Supplement Savvy:
Tremendous Potential
Swallowing Hype or Health?
Generally safe Relatively inexpensive
Christopher D. Gardner, PhD Stanford University School of Medicine
Stanford Prevention Research Center
Tremendous Potential Largely unrealized
H.O.P.E Study 2545 women, 6996 men, CVD or diabetes and 1 risk factor, 4.5 years
400 IU Natural Vitamin E Placebo (n=4,780)
20 P=0.3
Negative / Inconsistent findings from trials
Vitamin E (n=4,761)
15
%
P=0.5 P=0.1
5
Lack of agreement on dose / form
0 NEJM 2000;342:154
Alpha-Tocopherol, Beta-Carotene Study 29,133 Finnish men, smokers, (5-8 year follow-up) No Beta-Carotene Beta-Carotene Other Cancer
Significantly WORSE with beta-carotene
Lung Cancer Ischemic Heart Disease ATBC Study Group NEJM, 1994:330:1029-35
0
100 200
300 400 500 600
Number of Deaths
P=1.0
P=0.7 10
700
MI, stroke, CVD death
MI
Stroke
CVD death
Total death
DSHEA (1994) Dietary Supplement Health Education Act
1
DSHEA (1994)
The FDA has fought for decades to regulate supplements, but have been defeated politically, and economically, by the supplement industry
Dietary Supplements ¾ Limited regulation ¾
Limited standardization
¾
Limited monitoring
¾
Limited substantiation of benefits or health claims
Raw garlic Kwai Tegra Fried garlic Allicor Kyolic Garlicin Steam distilled oil Garlet Oil macerate
Pure-Gar
Garlic ether extract Hoefels Original Garlic Oil
209% 123%
151% 136%
209% 129%
120%
123%
119%
100%
100%
%
%
Allicin Potential
Allicin Release
(crushed tablets dissolved in water)
(2-hrs in intestinal buffer USP Method 724A)
Tablet claim (585-6500 ng/tablet)
3930 5410
750
585
3900 5400 4000 3600 2400 6500 4000 6000 4450
0%
Commercially Available Garlic Powder Tablets Lawson, J Agric Food Chem 2001;49:2592-9
151% 136%
129%
120%
119%
100%
100%
Allicin release under % Allicin physiologically relevant Allicin Potential Release (crushed conditions from specific(2-hrs in tablets intestinal dissolved buffer supplement brands used in in water) USP Method recent published trials was 724A) 0% 2-18% of allicin potential Tablet claim %
3930 5410
(585-6500 ng/tablet)
750
585
3900 5400 4000 3600 2400 6500 4000 6000 4450
Commercially Available Garlic Powder Tablets Lawson, J Agric Food Chem 2001;49:2592-9
2
N=192 (~48/group) Fresh Garlic
Placebo
WITH
Garlicin (garlic powder)
Garlicin
Without
Kyolic (aged garlic extract)
Kyolic Placebo
Placebo
Kyolic
120
6
6 months
(PERCENT CHANGE: mean +/- SEM)
Garlicin
Kyolic
#5 En dst ud y
#4 M
on
th
#3 M
on
th
#2
th on
Conclusions/Implications: Garlic study
Placebo
8%
M
th
on
B
6-month changes relative to baseline
th
#1
0
3-Year Project, funded by NIH / NCCAM
Raw Garlic
Placebo
Goal
Without
Lipids
2%
Neither raw garlic, nor herbal supplements effectively lowered LDL-cholesterol over 6 months
0%
among moderately hypercholesterolemic adults,
6%
Percent change
Garlicin 140
on
4
Raw Garlic
160
M
2
No significant differences
180
as el in e
0
Without
200
M
Months
LDL-cholesterol by treatment group and time point
Daily Sandwiches WITH or Daily WITHOUT Tablets garlic
LDL-C (mg/dL)
Garlic Study: Design
4%
-2%
when taken at a dose of ~1 clove/day
-4%
The major effect of garlic on your cholesterol is more likely due to the foods you flavor with garlic, than to the garlic itself.
-6% -8%
p=0.3
p=0.3
LDLCholesterol
HDLCholesterol
p=0.9
p=0.3
Triglycerides Tot-C/HDL-C Ratio
Commercial supplements, despite claims of effectiveness, are not helpful for high cholesterol
NEW ENGLAND JOURNAL of MEDICINE The
ESTABLISHED IN 1812
JULY 28, 2005
VOL. 353 NO. 4
An Evaluation of Echinacea anjustifolia in Experimental Rhinovirus Infections Ronald B. Turner, M.D., Rudolf Bauer, Ph.D., Karen Woelkart, Thomas C. Hulsey, D.Sc., and J. David Gangemi, Ph.D.
CONCLUSIONS …extracts of E. angustifolia root, either alone or in combination, do not have clinically significant effects on infection with a rhinovirus or on the clinical illness that results from it.
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NEW ENGLAND JOURNAL of MEDICINE
NEW ENGLAND JOURNAL of MEDICINE
The
ESTABLISHED IN 1812
FEBRUARY 9, 2006
VOL. 354 NO. 6
Saw Palmetto for Benign Prostatic Hyperplasia Stephen Bent, M.D., Christopher Kane, M.D., Katsuto Shinohara, M.D., John Nuehaus Ph.D., Esther S. Hudes, Ph.D., M.P.H., Harliey Goldberg, D.O., and Andrew L. Avins, M.D., M.P.H.
CONCLUSIONS …saw palmetto did not improve symptoms or objective measures of benign prostatic hyperplasia
The
FEBRUARY 23, 2006
ESTABLISHED IN 1812
VOL. 354 NO. 8
Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis Daniel O. Cleg, M.D., Domenic J. Reda, Ph.D., Crystal L. Harris, Pharm D., Marguerite Klein, M.S., James R. O’Dell, M.D., Michele M. Hooper, M.D., ……and H. James Williams, M.D.
CONCLUSIONS Glucosamine and chondroitin sulfate alone or in combination did not reduce pain effectively in the overall group of patients with osteoarthritis of the knee. May be effective in subgroup with moderate-to-severe knee pain.
GISSI
Gruppo Italiano por lo Studio della Sopravvivenza nell’infarcto miocardio
850 mg EPA:DHA (1:2) – Comparable to 100 g fatty fish (300 mg synthetic alpha tocopherol) 11,324 Women and Men, MI survivors, 3-5 year follow-up 15
%
10
RR=0.90 (0.82-0.99) 782 of 5668 13.9%
5 0
Does the product contain what is says it contains? http://www.consumerlabs.com/
715 of 5666 12.6%
RR=0.89 (0.80-1.01) 608 of 5668 10.8%
Death non fatal MI non fatal stroke
547 of 5666
Control n-3 PUFA
9.7%
CVD death non fatal MI non fatal stroke
GISSI, Lancet, 1999;354:4447-55
Berkeley Wellness Letter www.wellnessletter.com
One-year subscription is $27.00
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5-HTP Airborne Aloe Vera Drink Alpha-lipoic Acid Arginine Avacor Bee Pollen Beta Carotene Bilberries Black Cohosh Blue-Green Algae Calcium Cat's Claw Chaparral CholesterolLowering Supplements Choline Chondroitin sulfate Chromium CLA Cod Liver Oil Coenzyme Q-10 Cold Remedies Colostrum, Bovine Coral Calcium CortiSlim Creatine DHEA Echinacea Enzyme Supplements
Ephedra Evening Primrose Oil Exercise in a Bottle & Fat Trapper Eye Supplements (Ocuvite) Feverfew Fish Oil Flaxseed Focus Factor Folic Acid Garcinia Garlic Pills GBL Gero Vita Ginger Ginkgo Biloba Ginseng Glucosamine Glyconutrients Goldenseal Grape Seed Extract Guggulipid Hawthorn Herbal (Diet) Teas Homeopathic Remedies Hoodia Human Growth Hormone Huperzine A Iron
Juice Plus+ Kava Lecithin Liver Supplements Lysine Lutein Magnesium Mangosteen Melatonin Memory and Brain Supplements Microhydrin Milk Thistle Minerals, Chelated Minerals, Colloidal MSM Multivitamins/ Minerals Muscle Supplements Niacin Noni Juice Phosphatidylserine Probiotics Psyllium Pycnogenol Red Yeast Rice Extract Rose Hips Royal Jelly SAM-e Sassafras Saw Palmetto
Selenium Senior Moment Sex Supplements Soy Isoflavones St. John's Wort Stanol/Sterol Supplements Starch Blockers Tocotrienols Valerian Vanadyl Sulfate Vitamin A Vitamin B-12 Vitamin C Vitamin D Vitamin E Vitamin K Wheat grass, Barley grass Yohimbe Zicam Zinc
Nutrition Action Health Letter Center for Science in the Public Interest
Password for this month: walnut
Iron – for anemia Calcium – for bone density (and fractures?) Stanol esters – for blood cholesterol Folic acid – for neural tube defects Fish oil – for triglycerides and heart disease
Vitamin E – for cardiovascular disease Garlic – for blood lipids Soy Isoflavones – for menopausal symptoms Vitamin C, Echinaceae – for colds Ginkgo biloba – for cognitive function And many more ………
My personal daily regimen of dietary supplements? Ephedra – for energy/weight loss Beta Carotene – for lung cancer (among smokers) Aristolochic acid – for weight loss, immune
Chewable, chocolate flavored calcium
stimulation, cough therapy, GI symptoms
Kava – for anxiety, insomnia, depression, stress
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Ongoing Research Studies Antioxidant Study Omega-3 Study UPBEAT Study
vs.
Ongoing Research Studies Antioxidant Study http://nutrition.stanford.edu/
vs. Understanding Pine Bark Extract as an Alternative Treatment
Omega-3 Study UPBEAT Study
http://ppop.stanford.edu/
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