recommended for clinical therapy and prevention of atherosclerosis in Russia (Kern ertelidze et al., 1982). Overall, even though tribulus is one of the most popular ingredients in supplements for bodybuilding, clinical support to back up its claims is still lacking.



Sexual Performance

Nikolova and Stanislavov (2000) performed a clinical study involving 51 patients using an extract of Tribulus terrestris (Tribestan) and found statistically significant improvement in parameters to measure infertility.



The use of tribulus treatment over 3 months produced reductions in the leukocyte count and the locally secreted immunoglobulins, elevation of tt-amylase levels, and normalization of seminal parameters. The authors noted that the treatment with Tribulns terrestris extract had a side benefit of improving overall male health, indicated by decreased cholesterol and triglyceride levels and elevated levels of lipoproteins by the end of the study.



Stanislavov and Nikolova (2000) reported thai in 15% of the infertile couples in Russia, 9% of males and 15% of women showed signs of infertility that might have been the result of imrnunological health. In a study of a cohort of this group, Tribulus terrestris extract (Tribestan) was chosen because of the presence of furostanol compounds in the plant and the absence of reported toxicity in humans. As a result of treatment, conception was reportedly good in these couples, especially when the males had high liters of sperm antibodies. The authors noted that due to the good results, they recommended treatment in similar cases in practice.



In a double-blind study with Tribulus terrestris, 45 men with fertility problems {moderate idiopathic oligozoosperms) were given a dry-powder extract or a placebo. After 3 months of treatment, 7 of the 36 men treated successfully conceived with their wives. In the treatment groups, significant increases in normal acrosome morphology and aero-some reaction test were found.



Athletic Performance

Ten highly trained cyclists were given a supplement of Tribulus terrestris and ipriflavone or a placebo for 38 days. Cyclists in the active group improved hormonal markers of overtraining and performance during the period of intense training and competition (McGregor et al., 2000). Street et al. (2000) gave capsules containing 250 mg of Tribulus terrestris, 100 mg of 7-ispropoxyisofavone, 100 mg ofAvena saliva, and 50 mg of saw palmetto to two bodybuilders to determine the effect of the supplement on plasma testosterone and luteinizing hormone. As part of the normal weight-lifting regime, the supplements were administered for 2 weeks, 8 capsules 2 times daily. The luteinizing hormone and plasma



Sports Supplements

Testosterone tevels were found not to change within the period of supplementation, nor were biochemical measures of liver function changed.



Hor a standardized extract (60% saponins), the dosage is 100-500 mg 3 times daily; an unspecified preparation of tribulus was used in a couple of clinical studies at the dosage of 750-1,350 mg/day along with other supplements (Brown et al., 2000, 2001a, 2001b, 2001 c).



The only reported side effect of tribulus is frequent urination, and because of its diuretic properties, tribulus is not recommended in cases of dehydration (Singh and Sisodia, 1971). There are no known drug interactions with tribulus.



Possible association with hepatotoxicity, photosensitization, and a disease called geeldikkop have been made with the ingestion of large amounts of tribulus by sheep but have never been confirmed (Bourke, 1984; Clastonbury, 1984).

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Dietary Supplements Containing Inosine

Inosine is part of a chemical family called purine nucleotides and acts as a precursor to adenosine, an important molecule for cellular energy. Inosine can be found in brewer's yeast and organ meats, such as liver and kidney, and is available as a supplement in its purified form.



Dietary supplements containing inosine are often marketed with claims for increased energy levels and endurance performance, enhanced adenosine triphosphate (ATP) production, improved heart function, and reduced lactic acid accumulation during intense exercise.



Many of the effects attributed to inosine stem from its potential role in increasing levels of a compound known as 2,3 diphosphoglycerate (DPG) in red blood cells. An enhanced 2,3 DPG level would ease the release of oxygen from the blood cells to the tissues and, in theory, enhance energy generation, promote lactic acid removal, and improve exercise performance overall.



Because there are no convincing studies demonstrating the beneficial effects of inosine as a dietary supplement, it is not recommended as a stand-alone dietary aid. Inosine is commonly contained as part of an overall mixture of ingredients in dietary supplements that may contSeveral studies have investigated the effects of inosine supplementation on aerobic performance in athletes, yet none have shown convincing benefits associated with the supplement. In at least two studies, a potential for inosine to interfere with energy metabolism was suggested, particularly in high-intensity sprint-type events.



Inosine has many possible metabolic roles in the body. Preliminary information suggests that inosine might stimulate axon growth from healthy nerve cells to injured nerve cells in the brain and spinal cord of the central nervous system (Bianchi et al., 1999). It penetrates the cell walls of both cardiac and skeletal muscles, where it promotes the generation of ATP, the energy substance that allows muscles to contract (Febbraio and Dancey, 1999; Norman, 1995). It also serves as a precursor ribute to energy metabolism.



Hypoxanthine, which may be phosphorylated into the nucleotide inosine monophosphate (IMP). IMP is claimed to be an important regulator between adenine and guanine nucleotide synthesis and may lead to the formation of ATP. Increased production of ATP leads to improved respiration and oxygen transport and serves to enhance all athletic performance, whether aerobic or anaerobic in nature. IMP also helps to maintain glycogen breakdown by activating phosphorylase b and increasing the formation of uric acid.



Inosine also contributes to erythrocyte metabolism by promoting the production of 2,3 DPG, which is necessary for die transport of oxygen molecules from the red blood cells to the cell for energy. Both inosine and hypoxanthine are believed to be vasodilating agents, which may enhance blood flow to the heart and skeletal muscles and lead to improvement of various heart conditions (Iwasa et al., 1997; Kipshidze et al, 1978).



A double-blind, placebo-controlled, crossover trial was conducted on 9 highly trained endurance runners to investigate the ergogenic effect of oral inosine supplementation on a 3-mile run time and oxygen uptake (VO2) peak. Each patient underwent four trials, which followed the same protocol and measured three separate tests within each trial: a 13-rninute subrnaximal treadmill warm-up, a 3-mile treadmill run test, and a maximal treadmill run to test VO2 peak. Patients were instructed to prepare for each trial as if preparing for a race. The patients were given 6,000 mg (3 doses of 2,000 mg) of inosine per day for 2 days or matching placebo prior to testing. The last dose was taken within 2 hours of testing. The results showed no significant effect of inosine in the 3-mile treadmill run test or in the maximal VO2 peak test (Williams et al., 1989).



Another randomized, double-blind, placebo-controlled, crossover trial was conducted in 7 healthy male volunteers to evaluate the use of inosine over a period of 5-10 days at a dosage of 10,000 mg/day on measures associated with aerobic and anaerobic performance. All patients completed three trial sessions, which included a series of three stationary cycling performance tests; a 5-6-second sprint, a 30-second sprint, and a 20-minute time trial. These trial sessions were completed prior to the study (at baseline), on days 6 and 11. Patients completed the performance tests after supplementation with inosine (two equal doses taken early morning and late afternoon, dissolved in orange juice) or a placebo. Each trial was separated by a 6-week washout period. The results showed no significant differences for any of the variables measured. It was concluded that inosine has no ergogenic effects, does not improve performance, and may cause possible health problems if taken over long periods (McNaughton et al., 1999).



A similar double-blind, placebo-controlled, crossover trial was performed on. 10 competitive male cyclists. These patients completed a bike test, a 30-minute self-paced cycling performance, and a supramaximal cycling sprint following 5 days of oral supplementation with 5,000 mg/ day of inosine and a matching placebo. The results showed no differences between the inosine and placebo groups within each test performed(Starling et al., 1996). These findings demonstrate that prolonged inosine supplementation does not appear to improve aerobic performance and short-term power production during cycling.



Another 8-week, double-blind, placebo-controlled, crossover trial was conducted to examine the effects of the Coenzyme Athletic Performance System (CAPS) on endurance performance to exhaustion. Eleven highly trained male triathletes were given 3 daily doses of CAPS or a matching placebo for two 4-week periods. CAPS consisted of 100 mg of coenzyme QlO, 500 mg of cytochrome C, 100 mg of inosine, and 200 III of vitamin E. A 4-week washout period separated the two treatment groups. After each treatment period, an exhaustive performance test consisting of a 90-minute treadmill run followed by cycling until exhaustion was performed. The results showed that the mean time to exhaustion and blood parameters for the patients using CAPS were not significantly different from the placebo group. In conclusion, CAPS had no apparent benefit on exercise to exhaustion (Snider et al., 1992).



The overall results obtained from these trials suggest that the anecdotal effects of inosine as stated by athletes and manufacturers hold little weight when tested in the laboratory'-. Therefore, inosine supplementation has no athletic performance benefit and may be detrimental to general health.



According to Japanese researchers, inosine may be used as a treatment for various heart conditions. A study was performed to evaluate the effect of the nucleoside inosine on the intracardiac hemodynamics and the contraction and relaxation of a diseased myocardium. The study included 102 patients with a macrofocal myocardial infarction. Twenty-two patients received inosine by intravenous drip in a single dose of 200 mg in the acute stage of infarction, SO patients were given inosine pills in a daily dose of 800 mg in the restoration period for 1 month, and 20 patients were given a placebo. Comparative appraisal of treatments showed prevailing improvement in die condition of patients treated with inosine. These patients had positive EGG dynamics, increased cardiac output, and decreased peripheral resistance. Inosine achieved maximum effect by 60-90 minutes after the beginning of the infusion (Yabe and Yoshimura, 1981).



Another study administered 200 mg of inosine through a central vein to 16 patients with various cardiac diseases, including effort angina pectoris, myocardial infarction, valvular disease, idiopathic cardiomyopathy, and congenital heart disease. Left ventricular performance was assessed by the time course of various hemodynamic parameters, including ejection fraction. The results demonstrated that inosine caused a significant decrease in pulmonary wedge pressure, left ventricular end-diastolic pressure, and systolic left ventricular pressure. Inosine caused increases in all of the other hemodynamic parameters, such as cardiac output and ejection fraction. Quantitative evaluation disclosed the beneficial effects of inosine on the left ventricular function through the remarkable load-reducing effect and the unequivocal positive inotropic effects (Iwasa et al., 1997). In general, supplemental inosine appears to be safe at doses of as much as 5-6 g for several weeks. In susceptible people, however, inosine supplementation may lead to buildup of uric acid levels. Uric acid is a byproduct of inosine metabolism and may lead to painful symptoms of gout, such as arthritic joints and toes caused by deposits of uric acid crystals.

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Dietary Supplements: Nicotinamide Adenine Dinucleotide (NADH)

NADH is the abbreviation for nicotinamide adenine dinucleotide, with the H indicating the reduced form that has an extra hydrogen atom. NADM functions as a coenzyme, meaning that it is a required cpfactor for a metabolic process. In the case of NADH, coenzyme functions include roles in energy generation and the production of neurotransmit-ters such as dopamine and norepinephrine. Thus, NADH supplements are generally promoted for increasing energy levels, reducing CFS, treating jet lag, and enhancing memory and cognitive function.



NADH supplements typically cost about $1 per 5-mg dose; therefore, an effective dose of the supplement may cost between $2 and $4 per day. Because of the nonexistence of any reliable treatment for chronic fatigue syndrome, the preliminary antifatigue benefits of NADH are promising. Nevertheless, the preliminary nature of these results also means that NADH may be most useful as an adjunct to more established antifatigue supplements such as cordyceps, rhodiola, and ginseng.



The precise cause of CFS is unknown (Calabrese et al., 1992). Symptoms include prolonged and debilitating fatigue, inability to concentrate, flu-like symptoms, muscle weakness, joint pain, headaches, and sleep disturbances (Chester, 1997; Komaroff and Buchwald, 1991). CFS affects about 500,000 Americans, but no effective treatment is known (Gantz and Holmes, 1989; Houde and Kampfe-Leacher, 1997). Researchers theorize that CFS stems from a lack of the chemical responsible for cellular energy, ATP (Klonoff, 1992). One theory is that both infections and stress deplete cellular ATP levels and lead to chronic fatigue, and that supplemental levels of NADH can stimulate ATP production and provide benefits to people suffering from fatigue and cognitive dysfunction (Colquhoun and Senn, 2000). Further benefits from NADH may stem from its role in stimulating the production of the neurotransmitters dopamine and norepinephrine (involved in brain function and memory) as well as from the stimulation of tyrosine hydroxylase, an enzyme involved in synthesizing neurotransmitters (Birkmayer el al., 2002).



Among the dozen or so clinical reports of NADU supplementation, however, only two arc randomized, double-blind, placebo-controlled trials (Birkmayer el al., 2002; Forsyth et a!., 1999). Of the many open-label studies of NADU administration to patients with Alzheimer disease, dementia, or Parkinson disease, most of the studies showing a positive effect come from the same clinic in Austria {Birkmayer et al., 2002), and the dosing regimens include oral as well as intravenous, parenteral, and intramuscular routes of administration. The positive benefits of NADU supplementation in these open-label studies have not been duplicated by other clinics or laboratories, and some open-label studies have shown no benefit of NADH supplements (10 rng/dayfor3 months) in cases of mild-to-moderate Alzheimer disease (Rainer et al., 2000).



In the two existing well-controlled studies of NADH supplementation, 10-20 mg of NADH showed some promising antifatigue effects. In one study {Forsyth et al., 1999), 10 mg/day of NADH for 4 weeks was effective in alleviating generalized symptoms of CFS in about one third of patients. In another study (Birkmayer el al., 2002), a 20-mg acute dose of a sublingual form of NADH improved cognitive function, mood, and sleepiness in subjects suffering from jet lag.



Some people report mild side effects such as nervousness and loss of appetite in the first few days of taking NADH. No serious side effects are documented, and animal studies have shown no problems associated with NADH supplementation (Birkmayer and Nadlinger, 2002). Commercial NADH supplements are generally available in 2.5-mg and 5-mg tablets, with suggested dosages ranging from 2.5-15 mg/day, depending on individual requirements (e.g., therapy or maintenance).

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Dietary Supplements: Rhodiola

Rhodiola comprises more than 200 related species of plants in the Crassulacea family and is generally found in the arctic mountain regions of Siberia (Kelly, 2001). Of the many species of rhodiola, only two have been studied at any appreciable level in humans: Rhodiola rosea and Rhodiola crenulalci ("Rhodiola rosea," 2002) The root of the plant is used medicinally and is also known as arctic root, golden root (for rosea), and more recently, crenulin (for crenulata). Rhodiola has been used for centuries to increase the body's resistance to physical and mental stresses (Zhang et al., 1989), As a modern-day dietary supplement, rhodiola is typically promoted for boosting energy levels, relieving stress and anxiety, and enhancing athletic performance.



Rhodioln roscn extract appears to be valuable as an adaptogen, increasing the body's ability to deal with a number of psychological and physiological stresses. Of particular value is the theoretical role of rhodiola in increasing the body's ability to take up and use oxygen, an effect similar to that of cordyceps, which may explain some of the nonstimulant "energizing" effects attributed to the plant. Rhodiola is often called the "poor man's" cordyceps based on ancient stories in which "commoners" used rhodioia for energy because the plants grew wild throughout the Rhodiola is typically considered an adaptogen (like ginseng) and is believed to invigorate the body and mind to increase resistance to a multitude of stresses. The key active constituents in rhodiola are believed to be rosavin, rosarin, rosin, and salidroside (Kelly, 2001), which are reported in animal studies to influence levels of neurotransmitters (serotonin, dopamine, and norepinephrine), catecholamines, and free radicals (Maslova et al., 1994; Ohsugi et al., 1999; Rege et al., 1999)



Unfortunately, most of what we know about the clinical effects of rhodiola supplementation comes from a handful of small studies in which standardized extracts of both Rhodiola rosea and Rhodiola crenulata have been shown to increase cognitive function and mental concentration while reducing feelings of general fatigue (Darbinyan et al., 2000, Spasov et al., 2000a, 2000b). One of the theoretical mechanisms of action for rhodiola's antifatigue effects is an enhancement of oxygen efficiency; although some studies have observed this effect (Ha et al., 2002), other studies have not (Wing et al., 2003). A possible reason for the discrepancy in these results is study design, with positive-effect studies tending to have larger numbers of subjects, longer durations of supplementation, and more complete characterizations of study materials (standardized Rhodiola extracts).



For example, one study of rhodiola followed 15 subjects supplemented with rhodiola for 7 days under simulated high-altitude conditions (4,600 meters) and found a reduction in hypoxia-induced oxidative stress but no change in hemoglobin saturation or blood oxygen levels (Wing et al., 2003). In contrast, a similar study (Ha et al., 2002) of 24 subjects living at a higher altitude (5,380 meters) for a longer duration (1 year) showed a beneficial effect of rhodiola supplementation on blood oxygen levels when rhodiola was given over a longer period (24 days).



Another significant factor among the handful of clinical studies on rhodiola is the material being studied, with well-characterized extracts (standardized to salidroside, rosavin, and other active/marker compounds) showing significant beneficial effects, while less well-characterized material (nonstandardized extracts and raw rhodiola root) tending to show modest or no beneficial effects. For example, three well-controlled studies of a standardized extract of Rhodiola rosea have shown benefits in reducing mental and physical fatigue in physicians working night duty (Darbinyan et al., 2000) and students under stress (Spasov et al., 2000a, 2000b).



Rhodiola rosea extract is thought to be quite safe. There are no known contraindications or interactions with other drugs or herbs, but there are anecdotal reports of mild allergic reactions (rashes) in some persons.


General dosage recommendations for extracts of both Rhodiola rosea and Rhodiola crenulata are typically in the range of 100-600 mg/day. Ideally, a standardized Rhodiola extract is preferred, with the best efficacy demonstrated for extracts with active/marker compounds in the ranges of 3-6% rosavin and 1-2% salidroside (Kelly, 2001).

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Dietary Supplements: Buckthorn

Sea buckthorn is a small shrub that produces berries used in Traditional Chinese Medicine and known since ancient Greek times for its ability to enhance energy, promote weight gain, and heal the skin and make it look younger. In more modern times, studies have found that it may be a good antioxidanl and that it contains palmitoleic acid, a rare fatty acid that is a component of our skin and promotes skin health. Other uses for sea buckthorn include promoting cardiovascular health, healing ulcers, and protecting the skin against damage from the sun's ultraviolet rays. Sea buckthorn oil is high in vitamin E, carotenoids, sterols, and the fatty acids: palmitic (16:0), oleic (18:ln-9), palmitoleic (16:ln-7), linoleic (18:2n-6), and a-linolenk (18:3n-3; Johansson et al., 2000).



Clinical research has not substantiated the claims for sea buckthorn as an energizer; however, experimental and clinical studies have found that it shows promise for promoting cardiovascular health, antioxidant functions (antiaging, cardiovascular), and as a wound and tissue healer.



Wound Healing and Dermatitis Treatment

A synthetic preparation of sea buckthorn oil (Aekol) was compared in a clinical setting on the treatment of 41 patients with natural sea buckthorn and standard wound-healing remedies. The patients studied exhibited various wound-healing complications, including open injuries on their limbs, pyoderma or necrosis from skeletal trauma, and tissue necrosis after operations. From the study ofvarious clinical and biochemical parameters for wound healing, it was concluded that Aekol exhibited a similar efficacy as natural sea buckthorn extract and far exceeded the traditional remedies (Kostrikova et al., 1990).



Yang et al. (2000) conducted a placebo-control led parallel study to examine the effect of the daily ingestion of 5 g of sea buckthorn seed oil compared with pulp oil or paraffin oil for 4 months. The outcome measure was the fatty acid composition of skin glycerophospholipids in patients with atopic dermatitis before and after treatment. The seed oil ingestion caused only a slight increase in docosapeniaenoic acid (22:5n-3) and a decrease in palmitic acid (16:0). The authors concluded that the composition of glycerophospholipids in the skin is well buffered and not significantly affected by short-term dietaiy changes.



Yang et al. (1999) studied the effect of daily supplementation for 4 months of 5 g of either sea buckthorn seed oil, pulp oil, or paraffin oil on atopic dermatitis. In a placebo-controlled, double-blind study, the clinical evaluation of each treatment on atopic dermatitis was evaluated, as well as changes in plasma and skin lipid content. The sea buckthorn seed oil was characterized as high in linolek (34%), a-linolenic (25%), and oleic (19%) fatly acids, whereas the pulp oil was high in palmitic (33%), oleic (26%), and palmitoleic (25%) fatty acids. Significant improvements were observed for dermatitis symptoms in the groups treated with pulp oil and paraffin oil, but no changes in the seed oil group were noted. No changes were detected in levels of triacylglycerols, serum total, or specific immunoglobulin E in either of the groups.



Cardiovascular Health

Johansson et al. (2000) studied the effect of sea buckthorn berry oil (supercriiical carbon dioxide extracted) on risk factors of cardiovascular disease in a pilot clinical study. After a treatment period of 4 weeks, the ingestion of 5 g of sea buckthorn oil was found to have no effect on phospholipid fatty acids, plasma lipids, or glucose. The treatment group, however, did show a marked decrease in the rate of adenosine-5'-diphos-phate-induced platelet aggregation and maximum aggregation.



The effect of supplementation of the total flavone fraction of sea buckthorn was studied on the sympathetic nerve activity in hypertensive patients. Specifically, the authors were investigating whether this fraction was able to exert an inhibitory effect on sympathetic activity after supine isometric exercise. The 88 participants were given the sea buckthorn flavone extract, nifedipine, orverapamil. After 8 weeks of treatment, the sea buckthorn flavone extract was found not to alter the sympathetic activity in the treatment of hypertension, but it did exhibit an inhibitory effect on the sympathetic activity after supine isometric exercise. The authors noted that for this reason, sea buckthorn flavones might provide a clinical benefit (Zhang et al., 2001).



Hccleston et al. (2002) studied the antioxidant profile of sea buckthorn juice and its effect on various biochemical markers in cardiovascular health: plasma lipids, low-density lipoprotein (LDL) oxidation, platelet aggregation, and plasma soluble cell adhesion protein concentration. This study was in response to the growing evidence that antioxidanl nutrients were able to affect cell response and gene expression relating to the oxidative processes that contribute to atherogenesis. After 8 weeks of treatment with sea buckthorn juice, there were no significant changes in plasma total cholesterol, LDL-C, platelet aggregation, or plasma.



Because few clinical studies have been performed on sea buckthorn, and because it has a diversity of potential uses, the optimal dosage recommendations are difficult to ascertain. Generally, it is taken orally, about 250-500 mg/day as an energy promoter, and up to 1 g or more as a topical skin protector or wound healer.

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Ginseng Supplements

Ginseng refers lo a group of adaptogenic herbs from the plant family Araliacae. Commonly, the term ginseng refers to "true" ginseng (Panax ginseng C.A. Meyer), as well as to a related plant called Siberian ginseng (Eleutherococcus seniicosus, or eleuthero for short). Medicinal preparations are made from the roots of the plants. Panax ginseng has been used in Traditional Chinese Medicine (TCM) for thousands of years as a tonic indicated for its beneficial effects on the central nervous system, protection from stress, antifatigue action, enhancement of sexual function, and acceleration of metabolism.



Siberian ginseng did not come into the picture as a botanical remedy until the twentieth century. Found in the northern regions of the former Soviet Union, the roots of Eleutherococcus seniicosus were sought out as a cheaper substitute for the expensive Oriental ginsengs. Soviet researchers found Siberian ginseng to be an excellent tonic to enhance athletic performance as well as to strengthen the body during times of stress.



Several other "ginsengs" are used as adaptogenic tonics throughout the world; among them are Panax quinquefolium (or Panax fjuijiquefoiius, also known as American ginseng, with a rich history of use by Native Americans) and ashwagandha, sometimes called Indian ginseng (not a true ginseng but with a long history of medicinal use by ayurvedic healers in India).



American ginseng is the most similar to the true Panax ginseng and is highly prized in the Orient, where it is thought to provide a "cooler" invigoration than the native Panax ginseng (considered "warming" by traditional Chinese healers).



In general, the various ginseng supplements available in the U.S. market are claimed to increase energy levels, relieve stress, enhance athletic performance, enhance immune system function, control blood sugar, improve mental function, and promote general well-being. In most of these functions, ginseng, whether Siberian, Panax ginseng, or one of the other varieties, is often termed an adaptogen a therapeutic and restorative tonic generally thought to produce a "balancing" effect on the body. The properties typically attributed to adaptogens are a nonspecific increase in resistance to a wide range of stressors (including physical, chemical, and biological factors) as well as a "normalizing" action irrespective of the direction of the pathological changes. In general, an adaptogen can be thought of as a substance that helps the body adapt to stress.



Among the many herbs promoted as energy boosters, Asian ginseng is by far the most popular. Although the term ginseng actually encompasses a family of roots, Panax ginseng, the type grown in China, Korea, and Japan, is die type generally known for its energetic and antistress properties. In TCM, Panax-ginseng is used as a tonic properties. In general terms, an adaptogen is a substance that boosts energy and aids in combatting stress and remaining calm. The research on ginseng's benefits as a tonic and energy booster is equivocal. Some studies have shown benefits in increasing energy levels in fatigued sub jects (Vogler et al., 1999; Wang et al., 1983), but most studies on ginseng as an aid to athletic performance have shown no effect (Bahrke and Morgan, 2000). The differences among study findings may have been the result of many commercially available ginseng supplements actually containing little or no ginseng at all; many researchers often take it for granted that a given product selected off the shelf for study will actually contain what it claims (not always a good assumption). The clearest indication that a supplement contains something other than real ginseng is the price; ginseng root is a very expensive ingredient, and "bargain" ginseng products may not contain real ginseng, enough ginseng, or the active saponin compounds that are thought to deliver ginseng's antifatigue and adaptogenic effects.



Siberian ginseng (eleuthero), is not truly ginseng (it is a shrub, rather than a root) but it is a close enough cousin (same botanical family but different genus) to deliver some of die same energetic benefits. Eleuthero is used in popular sports supplements. The Siberian form of ginseng is generally a less expensive alternative to true Asian or Panax ginseng, though it may have more of a stimulator;' effect rather than an adaptogenic effect (not necessarily a bad thing if you just need a boost). Often promoted as an auhletic performance enhancer, eleuthero may also possess mild-to-moderate benefits in promoting recover}' following intense exercise, perhaps the result of an enhanced deliver}' of oxygen to recovering muscles.



Ashwagandha is an herb from India that is sometimes called Indian ginseng, not because it is pan of the ginseng family but to suggest energy-promoting and stress-reducing benefits similar to those attributed to the more well-known Asian and Siberian ginsengs. Although there has been very little human research done on ashwagandha, herbalists and natural medicine practitioners often recommend the herb to combat stress and fatigue, and it does appear to be particularly suited as a relaxant following stressful events.



Although the scientific evidence for the benefits of ginseng and its mechanisms of action can be considered inconclusive, the adaptogenic role of the various ginseng strains have proven beneficial for many thousands of years and may therefore prove valuable as normalizing substances during stressful conditions.



The active components in Panax ginseng and American ginseng are thought to be a family of triterpenoid saponins that are collectively referred to as ginsenosides. In general, most of the top-quality ginseng products, whether whole root or extract, are standardized for ginsenoside content. The active components in Siberian ginseng are considered to be a group of related compounds called eleutlierosides. It has been theorized that ginseng's action in the body is the result of its interaction within the hypothalamic-pituitary axis to balance secretion of adrenal corticotropic hormone (ACTH). ACTH has the ability to bind directly to brain cells and can affect a variety of stress-related processes in the body. These behaviors might include motivation, vitality, performance, and arousal.



In a widely cited, though poorly conducted, study of student nurses on night duty, 1,200 mg/day of Panax ginseng appeared to improve general indices of stress and mood disturbances (Coleman et al,, 2003). Levels of free fatty acids, testosterone, and blood sugar, which were all elevated by night work, were significantly reduced to the levels observed under day work. In another study, 2,700 mg/day of Panax quinquefoUus was able to reduce blood sugar levels and insulin requirements in a group of diabetic subjects following 3 months of supplementation (Vuksan et al., 2000). One study of the effects of 200 mg/day of Panax ginseng extract for 12 weeks showed improvements over baseline values of mental performance: attention, mental processing, logical deduction, and both motor function and reaction time (Kennedy and Scholey, 2003).



Over a period of several decades, German and Soviet researchers have studied the effects of ginseng extract, typically standardized to 4% ginsenosides, on the performance of athletes. One study compared 200 mg/day of eleuthero versus a placebo in 14 highly trained male athletes (Dowling et al., 1996). The ginseng group showed an increase in maximum oxygen uptake compared with the placebo group as well as a statistically significant improvement in recovery time and lower serum lactate values. Other studies in various groups of young athletes have shown ginseng extract to provide statistically significant improvements in performance measures, such as forced vital capacity and maximum breathing capacity, compared with the placebo groups (Pieralisi et al., 1991; Ziemba et al., 1999).



In a double-blind, placebo-controlled, crossover study (8 weeks on treatment, 2 weeks of washout, and 8 weeks on treatment), 45 patients were given 900 mg of ginseng 3 times a day. Mean International Index of Erectile Function scores were significantly higher in patients treated with the ginseng than those who received a placebo. The authors concluded that ginseng may be an effective alternative for treating male erectile dysfunction (Hong et al., 2002).



An open study consisting of 36 children ranging from 3 to 17 years old were given a combination product containing Panax quinquefolium (200 mg) and Ginkgo ttloba extract (50 mg) to be taken twice daily for 4 weeks. At the beginning of the study, after 2 weeks, and then at week 4, parents completed the Conners' Parent Rating Scale. After 4 weeks of treatment, the proportion of subjects exhibiting improvements ranged from 44% for the social problems attribute to 74% for the Conners' attention-deficit/ hyp era ctivity disorder (ADHD) index and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-JV) hyperactive-impulsive attribute. The authors concluded that the combination treatment may improve symptoms of ADHD and that further research on the combination should be done (Lyon et al., 2001).



Unfortunately, the scientific evidence for ginseng is far from definitive. For every study showing a positive benefit in terms of energy levels and/ or physical or mental performance, there is at least one other study showing no benefits (Bahrke and Morgan, 2000). Part of the discrepancy in results from well-controlled studies may have to do with differences among the ginseng extracts used in various studies (nonstandardized extracts with unknown quantities of active components).

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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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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.

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Brewer's Yeast Supplements

Brewer's yeast is not the same as the baker's yeast that makes bread rise or the yeast that causes yeast infections. It is just what it sounds like it should be the yeast used in making beer. Because of the different methods used in its culture, it can vary in its nutritional profile; however, it tends to be a good source of several B vitamins and a few minerals: thiamin (B,), riboflavin (B2), niacin (B3), folic acid, pyridoxine (Bfi), B12, chromium (known as glucose tolerance factor [GTF]), copper, iron, and zinc.



Most of the clinical work that has been performed on brewer's yeast has been for its potential use as a source of organic chromium, which has been theorized and confirmed in several studies to improve glucose cohtrol and lipid values. It is this application that has led to claims about brewer's yeast being good for reducing blood sugar and cholesterol. One study suggests its beneficial role in athletic recovery. The energy claims made on brewer's yeast are yet unfounded by clinical research.



One product made from brewer's yeast that is not included in this review is called brewer's yeast cell wall. It is a byproduct of producing brewer's yeast extracts and is being promoted as a functional food for modulating the immune system, controlling cholesterol, and promoting healthy intestinal flora (Tomohiko et al, 2000, 2001).



AcneWeber et al. (1989) studied the effects of a maximum of 5 months of brewer's yeast supplementation (Saccharomyces cerevmae Hansen CBS 5926 [Perenterol]) in 139 patients with acne. Physicians' rating of the results on the treatment group was very good or good in 74% of the patients versus 21.7% in the placebo group. In the treatment group that was rated very good or good, 80% of the patients were considered healed or very much better compared with only 26% of the placebo group that was rated very good or good.



Athletic Recovery and Antioxidant

In a nonblinded, controlled study, the effect of an undefined yeast cell preparation (high in antioxidant vitamins, antioxidant enzymes, trace elements, and minerals) on the stress reaction and antioxidant status of nine highly trained athletes was studied. Venous blood samples were drawn and tested in the resting state after an overnight fast followed by a 15-km cross-country race. The treatment with the yeast cell preparation gave an improvement in the systemic and muscular stress reaction, reflected by a lower soluble interleukin-2 receptor and plasma fibrinogen and higher plasma fibronectin in the resting state, and a significant difference in fibrogen and fibronectin 1 hour after the race. Myoglobin, CKMM3, and mangan superoxide dismutase were reduced, reflecting a decrease in free-radical stress (Konig et al., 1999).



Blood Sugar and Diabetes

The effect of daily chromium supplementation (either brewer's yeast containing 23.3 u.g of chromium, or carbon tetrachloride providing 200 u.g of chromium) was tested on glucose tolerance, serum lipids, and drug dosage in 78 type 2 diabetes patients. The study was a double-blind, placebo-controlled, crossover design that lasted 32 weeks. The authors concluded that the supplementation with chromium resulted in better control of glucose and lipid variables, with decreases of drug dosages (to the point that some subjects no longer needed insulin). The brewer's yeast supplementation of chromium increased the time chromium was retained in the body and extended the beneficial effects as a result.



The effect on serum glucose and lipids of brewer's yeast supplementation (10 g/day for 12 weeks) was studied in a controlled (torula yeast) study of 22 Chinese adults. Blood was drawn before the glucose load and at 30-, 60-, 90-, and 120-minute intervals after. The treatment group resulted in decreases in serum triacylglycerol values and in 60- and 90-minute values of oral glucose tolerance testing (Li, 1994).



Rabinowitz et al. (1983) studied the effect of chromium supplementation on carbohydrate utilization in a double-blind, random, crossover trial involving 43 men. This study was conducted because of the observation of diabetes resulting from chromium deficiency in experimental animals and humans during long-term parenteral nutrition. The groups were given either inorganic chromium (chromium trichloride), a brewer's yeast containing GTF (an organic form of chromium), a brewer's yeast not containing GTF, or a placebo. The patients were further split into subgroups of 21 ketosis-prone men, 7 ketosis-resistant nonobese men, and 15 ketosis-resistant obese men. Chromium levels were found to increase In the body pools of the men from treatment with either organic or inorganic forms of chromium by about 25%. Additionally, in the ketosis-resistant subgroups, there was a significant increase in postprandial insulin from treatment with brewer's yeast that contained GTF. No effects were found, however, on carbohydrate metabolism in any of the groups.



In one study of 23 elderly people, the effect on glucose tolerance, insulin, cholesterol, and triglycerid.es of 200 jig of chromium (from chromic chloride), 5 g of brewer's yeast, or placebo supplementation was studied. After 10 weeks, no differences were found among the groups on the measured parameters. Plasma chromium content, however, rose after the supplementation with chromic chloride, but not with brewer's yeast. The authors concluded that age was not a factor leading to chromium deficiency.



Saner etal. (1983) conduced a study of the effect of chromium supplementation (with 30 g/day of brewer's yeast containing 50 iig of chromium) for S weeks on patients with Turner syndrome, which is characterized by a high incidence of diabetes. Chromium- and lipid-value testing suggested that the study patients had chromium deficiencies and that these deficiencies could have a role in the abnormal glucose tolerance tests found in many Turner syndrome patients.



In a small pilot study involving 10 patients with type 2 diabetes, the effect of brewer's yeast supplementation was studied. Eight of the 10 patients showed improvement in glucose tolerance. No significant changes in serum insulin, total cholesterol, or triglycerides were found (Bialkowska etal., 1981).



Glucose control and lipid values were compared after the daily ingestion of either 9 g of chromium-rich brewer's yeast or chromium-poor torula yeast for 8 weeks. The 24 participants in the study were older (mean age of 78 years) and were divided into normal and diabetic subgroups. In the brewer's yeast group, glucose tolerance improved significantly and insulin output was reduced after supplementation. Additionally, cholesterol and total lipids fell after supplementation in this group, with higher decreases in the hypercholesterolemic people. The torula yeast group showed no significant changes in glucose control, insulin, or lipids. Cholesterol was found to have significantly decreased in the subgroup of nondiabetics but not in the diabetic group.



Cardiovascular Health

A review of yeast-derived fiber products has suggested that they are a heller source of fi-glucan (a dietary fiber) than are oat products because they are more concentrated; therefore, yeast products may be better dietary additions to lower serum cholesterol levels (Bell et ah, 1999). Apart from being a E-glucan source, brewer's yeast and chromium is known to improve blood lipid values, cholesterol, and triglycerides. Several of these studies have been cited here.



It is important to look at the nutritional content of the brewer's yeast product to verify that it contains GTF (or chromium) if its intended use is for chromium supplementation. Some people report mild gastrointestinal (GI) upsets when first taking brewer's yeast. Starting with small amounts (1/4 teaspoon daily) and increasing as desired (to 1-3 tablespoons daily) can help patients avoid GI upsets. In clinical studies for blood sugar control, from 5-30 g of GTF-containing brewer's yeast was taken daily with beneficial results. No other serious side effects have been noted.

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