Y khoa, dược - Spotlight on dietary supplements and functional foods

Spotlight on Dietary Supplements and Functional FoodsDietary Supplements: Vitamins and MineralsVarious formsVitamins, minerals, amino acids, herbs, glandular extracts, enzymes, etc.Moderate SupplementationIn the range of the Daily Values (DVs)MegadosesHigh levels; multiples of the DVsDietary Supplements: Vitamins and MineralsModerate supplementationIncreased nutrient needs and/or poor intakeWomen of childbearing age who may become pregnantPregnant and breastfeeding womenWomen with heavy menstrual lossesChildrenDietary Supplements: Vitamins and MineralsModerate supplementationIncreased nutrient needs and/or poor intakeInfantsPeople with severe food restrictionsStrict vegetarians who abstain from animal foods and dairy productsOlder adultsOthersDietary Supplements: Vitamins and MineralsModerate supplementationLook for brands that contain at least 20 vitamins and mineralsNo more than 100% of its DV Dietary Supplements: Vitamins and MineralsMegadoses in conventional medical managementConventional medicineDrug interactionsMalabsorption syndromesTreatment of deficienciesDruglike effectsDietary Supplements: Vitamins and MineralsMegadosing beyond conventional medicine: orthomolecular nutritionAchieving the optimal nutrition levels in the bodyDrawbacks of megadosesCan act as a drugCan create deficits of other nutrientsCan interfere with absorption of othersDietary Supplements: Natural Health ProductsNatural health productsHerbal therapy (phytotherapy)Traditional medical practicesLittle scientific evidence of efficacy, safetyDietary Supplements: Natural Health ProductsHelpful herbs, harmful herbsSt. John’s wortMilk thistleGinkgo bilobaSaw palmetto extractCranberry juiceDietary Supplements: Natural Health ProductsHelpful herbs, harmful herbsStrong enough to help, strong enough to hurtCan interfere with standard medicinesDANGER: Examples of products with toxic side effectsSt. John’s WortYohimbe EphedraChaparralComfreyDietary Supplements:Natural Health ProductsQuality control issuesContaminantsPoorly standardized strength or potencyRegulationsCurrent good manufacturing practicesOther dietary supplementsHundreds of productsDietary Supplements in the MarketplaceFreedom of speech and pressThe FTC and supplement advertisingFederal Trade CommissionThe FDA and supplement regulationDietary Supplement Health and Education ActDietary supplements are not drugsDietary supplements are not food additivesApproval by FDA is not requiredDietary Supplements in the MarketplaceSupplement labelsIngredient informationSupplement fact panelDietary Supplements in the MarketplaceSupplement labelsClaims allowedHealth claims (approved by FDA), structure/function claims, and nutrient content claimsExamplesCalcium and osteoporosisFolate and neural tube defectsDietary Supplements in the MarketplaceStructure/function claimsMust have “disclaimer” statement on labelDietary Supplements in the MarketplaceNutrient content claimsConsistent with definitions approved for foodsCanadian regulationsNatural health products regulationsDietary Supplements in the MarketplaceChoosing dietary supplementsIs the quantity enough to have an effect?Is the product new to you?What is its bioavailability?Can it interact with any prescription or other medications you are taking?Does the product promise too much?Who is selling the product?U.S. Pharmacopeia verificationDietary Supplements in the MarketplaceFraudulent productsPotential warning signs (examples)Claim to be alternatives to FDA-approved drugsClaim to be a legal alternative to steroidsMarketed primarily in a foreign language/mass emailsDietary Supplements in the MarketplaceFraudulent productsSecret cure (“breakthrough”)Pseudomedical jargon (e.g., “detoxify”)Cures a wide range of diseasesNo side effects, only benefitsBacked by “scientific research” you can’t findRemember, if it sounds too good to be trueFunctional FoodsProvide health benefits beyond nutritionPhytochemicalsAntioxidantsNeutralize free radicalsReduce heart disease, cancer riskFound in fruits, vegetables, whole grains, legumes, and wineFunctional FoodsPhytochemicals make food functionalSubstances in plantsPromote healthAre not essential for lifeAre a benefit to the plant itselfPhytochemicals Make Food FunctionalBenefits of phytochemicalsAssociated with a decreased risk of chronic diseasesCancerCardiovascular diseasesPrevent chronic diseasePhytoestrogensNeutralize free radicalsPhytochemicals Make Food FunctionalAdding phytochemicals to your dietInclude more functional foods and fewer empty caloriesMore fruitMore vegetablesMake half of your grains wholePhytochemicals Make Food FunctionalFoods enhanced with functional ingredientsAdding health promoting properties during processingPhytochemicals Make Food FunctionalRegulatory issues for functional foodsFoodDrugsDietary supplementsAdditives in functional foodsHerbs and other novel ingredientsGRAS guidelines applyFood AdditivesDirect additivesAdded to foods for specific reasonIndirect additivesUnintentionally become part of a foodFood AdditivesPurpose of direct additivesMaintain product consistencyImprove or maintain nutritional valueKeep food appetizing and wholesomeProvide leavening or control acidity and alkalinityEnhance flavor or colorFood AdditivesRegulation by FDAFood additives: FDA approval; manufacturer must prove safetyColor additives: FDA approval; manufacturer and FDA tests batches for purityExample: any dye that impacts colorFood AdditivesRegulation by FDAGenerally Recognized as Safe (GRAS)Example: salt, sugar, spicesPrior-sanctioned substanceExample: sodium nitrite and potassium nitriteFood AdditivesDelaney ClauseApply to food additives Apply to color additivesNo approval if additive causes cancerHumanAnimalsControversy associated with amount tested in animals vs. actual human consumptionClaims for Functional FoodsStructure/function claims for functional foodsBased on nutritive value of foodsNot as stringently regulated as health claimsStrategies for Functional Food UseStick with the scienceEat fruit and vegetablesEat nutrition-fortified products as neededRead, read, read (scientific articles)Be critical of advertising and hypeIf it sounds too good to be true, it probably is!Complementary and Alternative Medicine (CAM)ComplementaryPractices used in addition to conventional medicineAlternativePractices used in place of conventional medicineComplementary and Alternative Medicine (CAM)Nutrition in CAMVegetarian dietsMacrobiotic dietFood restrictions and prescriptionsNeed for scientific evaluation