Traditional Remedies and Food Supplements
Since 1991, the Medical Toxicology Unit (MTU) at Guys’ Hospital, London, has been assessing the toxicological problems associated with the use of traditional and herbal remedies and dietary supplements. This assessment was carried out by evaluating reports to the National Poisons Information Service (London) [NPIS(L)] which provides emergency information to medical professionals. Relevant telephone enquiries to NPIS(L) were identified. Further case details were obtained by follow-up questionnaire, clinical consultation, toxicological analysis of samples from patients and/or products and botanical identification of plant material.
Of 1297 symptomatic enquiries evaluated there was a possible/confirmed association in 785 cases. Case series have been identified which substantiate previous reports, including liver problems following the use of Chinese herbal medicine for skin disorders, allergic reactions to royal jelly and propolis and heavy metal poisoning caused by remedies from the Indian subcontinent. Although the overall risk to public health appears to be low, certain groups of traditional remedies have been associated with a number of potentially serious adverse effects.
Considering the extent of use of herbal remedies and food supplements a comprehensive surveillance system for monitoring the adverse health effects of these products is essential. Surveillance of a large population is needed for the complex task of identifying the uncommon and unpredictable adverse effects which are potentially serious. In the UK, the Medicines Control Agency responded to the MTU report by recognising the need for vigilance and by incorporating adverse reactions reporting on unlicensed herbal remedies into their drug reaction monitoring function. As a further step to safeguard the patients/consumers an effective single regulatory system is required which would ensure the safety and quality of all herbal remedies and food supplements available in the UK.[1]
The Role of Functional Foods, Nutraceuticals, and Food Supplements in Intestinal Health
New eating habits, actual trends in production and consumption have a health, environmental and social impact. The European Union is fighting diseases characteristic of a modern age, such as obesity, osteoporosis, cancer, diabetes, allergies and dental problems. Developed countries are also faced with problems relating to aging populations, high energy foods, and unbalanced diets. The potential of nutraceuticals/functional foods/food supplements in mitigating health problems, especially in the gastrointestinal (GI) tract, is discussed. Certain members of gut microflora (e.g., probiotic/protective strains) play a role in the host health due to its involvement in nutritional, immunologic and physiological functions. The potential mechanisms by which nutraceuticals/functional foods/food supplements may alter a host’s health are also highlighted in this paper. The establishment of novel functional cell models of the GI and analytical tools that allow tests in controlled experiments are highly desired for gut research.[2]
Adverse events of herbal food supplements for body weight reduction: systematic review
Herbal weight-loss supplements are marketed with claims of effectiveness. Our earlier systematic review identified data from double-blind, randomized controlled trials for a number of herbal supplements. The aim of this systematic review was to assess all clinical evidence of adverse events of herbal food supplements for body weight reduction for which effectiveness data from rigorous clinical trials exist. We assessed Ephedra sinica, Garcinia cambogia, Paullinia cupana, guar gum, Plantago psyllium, Ilex paraguariensis and Pausinystalia yohimbe. Literature searches were conducted on Medline, Embase, Amed and The Cochrane Library. Data were also requested from the spontaneous reporting scheme of the World Health Organization. We hand-searched relevant medical journals and our own files. There were no restrictions regarding the language of publication. The results show that adverse events including hepatic injury and death have been reported with the use of some herbal food supplements. For herbal ephedra and ephedrine-containing food supplements an increased risk of psychiatric, autonomic or gastrointestinal adverse events and heart palpitations has been reported. In conclusion, adverse events are reported for a number of herbal food supplements, which are used for reducing body weight. Although the quality of the data does not justify definitive attribution of causality in most cases, the reported risks are sufficient to shift the risk–benefit balance against the use of most of the reviewed herbal weight-loss supplements. Exceptions are Garcinia cambogia and yerba maté, which merit further investigation.[3]
Lipopolysaccharides in food, food supplements, and probiotics: should we be worried?
The fever-inducing effect of lipopolysaccharides (LPS) is well known, and human blood is extremely responsive to this pyrogen. Recently, the safety of LPS-containing food supplements and probiotic drugs as immune-stimulants has been questioned, although these products are orally taken and do not reach the bloodstream undigested. The concerns are understandable, as endotoxaemia is a pathological condition, but the oral uptake of probiotic products containing LPS or Gram-negative bacteria does not pose a health risk, based on the available scientific evidence, as is reviewed here. The available methods developed to detect LPS and other pyrogens are mostly used for quality control of parentally applied therapeuticals. Their outcome varies considerably when applied to food supplements, as demonstrated in a simple comparative experiment. Products containing different Escherichia coli strains can result in vastly different results on their LPS content, depending on the method of testing. This is an inherent complication to pyrogen testing, which hampers the communication that the LPS content of food supplements is not a safety concern.[4]
Current trends in the analysis and quality control of food supplements based on plant extracts
Food (dietary) supplements include a wide range of products that are designed to be taken because of their added nutrients and presumed health benefits. Global food supplement sales are experiencing rapid growth and supplements that based on botanicals are among the most popular. The meteoric rise in sales coupled with the general lack of a commitment to pass effective regulation make this market more vulnerable to dishonest producers, increase the likelihood that supplements containing adulterants are sold on the market, and a greater prevalence of safety and quality issues (contamination by pesticides and mycotoxins). In this paper, we present an overview of various sample preparation and analytical techniques that can be used for the determination of bioactive substances in food supplements based on plant extracts and for making purity assessments of plant extracts in these preparations. The analysis looks at data collected from 2012 to 2017. The work is divided according to the different approaches taken when analysing food supplements and groups of bioactive substances found in plant extracts (purity assessments and the determination of bioactive substances).[5]
Reference
[1] Shaw, D., Leon, C., Kolev, S. and Murray, V., 1997. Traditional remedies and food supplements. Drug safety, 17(5), pp.342-356.
[2] Cencic, A. and Chingwaru, W., 2010. The role of functional foods, nutraceuticals, and food supplements in intestinal health. Nutrients, 2(6), pp.611-625.
[3] Cencic, A. and Chingwaru, W., 2010. The role of functional foods, nutraceuticals, and food supplements in intestinal health. Nutrients, 2(6), pp.611-625.
[4] Wassenaar, T.M. and Zimmermann, K., 2018. Lipopolysaccharides in food, food supplements, and probiotics: should we be worried?. European Journal of Microbiology and Immunology, 8(3), pp.63-69.
[5] Fibigr, J., Šatínský, D. and Solich, P., 2018. Current trends in the analysis and quality control of food supplements based on plant extracts. Analytica chimica acta, 1036, pp.1-15.
