Biologically Based Therapies -1 (Diet & Supplements) PDF

Biologically based therapies -1 (diet & supplements) Prepared by: Prof. Madiha R. Mahmoud Pharmacology department College of Medicine University of Hail Background Dieticians in conventional settings tend to work mainly with certain patients, such as those with diabetes, obesity, digestive or swallo...

Biologically based therapies -1 (diet & supplements) Prepared by: Prof. Madiha R. Mahmoud Pharmacology department College of Medicine University of Hail Background Dieticians in conventional settings tend to work mainly with certain patients, such as those with diabetes, obesity, digestive or swallowing problems, or cardiovascular risk factors. Apart from the treatment of gross nutritional deficiencies and rare metabolic disorders, other nutritional interventions generally fall outside the mainstream and can therefore be described as complementary medicine. Nutritional interventions Unconventional nutritional interventions can be broadly divided into three categories: nutritional supplements, dietary modification, and therapeutic systems. Sports Nutrition & Healthy Foods 1- Nutritional supplements As well as various vitamins and minerals, the range of nutritional supplements includes many animal and plant products. Some of these have known active ingredients, such as γ-linolenic acid in evening primrose oil. Others, such as blue-green algae and kelp, have not been fully characterized biochemically. Some supplements are taken to improve general health and performance, while others are for specific clinical indications. Most are taken in pill form. There is some overlap between herbal and nutritional supplements. Box 1. Examples of nutritional supplementation High dose vitamin C for cancer Zinc for the common cold High dose vitamins for learning disability (‘orthomolecular’ therapy) Evening primrose oil for atopic dermatitis Evening primrose oil for premenstrual syndrome Vitamin B6 for morning sickness Vitamin B6 for premenstrual syndrome Garlic for lowering cardiovascular risk Multivitamins for improvement in general health 2. Dietary modification Many diets, such as vegetarianism and veganism, originated as ‘movements’ characterized by political and ecological concerns, a moral stance towards food, and a view of diet as inseparable from lifestyle. Many diets are based on theoretical considerations rather than empirical data. For example, the rationale for the Hay diet’s principle that starch, and protein should not be eaten together is that each type of food requires a different pH for optimum digestion. The principle of the Stone Age diet is that humans are not adapted by evolution to eat grains and pulses. Box 2. Examples of diets claimed to improve general health Hay diet – proteins and carbohydrates are eaten separately. Blood type diet – an ideal diet should be determined by an individual’s inherited ABO blood type. Raw foods diet – avoids cooked foods. Stone Age diet – avoids grains, pulses, and other products of the agricultural revolution. Macrobiotic diet – largely based on grains and vegetables. Foods are chosen and balanced in accordance with traditional oriental principles such as yin and yang. Veganism – avoids all animal products 3. Therapeutic systems These include techniques such as elimination dieting and naturopathy. Elimination dieting is based on the principle that foods particular to each patient may contribute to chronic symptoms or disease when eaten in normal quantities. Diagnosis consists of eliminating all but a few foods from the diet and then reintroducing foods one by one to see if they provoke symptoms. After a period of complete exclusion, the problem substances can usually be gradually reintroduced without recurrence of symptoms. Although practitioners commonly diagnose wheat and dairy ‘intolerance’, each patient is said to be sensitive to a different set of foods. Naturopathy is a therapeutic system emphasising the philosophy of ‘nature cure’ and incorporating dietary intervention among other practices such as hydrotherapy and exercise. For example, a naturopath might advise a patient with recurrent vaginal candidiasis to undertake a limited fast, to reduce the intake of foods containing sugar and yeast, and to take herbal and probiotic preparations. Another therapeutic system tests patients for ‘subclinical’ nutritional deficiencies – thought to arise where systems of food intake, digestion, or absorption are not fully functional – and gives appropriate supplementation. What happens during a treatment? Many people make unconventional nutritional changes without consulting a practitioner (see below). But when practitioners are involved in treatment, consultations may involve some testing for deficiencies of certain nutrients or hidden allergies. Such tests include biochemical assays of the vitamin and mineral content of blood or hair. In ‘Vega’ or electrodermal testing, an electric circuit is made that includes both the patient and the foodstuff suspected of causing disease. Electrical readings are said to confirm or refuse these foodstuff ’s involvement. In applied kinesiology ‫ﻋﻠم اﻟﺣرﻛﺔ‬, practitioners claim to be able to diagnose an allergy or deficiency on the basis of changes in muscle function. Evidence of therapeutic scope There is evidence that exclusion dieting can be of benefit for various conditions including rheumatoid arthritis, hyperactivity, and migraine. Randomized trials have shown that increasing the consumption of polyunsaturated fatty acids – for example, by supplementation with products such as fish oils or evening primrose oil – and reducing saturation can be beneficial in cases of hyper-triglyceridaemia, rheumatoid arthritis, and inflammatory bowel disease. Box 3. Examples of dietary interventions claimed to help in specific conditions Dong diet for arthritis – recommends a diet similar to that of Chinese peasants Feingold diet for attention deficit disorder – recommends elimination of food additives Polyunsaturated fatty acid diet for multiple sclerosis Gluten-free diets for schizophrenia Dairy-free diet for recurrent respiratory disease Gerson diet for cancer – strictly vegetarian, largely raw food, diet with coffee enemas, and various supplements Macrobiotics diet – claimed to help many specific diseases including cancer Safety Most unconventional diets recommend generally healthy patterns of eating reduction or elimination of fat, sugar, alcohol, and coffee and an increase in fresh vegetables and fibre), which most people with a normal digestion can tolerate without side effects. Some diets, such as veganism or macrobiotics, are restrictive and can lead to complications such as reduced bone mass or anaemia, especially in children. Children, pregnant and lactating women, and patients with chronic illness should undertake such major dietary changes with care. High dose nutritional supplementation can lead to acute adverse effects such as diarrhoea (vitamin C) and flushing (niacin) during treatment. Chronic use of high dose vitamin B6 may lead to neuropathies. High doses of fat-soluble vitamins: vitamin A has been linked with birth defects (if taken during pregnancy) and irreversible bone and liver damage, and vitamin D with hypercalcaemia. High doses of single minerals or amino acids may induce deficiency in nutrients that share similar metabolic pathways. Vitamins and minerals can interfere with chemotherapy and radiotherapy; in cancer patients are advised to avoid supplements during treatment, and for a few weeks before and after. Common supplements include: Vitamins (such as multivitamins or individual vitamins like vitamin D and biotin). Minerals (such as calcium, magnesium, and iron). Botanicals or herbs (such as echinacea and ginger). Botanical compounds (such as caffeine and curcumin). Amino acids (such as tryptophan and glutamine). What are 3 benefits of dietary supplements? Supplementing may help you by: Providing nutrients, you can't get from your diet. Increasing your levels of nutrients if you have deficiencies. Supporting overall and specific wellness goals. Complementing mainstream medical treatment plans. Offering alternative therapeutic options. Dietary supplement uses Dietary supplements could be useful if you can’t get all the nutrients you need from food sources. This may be due to: Dietary habits: Following a restrictive diet like a keto or vegan diet increases your chances of nutrient deficiencies. Lifestyle factors: persons who are travelling a lot or working long hours. Physical considerations: such as difficulty to eat or digest certain foods and may need another method of getting nutrients. Also, pregnant or breastfeeding often need supplements. Certain medical conditions who are suffering from nutrient deficiencies (type 2 diabetes are more likely to be deficient in nutrients like B12 and magnesium). Personal health history: such as mineral deficiency Dietary supplement risks Interact with medications Worsen existing health conditions Cause side effects or allergic reactions Complicate surgery The FDA doesn’t regulate dietary supplements in the same way as drugs — instead, it regulates them in a similar way to food. Manufacturers are supposed to ensure that supplements are safe before bringing them to the marketplace. Dietary supplement side effects and adverse reactions Many supplements such as ginger or curcumin or echinacea, are usually considered safe for most people when taken properly. The government deems these substances “generally recognized as safe” (GRAS). Side effects. Common side effects include upset stomach, diarrhea, headaches, and nausea some cause liver damage or fatal development issues or even life threatening. Allergic reaction. Allergies can manifest as itching, swelling, rashes, and even anaphylaxis. Overdosing. can lead to serious long-term or irreversible effects. Complications with existing medical conditions. Interactions with drugs or other supplements, e.g., sometimes combining supplements with prescribed drugs, over-the-counter. Precautions Confirm that the supplements you’re considering are a good idea for you, Some supplements can block the absorption or alter the effects of medications. Here are some common supplements that don’t mingle so nicely with certain prescription medications: St. John’s wort can muck ‫ﺗﻔﺳد‬with birth control and treatments for HIV, heart disease, depression, and organ transplants. Gingko biloba, ginseng, and vitamins E and K can change blood thin and cause health problems if you’re taking blood thinners like warfarin. Antioxidant supplements could interfere with some forms of chemotherapy. Liquorice, cranberry, and grapefruit have also been known to affect some medications. Most research on the safety of supplements doesn’t include pregnant or nursing women or children. Supplements and surgery can be a poor pairing. REFERENCES Costache I-I, et al. (2019). Pharmacokinetic interactions between cardiovascular medicines and plant products. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7012273/ Dietary supplements. (2021). https://www.fda.gov/consumers/consumer-updates/dietary-supplements Guidance for industry, Q7A Good Manufacturing Practice guidance for active pharmaceutical ingredients. 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Vitamin D deficiency. https://www.ncbi.nlm.nih.gov/books/NBK532266/ Stover PJ. (2020). Vitamin B12 and older adults.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130103/ Tavares Bello C, et al. (2017). Vitamin B12 deficiency in type 2 diabetes mellitus.https://pubmed.ncbi.nlm.nih.gov/29268066/ Using dietary supplements wisely. (2019).https://www.nccih.nih.gov/health/using-dietary-supplements-wisely Wakeman M, et al. (2020). Metformin and micronutrient status in type 2 diabetes: Does polypharmacy involving acid-suppressing medications affect vitamin B12 levels?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308123/ What you need to know: Dietary supplements. (2019). https://ods.od.nih.gov/factsheets/WYNTK-Consumer/ Many Thanks