Liquid Dietary Supplements Research Articles

Determination of the level of chromium and nickel in selected dietary supplements stimulating the immune system of the human body

An important group of dietary supplements are those preparations stimulating the defence mechanism of the human body. Often powdered plant raw materials or dry extracts from herbs are included in these dietary supplements, therefore these preparations, apart from being biologically active, can contain considerable quantities of the mineral matter. The purpose of our work was to assess the levels of chromium and nickel in selected dietary supplemental products produced in the form of capsules and pills (Acerola Plus, Cat's Claw, Maca, Maca 50 Plus, Spirulina, Spirulina Hawaian, Spirulina Pacifica, Vilcacora, Żeń-szeń from the “Herbalist's Plants of 'Herbapol' in Cracow”, Żeń-szeń – Ginseng from “KRKA”, Żeń-szeń supplied by Naturell, Żeń-szeń Korean from “Walmark”, Żeń-szeń supplied by “Vita-complex”) and in liquid preparations (Aloe - juice, Aloe vera drinking gel, Aloes Activ, Aloes Young, Bodymax Tonik, Ginsengin 400, Ginsenol, Noni - juice, Noni-vita, Noni Plus). Prepared Samples (3-5) of each of preparations were examined, in two parallel runs with analysis was carried out using a Pye Unicam SP 192 atomic absorption spectrometer, while applying specific determination parameters for given element. In supplements in the form of capsules and pills, the chromium content fluctuated, on average, from 0.33 μg/g (Acerola Plus), to 13.79 μg/g (Spirulina), and of nickel, from 0.16 μg/g (Acerola Plus), to 4.10 μg/g (Żeń-szeń (ginseng) - “Herbalist's Plants of 'Herbapol' in Cracow'). In the liquid dietary supplements that were tested, the values were as follows: the amounts of chromium were up to 0.12 μg/ml, while nickel was up to 0.27 μg/ml. In studied preparations, chromium and nickel levels diverged widely, depending on the form and composition of the dietary supplement. What is more, special predispositions of certain raw plant materials (marine alga - spirulina and of root of ginseng) were observed, for the accumulation of the determined micro-elements.

Proficiency testing for the improvement of analytical practice

The results of an individual laboratory’s participation in proficiency testing are often taken in isolation. A single poor assessment may be investigated, or a trend of participation over time may be charted. However, the overall results of proficiency testing (over all participants and over time) may also provide some insights into aspects of the analysis being undertaken. Two examples are summarised here. Analysis of sodium in various foods appears to be difficult with no obvious method trends. Analysis of vitamin B2 in liquid dietary supplement requires enzymatic dephosphorylation, as well as acidic digestion. In the latter case, some participants appear to have changed their method since the first reporting of the problem. Investigation of proficiency testing results and the implications for the analysis takes time and requires data sets to be retrieved from archive. This may not be the highest priority in the workload of a busy proficiency testing provider. However, the benefits to the analytical community from such investigations are great, and their reporting is to be encouraged.

Case Series Of Selenium Toxicity From A Nutritional Supplement

Introduction. Selenium is an essential trace element, but can be toxic in excess. In May 2008, US FDA reported 201 individuals with adverse reactions to liquid nutritional supplements containing excess selenium and chromium resulting in the largest epidemic of selenosis in the history of the United States. Objective. To describe the clinical features, biomonitoring data of selenium levels, and the estimated total dose of selenium ingestions of nine patients with selenium toxicity who presented after use of a liquid dietary supplement with a formulation error. Methods. A retrospective observational case series was performed on nine patients presenting to our medical toxicology clinic between March 2008 and May 2008 with symptoms of selenosis after consuming a nutritional supplement. Institutional IRB approval was obtained for this case series. Results. Supplement testing revealed almost 200 times the reported amount of selenium. There were 5 males and 4 females and their ages ranged from 15 to 57 years (median 46 years, mean 44.2 years). The mean estimated cumulative dose of selenium ingested in our patients was 1.3 gram over a mean period of 37.5 days (10–60 days). In each case, the symptoms of selenium toxicity manifested within 1 week from the start of ingestion. Initial symptoms included alopecia, dystrophic fingernail changes, GI symptoms, and memory difficulties. The initial whole blood selenium concentrations ranged from 150 to 732 mcg/L (reference mean range 123–193 mcg/L) at an average of 27 days post cessation of the formula. The urinary selenium concentrations ranged from 41 to 220 mcg/g Creat (reference < 25 mcg/g Creatinine). None of the patients required more than supportive care for symptoms and none required hospitalization. Conclusion. Selenium is an essential element, which can result in significant toxicity if ingested in large amounts.

Proficiency testing has improved the quality of data of total vitamin B2 analysis in liquid dietary supplement

A previously reported proficiency test for the analysis of vitamin B(2) in liquid dietary supplement demonstrated bimodality. The same trend has now been observed in four subsequent tests of this type. The trend would not so easily have been observed without applying a fit-for-purpose standard deviation that is more generous than that predicted by the Horwitz equation. Since originally reporting the bimodal problem and hypothesising its cause by incomplete enzymic digestion of riboflavin-5-phosphate, there has been a general improvement in the reporting of the higher mode. This is thought to correspond to free riboflavin following complete digestion of the sample. Several individual participants appear to have learned from the experience and have changed their reporting of the lower mode to the higher mode.

Impact of 2‐week Oral Consumption of Gynostemma pentaphyllum (Jiaogulan)‐containing Liquid Dietary Supplement, JULE of the Orient™ on Various Subjective Symptoms, Blood Circulation, Blood Pressure and Other Anthropometric Parameters: A Randomized, Placebo‐controlled, Double‐blind Human Clinical Study

A randomized, double‐blind, placebo‐controlled human clinical trial has examined the general effects of orally consumed saponin‐standardized Gynostemma pentaphyllum (jiaogulan)‐containing herbal tonic named JULE of the Orient™ (JULE). JULE or a placebo was provided as a beverage to healthy adults for 14 days (120 ml/day). Subjective questionnaire ratings (0–5) were used to measure general feelings of well‐being, neurological/psychological traits, gastrointestinal, musculoskeletal and cardiovascular complaints and any adverse effects. Blood circulation in hands was measured using laser Doppler. Questionnaire data were analyzed between day 1 and day 15 with the nonparametric Wilcoxon matched pairs tests. Significant differences were found in the JULE group (N=12) and consisted of decreased ratings for tiredness, procrastination, stiff shoulder, heartburn, physical discomfort, vision issues, stress, memory loss, daydream and increased stamina. Blood circulation in JULE group tended to be increased by about 30% compared to the pre‐intervention. In contrast, the placebo group (N=12) showed no significant changes. All other parametric data, such as body weight, BMI, blood pressure were not significantly different. These results suggest that JULE intake may increase subjective feelings of general well‐being and neurological/psychological traits by enhancing blood circulation.

Comparison of Lycium barbarum‐containing Liquid Dietary Supplements to Caffeinated Beverages on Energy/Caloric Metabolism Activity and Salivary Adrenocortical Hormone levels in Healthy Human Adults

Impact of L. barbarum‐containing liquid dietary supplements on energy metabolism was compared to caffeinated beverages (tea, coffee and other commercially available products). The tested products were GoChi® (non‐caffeinated L. barbarum juice); Chi3® (caffeinated L. barbarum juice with B vitamins, folate, taurine, L‐phenylalanine, N‐acetyl‐L‐tyrosine, glucuronolactone and green tea extract); and TAIslim® (L. barbarum juice with caffeinated standardized tea polyphenols, soluble dietary fiber, L‐phenylalanine and N‐acetyl‐L‐tyrosine). Subjects (age=34.5 y) took single bout of 1 serving of test samples after a 12 h fast. Resting metabolic rate (RMR) was measured by indirect calorimeter immediately before (baseline), 1, 2 and 4 h after sample intake. Salivary cortisol and DHEA levels were analyzed by EIA one day prior and post intake. While non‐L. barbarum‐containing caffeinated beverages did not increase area under the curve (AUC, 0–4 h) of RMR from the control level (395 kcal‐h), all L. barbarum‐containing products increased RMR AUC by 752–927 kcal‐h over baseline (1,761 kcal), higher than the control or other beverages (P&lt;0.05). Unlike caffeinated beverages, cortisol and DHEA were significantly reduced by GoChi intake. These results suggest that L. barbarum‐containing products exhibit energy stimulating effect, which may be related to acute adrenocortical hormonal reduction, a different mechanism than that of caffeine.

Kinetic Analysis of A Single Bolus Intake of Gynostemma pentaphyllum (Jiaogulan)‐containing Liquid Dietary Supplement, JULE of the Orient™ on Human Peripheral Blood Circulation

We examined the effects of a single bolus intake of Gynostemma pentaphyllum (jiaogulan)‐containing herbal tonic named JULE of the Orient™ (JULE) on peripheral blood circulation at various time points after intake in healthy female human subjects (n=6; average age=34.5 y) who complained of cold hands and feet. JULE contains water‐extracted jiaogulan standardized for its main active constituents, gypenoside saponins, which is reported to increase nitric oxide generation in the arterial wall in in vitro study. The kinetic effect of a single bout of JULE (60 ml) intake on peripheral blood circulation was investigated as flow rate in both hands scanned by laser‐Doppler at baseline, 0.5, 1, 2, 4 and 6 hours after intake. The flow rate was statistically analyzed by paired t‐test. JULE intake significantly increased circulation by 60% more than baseline level at 2–4 hours after intake (P&lt;0.01) and gradually lowered 6 hours after intake. The area under the curve 0 through 6 hours over the baseline level after JULE intake was significantly higher than placebo group (P&lt;0.01). These results suggest that JULE may have an acute stimulating effect on peripheral blood circulation that may contribute to its improvements in various subjective symptoms shown in a separate clinical study.

Sub‐Chronic Effects of Orally Ingested Liquid Dietary Supplement, TAIslim® Containing A Combination of Soluble Dietary Fiber, Phenylalanine, N‐Acetyl‐Tyrosine, Tea Polyphenols with Caffeine and Lycium barbarum on Body Weight and Other Anthropometric Parameters in a Controlled Cross‐over Human Clinical Study

Three month intake of TAIslim® containing soluble dietary fiber, L‐phenylalanine, N‐acetyl‐L‐tyrosine, standardized tea polyphenols with caffeine and Lycium barbarum was examined in a controlled human clinical study in a cross‐over design. Total 25 healthy overweight adults (age=40.7 y, BMI=29.9 kg/m2) consumed 60 ml of TAIslim 3 times/d immediately before meals. Anthropometric parameters and resting metabolic rate (RMR) measured by an indirect calorimeter were examined at baseline, on 30, 60 and 90 days in both phases. The phase interval was 60 days. Subjects were required to walk 30 min daily monitored by pedometer and to curtail caloric intake after 7 PM. A protein‐based diet with multi‐vitamin and Lycium barbarum supplement resume program (about 1,200 kcal/d) was required and monitored by diary. Average parameters were significantly reduced by 6.3% (body weight), 6.1% (BMI), 7.4% (waist circumference), 5.4% (waist/hip ratio), 5.4% (total body fat), 14.5% (fasting blood glucose level), blood pressure (SBP by 8.4%, DBP by 14.3%) and heart rate by 7.2% (P &lt; 0.05) from pre‐intervention. RMR was significantly increased by 220 kcal, about 14% over baseline (1,679 kcal) 2h after TAIslim intake. To the contrary, during the control phase, all parameters were not significantly changed compared to the baseline. These results suggest that TAIslim may affect anthropometric parameters by enhancing energy expenditure.

Acute Selenium Toxicity Associated With a Dietary Supplement

Selenium is an element necessary for normal cellular function, but it can have toxic effects at high doses. We investigated an outbreak of acute selenium poisoning. A case was defined as the onset of symptoms of selenium toxicity in a person within 2 weeks after ingesting a dietary supplement manufactured by "Company A," purchased after January 1, 2008. We conducted case finding, administered initial and 90-day follow-up questionnaires to affected persons, and obtained laboratory data where available. The source of the outbreak was identified as a liquid dietary supplement that contained 200 times the labeled concentration of selenium. Of 201 cases identified in 10 states, 1 person was hospitalized. The median estimated dose of selenium consumed was 41 749 microg/d (recommended dietary allowance is 55 microg/d). Frequently reported symptoms included diarrhea (78%), fatigue (75%), hair loss (72%), joint pain (70%), nail discoloration or brittleness (61%), and nausea (58%). Symptoms persisting 90 days or longer included fingernail discoloration and loss (52%), fatigue (35%), and hair loss (29%). The mean initial serum selenium concentration of 8 patients was 751 microg/L (reference range, < or =125 microg/L). The mean initial urine selenium concentration of 7 patients was 166 microg/24 h (reference range, < or =55 microg/24 h). Toxic concentrations of selenium in a liquid dietary supplement resulted in a widespread outbreak. Had the manufacturers been held to standards used in the pharmaceutical industry, it may have been prevented.

Acute Effects of A Liquid Dietary Supplement, TAIslimTM Containing A Combination of Indigestible Soluble Dietary Fiber, Phenylalanine, N‐Acetyl‐Tyrosine, Caffeine, Tea Polyphenols and Lycium barbarum on Resting Metabolic Rate: A Randomized, Double‐Blind, Placebo‐Controlled Study

TAIslim is a blend of soluble indigestible fiber, phenylalanine, N‐acetyl‐L‐tyrosine, caffeine, standardized tea polyphenols and Lycium barbarum; some of which are known to improve energy balance. The objective of this randomized, double‐blind, placebo‐controlled clinical study was to determine whether consumption of TAIslim (120 ml/d) for 14 d would have an impact on resting metabolic rate (RMR), anthropometric parameters and subjective feelings of appetite and gastrointestinal conditions. Measurements were taken at baseline and endpoint. A total of 32 healthy adults (age=33.2 y, BMI=27.8 kg/m2) were enrolled. A nutritional beverage (360 kcal) was provided at the completion of the 1st RMR measurement. RMR in a group consuming TAIslim (n=11), a half dose of TAIslim (n=9) and placebo (n=12) was increased by 255, 200 and 150 kcal, about 14%, 11% and 8% of baseline (1,823 kcal), respectively. TAIslim increased RMR to a greater extent than placebo (P &lt; 0.05). Waist circumference and feeling of appetite tended to decrease in the TAIslim group whereas there was no significant difference in the other groups. Other anthropometric parameters and gastrointestinal conditions were not different between groups or between pre‐ and post‐intervention for either group. These results suggest that TAIslim may affect waist circumference by enhancing energy expenditure. A longer term study may clarify potential of body weight control.

A rapid and simple procedure for the determination of synephrine in dietary supplements by gas chromatography-mass spectrometry

A simple and rapid procedure based on gas chromatography-mass spectrometry (GC-MS) is described for determination of synephrine, active principle of Citrus aurantium plant, in solid and liquid dietary supplements. After the addition of 3,4-methylenedioxypropylamphetamine as internal standard (I.S.), a liquid–liquid extraction procedure in alkaline conditions with chloroform/isopropanol (9:1, v/v) was applied to the samples prior to analysis. Chromatography was performed on a fused capillary column and synephrine and I.S., derivatized with pentafluoropropionic anhydride, were determined in the selected-ion-monitoring (SIM) mode. The method was validated in the range 0.1–50 μg/mg or μg/mL synephrine. Mean recovery ranged between 89.3% and 90.5% in both solid and liquid dietary supplements. The quantification limit was 0.1 μg/mg or μg/ml. The method was applied to analysis of various dietary supplements promoted for aiding weight control containing, among other constituents such as ephedrine alkaloids and methylxanthines, Citrus aurantium. Amount of synephrine present in such products ranged from 3.1 μg/mg solid product to 480.2 μg/mL liquid product.

Dietary Counseling Is Beneficial for the Patient With Cancer

The maintenance of good nutritional status during initial treatments for cancer is generally recommended to increase the likelihood of successful completion of prescribed therapies, and possibly to promote improved quality of life during and after that phase of care. In cross-sectional studies, reduced intake and poor nutritional status have been observed to be correlated with poor outcome, but cause and effect cannot be assumed from such observations. Results of a randomized controlled study focused on colorectal cancer patients undergoing radiation therapy reported in this issue of the Journal of Clinical Oncology provide scientific evidence for the benefits of nutritional counseling in the management of these patients. The study confirms that individualized dietary counseling can promote the maintenance of adequate dietary intakes and body weight, resulting in a marked reduction in the incidence and severity of anorexia and diarrhea, and improved quality of life. Most notably, the beneficial effects observed in association with dietary counseling were generally maintained 3 months after the completion of radiation therapy. In this study, various effects of individualized dietary counseling focused on regular foods were compared with the effects of prescribing nutrient-dense, high-protein liquid dietary supplements or ad libitum intake in 111 colorectal cancer patients treated with radiation therapy. The prospective study design allows a comparison of the effects of intervention across the study arms over time, and several types of outcome variables were measured, including symptom severity, health-related quality of life, and nutritional status indicators. Another important characteristic of the study is the inclusion of a study arm that involved prescribing liquid dietary supplements, an approach that theoretically addresses the challenge of maintaining adequate intakes for these patients, but with less intensity or specificity than is achieved with dietary counseling. The randomization was stratified by stage; at baseline, malnutrition was evident only among the patients who had been diagnosed at more advanced stages of colorectal cancer. Measures that were conducted at baseline, at completion of prescribed radiation therapy, and 3 months thereafter included anthropometric measurements, an index of nutritional status based on a multicomponent assessment tool, a detailed dietary history, the presence and degree of symptoms related to radiation therapy (such as anorexia, nausea and vomiting, and diarrhea), and health-related quality of life. The latter was assessed with an established cancer-specific questionnaire that included queries relating to various functions such as physical, cognitive, social, symptoms, and other potential negative results of the disease or condition. The goal of nutrition intervention, in both the dietary counseling and supplement study arms, was to enable the patient to meet the estimated requirements for intakes of energy, protein, and other nutrients, determined by standard calculations. After completion of the prescribed radiation therapy, both the dietary counseling group and the liquid dietary supplement group exhibited an increase in energy intake (averaging an increase of 555 and 296 kcal/d, respectively), whereas the ad lib group reported a decline in energy intake (averaging 285 kcal/d). At 3 months postradiation therapy, the counseling group maintained their intakes, while both of the other groups exhibited a decline at that time point. As a result of these intakes, the patients determined to be malnourished at baseline in the dietary counseling group actually recovered an average 4 kg of body weight at the 3-month follow-up time point. After radiation therapy, only three of 37 patients in the dietary counseling group exhibited a decline from baseline in nutritional status, compared with 19 of 37 patients in the liquid supplement group and 34 of 37 patients in the ad libitum group. In association with good dietary intakes and nutritional status, the dietary counseling group also exhibited the lowest symptom severity score, JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 23 NUMBER 7 MARCH 1 2005

Not all noni liquid dietary supplements are created equal

Not all noni liquid dietary supplements are created equal

Effect of liquid dietary supplements on energy intake in the elderly

Undernutrition is a risk factor for increased mortality in older adults. Therapeutic intervention includes the administration of liquid dietary supplements. We investigated the effect of liquid dietary supplements on satiation, satiety, and energy intake in older adults. This study had 2 phases in a within-subject, repeated-measures design. The energy intake of 15 elderly (aged >70 y) and 15 younger (aged 20-40 y) healthy subjects was measured after 4 liquid preloads: water, high fat, high carbohydrate, and high protein. The preloads were administered within 5 min of a test meal in phase 1 and >or=60 min before the test meal in phase 2. Palatability, fullness, and hunger were assessed by using visual analogue scales. Mean energy consumption of the test meals was significantly lower in the older than in the younger subjects (P = 0.001), as was mean macronutrient consumption of fat and carbohydrate (P = 0.002 and 0.001, respectively). Mean energy intake and macronutrient consumption were higher in phase 2 than in phase 1 in both older and younger subjects (P < 0.05). Satiety lasted longer in older than in younger subjects after the high-protein and high-fat preloads (P = 0.001). In the elderly, administration of dietary supplements between meals instead of with meals may be more effective in increasing energy consumption.

Validation of a Short Food Frequency Questionnaire (FFQ) to Assess Calcium Intake in Children and Adolescents With Cystic Fibrosis (CF)

LEARNING OUTCOME: Develop and validate a short FFQ for clinical or research purposes to quantitate calcium intake in children and adolescents with CF. With increasing lifespan of CF patients, published reports of osteopenia and osteoporosis in young adults with CF have emerged. Although the exact mechanisms remain undefined, prolonged steroid use, decreased exercise, decreased lean body mass, and dietary calcium intake could all play a role. Therefore, it is important that children and adolescents with CF maintain a high calcium intake throughout their growth years to maximize peak bone mass. A quick and easy tool to screen for dietary calcium intake during outpatient visits is needed. A previously validated FFQ which determined the amount of calcium consumed daily in perimenopausal women was adapted for use in children and adolescents with CF living in Louisiana. In addition, this FFQ serves as an educational tool in diet counseling to patients and families. The original FFQ was reduced from 53 to 36 items with deletion of food items not commonly eaten by children such as tofu, figs or almonds, and addition of food items usually consumed by CF children such as cereal with milk, milkshakes, and liquid dietary supplements. In addition, food items commonly eaten in Louisiana such as shellfish and oysters were also included. Twenty CF patients (M=12, F= 8; mean age 4.8 yrs, range 2.0-17.5 yrs) were recruited from the CF center. They or their guardians completed the modified FFQ in clinic and within the next two weeks completed a 5-day food record at home using scales and measuring utensils. The mean daily intake of calcium from the 5-day food record was 1476±924 mg. Calcium intake derived from the FFQ was reproducible (n=12; r=0.94) and was highly correlated with the calcium intake from the 5-day food record (r=0.94; p<0.001). We conclude that our modified FFQ offers an easy and reliable means for assessment of calcium intake of CF patients in Louisiana. We postulate that such FFQ may provide an important clinical tool for the longitudinal assessment and maintenance of adquate calcium intake in CF. (Supported in part by a MCH Training Grant MCJ-229163)

Effect of a Supplement on Dietary Intakes of Female Collegiate Swimmers.

In brief This study describes the diets of female swimmers and assesses the effects of a liquid supplement. The self-selected diets provided more than the recommended dietary allowances (RDA) of food energy and six nutrients and less than the RDAs of vitamin D and iron. Consumption of the liquid dietary supplement increased the intake of all nutrients except cholesterol and increased the frequency of food intake. More frequent food consumption may improve performance by increasing alertness, avoiding hunger discomfort, and decreasing the rate of lipogenesis. A liquid dietary supplement is one way to improve the nutritional quality of athletes' diets and increase the frequency of food consumption.

DIETARY SUPPLEMENTATION AND NUTRITIONAL STATUS IN ELDERLY WOMEN

A group of 18 elderly nursing home residents, whose food intake was considered inadequate, was evaluated with respect to nutrient intake and selected biochemical measurements. Food eaten provided less than two-thirds of the recommended amounts of vitamin A, thiamin, riboflavin, and calcium for approximately 50% of the women. Intake of iron by one-third of the women was also less than adequate. Forty-four, 61 and 50% of the hemoglobin, serum protein and vitamin A values, respectively, were low or deficient. The amounts of thiamin and riboflavin excreted in urin were low in 31 and 88% of the women, respectively. The addition of a liquid dietary supplement to the diets of the elderly women improved food intake and biochemical measurements of selected nutrients in some cases. The percentage of low hemoglobin, serum protein and vitamin A values decreased 22, 50, and 17%, respectively. Urinary excretion of riboflavin and thiamin for each subject exceeded the acceptable levels at the close of the 30-day suppleme...