Natural Dietary Supplements
The business of dietary supplement in the Western World has expanded from the Health Store to the pharmacy. Alternative medicine includes plant based products. Appropriate measures to ensure the quality, safety and efficacy of these either already exist or are being answered by greater legislative control by such bodies as the Food and Drug Administration of the USA and the recently created European Agency for the Evaluation of Medicinal Products, based in London. In the USA, the Dietary Supplement and Health Education Act of 1994 recognised the class of phytotherapeutic agents derived from medicinal and aromatic plants. Furthermore, under public pressure, the US Congress set up an Office of Alternative Medicine and this office in 1994 assisted the filing of several Investigational New Drug (IND) applications, required for clinical trials of some Chinese herbal preparations. The significance of these applications was that each Chinese preparation involved several plants and yet was...
Vitamins, minerals, and dietary supplements can be sold over the counter (OTC), that is, without a prescription. These products can be purchased in drug stores, health food stores, some department stores, and over the Internet. The FDA does not regulate OTC products as they do prescription medications. Because of this, certain claims can be made without clinical trials or scientific evidence to support the claims. Therefore, you should be aware of what you're buying and do some research in advance. The Consumer Labs Web site (www.consumerlabs.com) provides an excellent resource for the contents of many products containing vitamins, minerals, herbals, and dietary supplements. The Consumerlabs.com site reports the results of independent testing to evaluate manufacturer's claims and the presence of amounts of ingredients in the tested products.
Most research in the UK has focused on touch and mind-body therapies. Cancer organisations and charities have information on these therapies. There is little information available, however, on medicinal and nutritional approaches such as vitamin use and dietary supplements. Patients do use these products, often without the knowledge of their health professionals. Their use may be intended as complementary but the effects may not be. Further attention needs to be given to this issue with consideration of possible drug interactions and interference with orthodox treatment and educating patients to make informed decisions about their use.
To be constipating, whereas magnesium may cause diarrhea. Many patients ingest dietary supplements containing these elements and may not be aware of their effects on bowel fUnction. Finally, many patients ingest health foods which often contain herbal products, including senna and aloe, which can have profound effects on gut function. Every patient needs to be asked about ingestion of these products. There is a separate chapter on alternative medicines (Chapter 58, Complementary and Alternative Medicines in Gastrointestinal Disease ).*
The treatment for patients who develop enterocutaneous fistulas is based on multiple factors. A septic patient may require early operation for resection of the involved bowel segment and drainage of any abscesses. An abscess in a stable patient may be amenable to percutaneous drainage. Otherwise, the patient is classified by fistula volume as aforementioned. It is obligatory to rule out a distal bowel obstruction with the use of contrast radiographic studies. Patients with low or moderate volume fistulas with no distal obstruction and no sepsis may be treated with supportive care. They should be made NPO and be placed on TPN to support their nutritional needs. Some patients can progress to taking elemental oral dietary supplements during their treatment. Fistula drainage should be controlled if possible with the use of an ostomy bag to prevent skin irritation and breakdown. Octreotide, the somatostatin analogue, slows gastric emptying and small bowel transit, and decreases salivary,...
Simple dietary measures such as encouraging smaller, more frequent, meals may be helpful and a wide variety of nutritional supplements are available. Appetite stimulants such as megestrol acetate may be beneficial but weight gain is usually modest. Recombinant human growth hormone, although expensive, may partially reverse HIV-associated weight loss. In patients unable to tolerate oral feeding, enteral and parenteral feeding are alternative forms of nutrition but their efficacy and place in management are still being evaluated. Enteral nutrition offers a safer and cheaper alternative to total parenteral nutrition which is perhaps most useful in patients with severe diarrhoea, nausea, and vomiting, in whom fluid balance and control of symptoms has been difficult.
There are a variety of valuable information sources available for physicians, although none of them are specifically focused on GI disease. Patients should not rely too heavily on the advice or recommendations provided by employees of health food stores or other stores selling herbal and nutritional supplements (Verhoef et al, 2002). Often only the owner or the manager of the store has much experience and knowledge about the therapies. Other employees may have relatively little training and may not be able to distinguish between treatments that are safe and appropriate for a given condition and those more commonly used for other GI complaints. General intestinal remedies sold at health food stores often contain laxatives.
Relevance Of Nutrition For Investigation Of Tumor Angiogenesis In The Laboratory And In Clinical Studies
Diet and nutritional status may also prove to be relevant to the outcome of clinical studies of antiangiogenic agents for cancer therapy. Patients enrolling in phase I and phase II trials are often extensively pretreated with chemotherapy, radiotherapy, and surgery. Each of these interventions can have significant impact on nutritional status. In addition, the majority of cancer patients consume some type of nonprescription diet or nutritional supplements during the course of their illness. This information is typically unknown to the clinical investigator, since physicians rarely inquire about these products. The control of dietary variables, or the incorporation of various measures of nutritional status into clinical studies of antiangiogenic agents, may ultimately assist efforts to maximize efficacy and minimize toxicity for the patients.
Deficiencies of water-soluble vitamins are relatively rare in short bowel patients. However, they may occur and it is therefore important that patients ingest 1 or 2 B-complex vitamin supplements and 200 to 500 mg of vitamin C daily. Vitamin B12 should be administered at a dose of 1,000 g intramuscularly every 3 months in patients who have had significant gastric or ileal resections, or in those who have active Crohn's disease in their remaining terminal ileum. The adequacy of vitamin B12 supplementation is best measured by following the serum methylmalonic acid (MMA) concentration. In the absence of sufficient B12, the MMA concentration will remain elevated because it will not be metabolized to succinyl coenzyme A. Similarly, folate is required for the metabolism of homocysteine to methionine. The Schillings test is not a test to determine vitamin B12 status, but to determine why a particular patient is vitamin B12 deficient. Once neuropathy (B12) or megaloblastic anemia (either) are...
Severe hepatotoxicity from some herbal products. However, in general, there are no major safety concerns with the common forms of therapy (herbs and nutritional supplements) used by GI patients. Potential risks include allergic reactions, contamination or mislabeling of herbal products, nutritional deficiencies resulting from restrictive diets, and neck and spine injury resulting from spinal manipulation. However, physicians and patients should be aware that some therapies are associated with the risk of serious side effects due to the therapy's chemical constituents (eg, hepatic veno-occlusive disease from herbs such as comfrey that contain pyrrolizidine alkaloids), contamination with heavy metals (reported with some medicines prepared in Asia), and the potential risk for toxicity to the fetus.
One of the remarkable effects of an insufficient dietary intake of w-3 PUFA (i.e. a low w-3 w-6 ratio diet produced by using a sunflower oil rather than a fish oil dietary supplement) was that heart size was significantly reduced in cultured post-smolt Atlantic salmon (Bell et al, 1991a). In severe cases a marked depletion in the amount of compacta and spongiosa of the ventricle made the ventricular wall exceedingly thin. Moreover, these fish became more susceptible to transportation-induced shock syndrome (a 30 mortality was observed). A
Proponents of complementary or integrative medicine tend to be interested in herbal remedies, vitamins, and other so-called dietary supplements. When Congress passed the Dietary Supplement and Health Education Act of 1994, it allowed significant differences between the marketing of prescription medicines and dietary supplements. Prescription drugs must provide proof of safety and efficacy to secure Food and Drug Administration (FDA) approval, but the agency cannot recall products sold as dietary supplements from the market unless the FDA can prove that they are harmful. Supplement manufacturers are permitted to use advertisements and testimonials claiming that their products are ''all natural'' and ''completely safe.'' Stores specializing in dietary supplements, herbs, and vitamins sell products that purportedly boost metabolism, improve cardiovascular health, prevent health attacks, and so forth. Food and beverage companies have experimented with ''functional'' or ''nutraceutical...
Devlin et al. (1997) takes issue with the common assumption by genetic researchers that maternal environment effects are trivial. They argue that the mother's womb provides an important early environment, one that witnesses substantial in utero brain growth, and that a huge number of perinatal factors, such as the mother's ingestion of alcohol, drugs, or lead, may lower the child's IQ, whereas other factors (e.g., dietary supplements) can raise a child's IQ. Therefore, maternal environmental effects on twins' IQs are likely to be rather large for twins and notable for siblings (because the mothers' physiological status and personal habits during pregnancy are likely to be similar, but not identical, from one pregnancy to another). Devlin et al. tried to fit four competing models to a large database composed of correlations between pairs of relationships that differed in genetic overlap (e.g., identical twins, fraternal twins, parent-child, siblings, adopting parent-child). The data...
Therapies can be classified in various ways. They may be grouped by whether they have a direct physical application (such as massage), a primarily psychological effect (such as visualisation), or whether they purport to have a pharmacological basis (such as dietary supplements). They can also be classified by application that is, they can be thought of as a complete system of care (such as homoeopathy), as useful techniques (such as aromatherapy), or as approaches to self help (such as meditation). More recently, the House of Lords select committee report provided a classification, grouping therapies according to their professional regulation and evidence base.
Tomatic , and the disease may go undetected. Polyuria and a reduced capacity to concentrate the urine are its main manifestations. Either of these two features may be the result of tubulointerstitial nephritis caused by sar-coidosis, and can be present in the absence of any altered calcium metabolism. Nephrocalcinosis also may be asymptomatic. In contrast, nephrolithiasis presents as renal colic or hematuria. Hypercalcemia develops only when the load of calcium to be excreted exceeds the ability of the kidneys to excrete the calcium load, either because of reduced renal function or, less commonly, when the amount of calcium absorbed is excessive. The magnitude of hypercalcemia determines its symptomatology. The circulating level of parathyroid hormone should be determined in patients with hypercalcemia. An increase in the prevalence of parathyroid adenomas seems to occur in sarcoidosis. In hypercal-cemia caused by elevated levels of calcitriol and by reduced renal excretion of...
An undetermined number of patients self-administer herbal dietary supplements. Many of these supplements contain ephedra alkaloids, which may predispose the patient to perioperative hypertension and cardiac arrhythmias 90 . Some herbals may result in the increased incidence of bleeding from coumadin-like substances. Antiobesity medications such as aminorex fu-marate, dexfenfluramine (Redux), fenfluramine (pon-damin) and phentermine (Ionamin, Adipex-P, Fastin, Oby-Cap, Obenix, Oby-trim, Zantryl) are associated with pulmonary hypertension and valvular heart disease, even with as little as 2 months of use. While most patients develop symptoms such as palpitations, dys
Efforts should also be made to avoid viruses, smoking (another drug), radiation and too much in the way of vitamin supplements. Finally, in another type of category, any type of stressful event, which will, of course, vary from person to person, should also be avoided. Prolonged stress during pregnancy can have deleterious effects on the developing embryo.
Table 26.3 summarizes adult mineral requirements and dietary sources. Broadly speaking, the best sources of minerals are vegetables, legumes, milk, eggs, fish, shellfish, and some other meats. Cereal grains are a relatively poor source, but processed cereals may be mineral-fortified. Table 26.3 Mineral Requirements and Some Dietary Sources
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