Use Of Herbal Dietary Supplements Research Articles

A Comprehensive Review on the Use of Herbal Dietary Supplements in the USA, Reasons for Their Use, and Review of Potential Hepatotoxicity

Herbal and dietary supplement (HDS) use has grown exponentially in the United States. Unfortunately, the incidence of HDS-related liver injury has proportionally increased. Despite the potential for certain HDSs to cause clinically significant liver injury, they are not regulated by the Food and Drug Administration. Recent efforts have been made to regulate HDSs but are far removed from the scrutiny of prescription medications. Scant literature exists on HDSs and their risks of causing liver injury. In this comprehensive review, we examine trends of HDS use in the United States and the pathophysiologic mechanisms of drug-induced liver injury (DILI) of certain HDSs. Finally, we review usage rates; benefits, if any; purported pathophysiology of DILI; and propensity for progression to fulminant hepatic failure of nine HDSs linked to clinically significant DILI.

Herbal dietary interventions for weight loss among regularly exercising women in Turkey

PurposeObesity is a chronic disease that is conjoined with increased mortality. Parallel to rising obesity rates, herbal dietary interventions to lose weight are also increasing. The purpose of this study is to assess and evaluate the use of herbal dietary interventions for weight loss among regularly exercising women.Design/methodology/approachA total of 545 regularly exercising women (aged 19–64 years) were recruited from several local sports centers. A questionnaire form to evaluate demographic characteristics, nutritional habits and herbal dietary intervention habits was administered by a trained dietitian. Anthropometric measurements including weight, height, fat mass, total body water and fat free mass were measured using a bioelectrical impedance analysis device.FindingsA total of 244 participants (44.8%) used herbal dietary interventions for weight loss within the last year. The most commonly used herbal dietary interventions were green tea (59.4%), lemon juice (27%), herbal tea mix (20.9%) and cinnamon powder (17.6%), respectively. Of the 244 women who used herbal dietary interventions for weight loss, 42.2% claimed that by using these products they experienced weight loss. Herbal dietary interventions were significantly higher among women with obesity (61.9%) than women with a healthy weight (37.5%). The use of herbal supplements increased among women who consider themselves as being overweight (p < 0.001). Furthermore, herbal dietary interventions decreased with more frequent attempts for a weight-loss diet (p < 0.001).Originality/valueTo the best of the authors’ knowledge, this study represents a first attempt at assessing the use of herbal dietary supplements for weight loss among regularly exercising Turkish women. With the increase of body mass index and body perception being as overweight, herbal dietary interventions were also increased. In particular, women with obesity (61.9%) used more herbal dietary interventions than women with healthy weight (37.5%). Moreover, women with an overweight body perception used more herbal supplements than those who thought they had a healthy body weight.

The Development of a Database for Herbal and Dietary Supplement Induced Liver Toxicity.

The growing use of herbal dietary supplements (HDS) in the United States provides compelling evidence for risk of herbal-induced liver injury (HILI). Information on HDS products was retrieved from MedlinePlus of the U.S. National Library of Medicine and the herbal monograph of the European Medicines Agency. The hepatotoxic potential of HDS was ascertained by considering published case reports. Other relevant data were collected from governmental documents, public databases, web sources, and the literature. We collected information for 296 unique HDS products. Evidence of hepatotoxicity was reported for 67, that is 1 in 5, of these HDS products. The database revealed an apparent gender preponderance with women representing 61% of HILI cases. Culprit hepatotoxic HDS were mostly used for weight control, followed by pain and inflammation, mental stress, and mood disorders. Commonly discussed mechanistic events associated with HILI are reactive metabolites and oxidative stress, mitochondrial injury, as well as inhibition of transporters. HDS–drug interactions, causing both synergistic and antagonizing effects of drugs, were also reported for certain HDS. The database contains information for nearly 300 commonly used HDS products to provide a single-entry point for better comprehension of their impact on public health.

Incorporation of absorption and metabolism into liver toxicity prediction for phytochemicals: A tiered in silico QSAR approach

An increased use of herbal dietary supplements has been associated with adverse liver effects such as elevated serum enzymes and liver failure. The safety assessment for herbal dietary supplements is challenging since they often contain complex mixtures of phytochemicals, most of which have unknown pharmacokinetic and toxicological properties. Rapid tools are needed to evaluate large numbers of phytochemicals for potential liver toxicity. The current study demonstrates a tiered approach combining identification of phytochemicals in liver toxic botanicals, followed by in silico quantitative structure-activity relationship (QSAR) evaluation of these phytochemicals for absorption (e.g. permeability), metabolism (cytochromes P450) and liver toxicity (e.g. elevated transaminases). First, 255 phytochemicals from 20 botanicals associated with clinical liver injury were identified, and the phytochemical structures were subsequently used for QSAR evaluation. Among these identified phytochemicals, 193 were predicted to be absorbed and then used to generate metabolites, which were both used to predict liver toxicity. Forty-eight phytochemicals were predicted as liver toxic, either due to parent phytochemicals or metabolites. Among them, nineteen phytochemicals have previous evidence of liver toxicity (e.g. pyrrolizidine alkaloids), while the majority were newly discovered (e.g. sesquiterpenoids). These findings help reveal new toxic phytochemicals in herbal dietary supplements and prioritize future toxicological testing.

Herbal self-medication use in patients with diabetes mellitus type 2

A considerable number of patients suffering from diabetes mellitus (DM) turn to self-medication using medicinal plants, preparations, and medicine. The aim of this study was to investigate self-medication using medicinal plants and the potential influence of health care professionals' advice or media information regarding the use of herbal dietary supplements with hypoglycemic effect in a population of patients with type 2 DM. This research, in the form of an analytic cross-sectional study, was conducted in 6 pharmacies in the territory of Nis, Serbia, during October 2013. The criterion set for the study was to include patients diagnosed with type 2 diabetes who used pharmacotherapy in addition to herbal supplements. Surveyed women showed a statistically significant difference in the frequency of using herbal supplements compared to men (P < 0.001). More frequent symptoms of hypoglycemia were reported in the group of diabetic respondents who used herbal dietary supplements (P < 0.05). The media was most responsible for influencing decisions about self-medication that included the use of herbal dietary supplements. The role of health professionals is indispensable and very important, especially when the media is a potential cause of seeking self-medication.

Increasing Circulating Testosterone: Impact of Herbal Dietary Supplements

Low circulating testosterone levels can present numerous problems related to the overall health and well-being of individuals, men in particular. This finding is well-documented in the literature and low testosterone appears more prevalent in older men, in particular those who are physically inactive and who present with elevated levels of body fat. Multiple botanical (herbal) products have been claimed to elevate circulating testosterone in men; however, data pertaining to the use of such herbal preparations obtained from human clinical trials are limited. This review examines the research to date pertaining to the use of herbal ingredients with regards to their ability to elevate blood testosterone levels. A collective summary of the findings indicate that certain herbal supplements may actually yield an increase in testosterone (e.g., Longjack root), while most others have little to no evidence in support of their use in human subjects. Additional, well-controlled clinical trials are needed to generate data relative to the use of herbal dietary supplements to increase circulating testosterone.

Suspected adverse reactions associated with herbal products used for weight loss: a case series reported to the Italian National Institute of Health

The aim of this study was to describe suspected adverse reactions (ARs) associated with herbal products used for weight control in Italy. Spontaneous reports of suspected ARs associated with herbal products used for weight control were collected by the Italian National Institute of Health (April 2002 to June 2010), and the causality assessment was performed. Forty-six of the suspected ARs were associated with herbal products used for weight control. Women were involved in 85% of the reports. The reactions affected mainly the cardiovascular system, the skin, the digestive system, the central nervous system, and the liver. A large proportion of ARs were serious. In more than half of the suspected ARs, the use of other therapies (herbs and/or drugs) was reported, while concomitant conditions were present in 22% of the reports. The use of herbal dietary supplements for weight loss is associated with several ARs. Considering the risk/benefit ratio, consumers should pay attention when using these products.

Ginkgo Biloba Extract Induces Gene Expression Changes in Xenobiotics Metabolism and the Myc-Centered Network

The use of herbal dietary supplements in the United States is rapidly growing, and it is crucial that the quality and safety of these preparations be ensured. To date, it is still a challenge to determine the mechanisms of toxicity induced by mixtures containing many chemical components, such as herbal dietary supplements. We previously proposed that analyses of the gene expression profiles using microarrays in the livers of rodents treated with herbal dietary supplements is a potentially practical approach for understanding the mechanism of toxicity. In this study, we utilized microarrays to analyze gene expression changes in the livers of male B6C3F1 mice administered Ginkgo biloba leaf extract (GBE) by gavage for 2 years, and to determine pathways and mechanisms associated with GBE treatments. Analysis of 31,802 genes revealed that there were 129, 289, and 2,011 genes significantly changed in the 200, 600, and 2,000 mg/kg treatment groups, respectively, when compared with control animals. Drug metabolizing genes were significantly altered in response to GBE treatments. Pathway and network analyses were applied to investigate the gene relationships, functional clustering, and mechanisms involved in GBE exposure. These analyses indicate alteration in the expression of genes coding for drug metabolizing enzymes, the NRF2-mediated oxidative stress response pathway, and the Myc gene-centered network named "cell cycle, cellular movement, and cancer" were found. These results indicate that Ginkgo biloba-related drug metabolizing enzymes may cause herb-drug interactions and contribute to hepatotoxicity. In addition, the outcomes of pathway and network analysis may be used to elucidate the toxic mechanisms of Ginkgo biloba.

Analysis of iridoids from Harpagophytum and eleutherosides from Eleutherococcus senticosus in horse urine

LC/ESI-MS n methods have been previously set up to detect the administration of (i) Harpagophytum and (ii) preparations containing a plant capable of anti-stress properties: Eleutherococcus senticosus. Harpagoside has been found to be the main indicator of Harpagophytum administration in the horse. These methods have been applied to a large number of horse urine samples of various origins. Regarding the detection of Harpagophytum administration, harpagoside, harpagide and 8-para-coumaroyl harpagide were detected together in only one sample out of 317. Eleutheroside E was found to be the main indicator of Eleutherococcus senticosus administration. It was detected in post-administration samples collected from two horses having received a feed supplement containing Eleutherococcus senticosus for several days. Out of the 382 samples tested, eleutheroside E was found in an unexpected large number of urine samples (39%) of various origins and its presence cannot be only due to the sole use of herbal dietary supplements.

Dietary Supplement Polypharmacy: An Unrecognized Public Health Problem?

Excessive and inappropriate use of medications, or ‘polypharmacy’, has been recognized as a public health problem. In addition, there is growing use of dietary supplements in the United States; however, little is known about the patterns of supplement use. Recent reports in the literature of cases of excessive or inappropriate use of herbal dietary supplements leading to the term ‘polyherbacy’. The clinical vignettes described in this article highlight the need for further research on the nature and extent of multiple and inappropriate dietary supplement use or ‘dietary supplement polypharmacy’. Clinical interviewing and population surveys both address this issue in complementary ways, and provide a further understanding of dietary supplement use patterns.

Effect of Pancreas Tonic (an ayurvedic herbal supplement) in type 2 diabetes mellitus

Although there is widespread use of herbal dietary supplements that are believed to benefit type 2 diabetes mellitus, few have been proven to do so in properly designed randomized trials; their efficacy for intermediate-term glucose control remains unclear. Pancreas Tonic is a botanical mixture of traditional Indian Ayurvedic herbs currently available as a dietary supplement. We report the results of a single-center, randomized, double-blind, placebo-controlled 3-month trial of Pancreas Tonic in type 2 diabetic patients inadequately treated with diet/lifestyle or stable doses of sulfonylureas and/or metformin for at least 3 months. Patients with type 2 diabetes for ≥ 1 year were entered into 2 strata of hemoglobin A 1c (HbA 1c) levels (stratum 1: 8.0% to 9.9%; stratum 2: 10.0% to 12.0%). All subjects began a 1-month single-blind placebo run-in phase, followed by randomization in a 2:1 ratio of active treatment: placebo, to 3 months of double-blind treatment with either Pancreas Tonic or matching placebo (2 capsules 3 times a day). Concurrent oral agents were continued unchanged throughout the study. The primary outcome was the change in HbA 1c from randomization; results of each stratum were analyzed independently. The baseline characteristics of 36 subjects who completed the study were comparable between treatment groups. Nineteen subjects entered stratum 1 and 17 entered stratum 2. A statistically significant reduction of HbA 1c from randomization to end-of-study was seen in the stratum 2 subjects (Pancreas Tonic: 10.1% ± 1.0% to 8.8% ± 1.9%, P = .004; placebo: 10.8% ± 1.4% to 11.2% ± 1.8%, not significant [NS]). No significant HbA 1c reductions were seen in the stratum 1 subjects. There were no significant treatment-related differences in the fasting plasma glucose (FPG), lipids, body mass index (BMI), body composition, blood pressure, insulin sensitivity estimates using the minimal model, glucose and insulin responses to a meal challenge, quality of life, adverse events, or other safety indices between treatment groups. Pancreas Tonic was well tolerated. Treatment with Pancreas Tonic (2 capsules 3 times per day) for 3 months significantly improved glucose control in type 2 diabetic patients with HbA 1c levels between 10.0% to 12.0%. This study represents the first properly designed, prospective intervention trial of therapy with an Ayurvedic herbal supplement for intermediate-term glucose control in type 2 diabetes.

Studies on molecular mechanisms of Ginkgo biloba extract

In the past decade, interest by the general public in the use of herbal dietary supplements has risen exponentially. As throughout history, individuals are now turning to the use of "natural" therapies for the prevention, treatment and cure of almost every ailment and aging malady imaginable. often without substantial proof of safety or efficacy. One of the most popular herbal supplements is Ginkgo biloba extract, taken for its perceived "memory enhancing" properties. Given the inordinate popularity, growing use, and substantial number of pharmaceutical products containing G. biloba, coupled with demands for product safety and "hard evidence," science has followed this trend closely with an ever-expanding body of pharmacological and clinical data on such preparations. Claims that standardized G. biloba extract (EGb 761) can modulate the cellular environment of an organism under both physiological and stress conditions may be attributed to its multivalent or totipotent properties, and can now be substantiated by the availability of modern molecular techniques. As opposed to pharmacologically manufactured or synthetic drugs, which provide a single target for a single receptor as the mechanism of action, EGb 761 is able to up- or down-regulate signaling pathways, gene transcription, cellular metabolism, etc., and thus assist in the regulation of the general physiological status of the cell and/or organism in response to stressors posed by both intracellular and extracellular conditions. Presumably, this is one of the biggest advantages of using natural products for the prevention and treatment of infirmity, as well as the maintenance of health in an organism.

Drug Interaction Between St. Johnʼs Wort and Cyclosporine

OBJECTIVE:To report a probable drug interaction between the herbal dietary supplement St. John's wort and cyclosporine.CASE REPORT:A 29-year-old white woman who received a cadaveric kidney and pancreas transplant, with stable organ function and stable cyclosporine concentrations began self-medicating with St. John's wort. After taking St. John's wort supplements for four to eight weeks, her cyclosporine concentrations became subtherapeutic; this was associated with organ rejection. Four weeks after stopping St. John's wort, her cyclosporine concentrations again became therapeutic. Subsequent to this rejection episode, she has developed chronic rejection and now has returned to dialysis.DISCUSSION:St. John's wort is suspected to be a significant inducer of CYP3A4 isoenzyme activity and of P-glycoprotein (P-gp) expression, both of which are important in the metabolism and absorption of cyclosporine. Cyclosporine exhibits a relatively small therapeutic window and is sensitive to medications that can modulate the CYP3A4 isoenzyme and P-gp in both the liver and small intestines.CONCLUSIONS:Patients taking St. John's wort concomitant with other prescription medications whose absorption and metabolism are mediated by the CYP3A4 isoenzyme and P-gp require close monitoring. Patient medication histories should include inquiries into the use of herbal dietary supplements.