15. ORTHOMOLECULAR Flashcards

Question 1

Q

What nutrient is reduced by the statin group of pharmaceutical drugs and why does this happen?

Answer

A

CoQ10.
Statins are drugs used to reduce cholesterol synthesis through the inhibition of (HMG CoA reductase and) the Mevalonate Pathway. But they also reduce CoQ10 because both compounds are synthesised via this metabolic pathway.

Slide 12-13

Question 2

Q

Why is Alpha Lipoic Acid so effective as an antioxidant?

Answer

A

ALA is referred to as ‘universal antioxidant’ since it functions in a fat-soluble and water-soluble environment. Exogenous forms scavenge free radicals intra- and extra-cellularly.
it can also regenerate other antioxidants such as vitamin E, C, glutathione and CoQ10.
It also up-regulates the expression of glutathione.

Summary
Universal antiOx
Exo scavnge freeRad inter/xtra
Regen ANtiOxs glutathione and coQ E C

Question 3

Q

What are THREE key ways that chondroitin
protects cartilage?

Answer

A

Chondroitin protects cartilage from degradation by:
- Reducing degradative enzymes.
- Decreasing inflammation — reduces inflammatory intermediates such as COX-2. This is also seen by reductions in the inflammatory marker ‘CRP’.
- Increasing hyaluronic acid synthesis, thereby enhancing joint lubrication.

Dos 200-400mg/x3/d Might make asthma worse (higher antibodies present)

Summary
!inflam.
!degrading enzymes. ¥hyulloronicacid

Question 4

Q

Glucosamine - its an aminosugar naturally present in most body tissues,

Therapeutic uses

IBD and
Intestinal permeability?

Dose 3-6g/d KIDS 6g/d adults

Answer

A

NAG supports the GI epithelial barrier by enhancing mucin functionality, which is dramatically altered in those with IBD. Mucins are a group of proteins found in mucus that form a barrier and prevent microbial overgrowth.
NAG also reduces biofilm formation associated with IBD.

Summary -
epithelial barrier, mucin fx, biofilm

Question 5

Q

Methyl Sulfonylmethane (MSM)

what is it?

Answer

A

MSM is a source of sulphur used by plants to create AMINO ACIDS, cysteine and methionine. (dietary source)

Question 6

Q

Methyl Sulfonylmethane (MSM)

food sources?

Answer

A

PLANT Green leafy veg,
alfalfa sprouts
algae
fruits
veg
grains

ANIMAL Milk (cows)

Question 7

Q

Methyl Sulfonylmethane (MSM)

Therapeutic Uses for
OSTEOARTHRITIS?

Answer

A

With glucosamine / chrondroitin can reduce pain / swelling.
Anti-inflammatory by inhibiting cytokine secretion (IL-6 & TNF-a) and COX-2
Sulphar is part of cartilage so protective effect on cartilage

Dose 500mg/x3/d

Question 8

Q

Methyl Sulfonylmethane (MSM)

Therapeutic Use
CVD HEALTH?

Answer

A

MSM reduces Homocysteine (donates methyl groups) and reduces lipid peroxidation.

Protects vascular endothelium from damage

Dose 3g/d

Question 9

Q

Methyl Sulfonylmethane (MSM)

Therapeutic Uses
Tissue Repair?

Answer

A

↓ oxidative stress and inflammation so helps repair GI mucosal injury and ↓chronic inflammation
Can be applied topically to hurt skin

dose 2g/x3/d

Question 10

Q

Methyl Sulfonylmethane (MSM)

Therapeutic Uses
Immune Modulator?

Answer

A

Useful for seasonal allergies and ↓inflammation

Inhibits NF-kB activity

dose 2.6g/d for allergies

Generally MSM recognised as safe. well tolerated up to 4g/d
GI sometimes mild nausea diarrhoea bloating. also headaches insomnia

Question 11

Q

Betaine / TMG - occurs naturally in the body (formed from choline)

how can betaine (TMG) reduce risk of CVD?

Answer

A

TMG serves as a methyl donor, facilitating the conversion of homocysteine to methionine.

(Elevated homocysteine is a risk factor for CVD, so betaine can be used therapeutically to support vascular endothelial health and prevent atherosclerosis.)

Question 12

Q

Betaine / TMG - occurs naturally in the body (formed from choline

What’s homocysteine

Answer

A

It’s a biomarker of CVD risk,
also indicates how well someone is methylating.

optimal blood levels 9umol/L. Excess of 14 is high risk of heath issues

Question 13

Q

Betaine / TMG - occurs naturally in the body (formed from choline

Betaine Food sources?

Answer

A

Beets (1-2 cups per day)
Quinoa
Spinach
Sweet potato

Animal - Seafood, Turkey

Question 14

Q

Betaine / TMG - occurs naturally in the body (formed from choline)

Therapeutic Uses
Skeletal muscle performance?

Answer

A

Reduces fat mass and increases muscle mass

Improves muscle endurance, body composition, arm size and bench press work capacity

Dos 2.5g/d

Question 15

Q

Betaine / TMG - occurs naturally in the body (formed from choline

Therapeutic Uses
Fatty Liver Disease?

Answer

A

Betaine improves liver function in NAFLD

Shown by reduction in liver enzymes and size

dose 3g/d

Question 16

Q

Dimethyl glycine (DMG) is trimethyl glycine (betaine) after it has donated its methylgroup

Therapeutic uses

Autism?

Answer

A

in 50% of cases, DMG
improves behaviours,
eye contact
frustration tolerance and speech
Reduce seizures

dose - preschool 65mg, older kids 125mg, Adult 1000mg

initial increase in hyperactivity is possible - just ↓dose
DMG is better tolerated than TMG for autistic patients

Question 17

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in brain

Neuronal membrane functions need it for?

Answer

A

maintenance of cell’s internal environment,
secretory vesicle release,
cell-to-cell communication and
cell growth regulation

Question 18

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in brain

Food sources of phosphatidylserine?

Answer

A

White beans,
whole grain barley,
carrots,
mackerel,
herring,
organ meats.

Question 19

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in brain

Therapeutic uses of phosphatidylserine?
for Alzheimers

Answer

A

Improves neuronal membrane functioning
Increases acetylcholine,
norepinephrine
serotonin
dopamine.
Preserves glucose metabolism during Alzheimers and reduces acetylcholinesterase activity and hippocampal activity.
Increases cognitive function and memory
More effective when symptoms are less severe

Dose 300mg/d

Question 20

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in bra

Therapeutic uses of Phosphatidylserine for depression?

Answer

A

improves mood as it effects cortisol regulation

Dose 100mg /x3/d

Question 21

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in bra

Therapeutic uses of Phosphatidylserine for ADHD?

Answer

A

Promotes attention and
reduces ADHD symptoms and increases short-term memory.

Dose 200mg/d

Question 22

Q

Phosphatidylserine (PS) is most abundant fat-soluble phospholipid in brain

Therapeutic uses of Phosphatidylserine for STRESS AND INSOMNIA?

Answer

A

Dampens prolonged cortisol secretion on brain function -
allows for better sleep and
decreased anxiety

Dose 400mg before bed for insomnia 200mg /d for stress

Generally seen as safe up to 6months.
possible additive effects when combined with cholinergic drugs

Question 23

Q

Phosphatidylcholine (PC) is major part of cell membranes, maintaining in

How is phosphatidylcholine synthesised?

Answer

A

synthesised from dietary choline or through methylation of phosphatidylETHANolamine

95% of body tissue stores of choline are found in PC

Question 24

Q

Phosphatidylcholine (PC) is major part of cell membranes, maintaining in

phosphatidylcholine food sources?

Answer

A

PLANT nuts
peanuts
brussel sprouts
broccoli
spinach
peas

ANIMAL eggs
fish
beef
chicken
pork
liver

95% of body tissue stores of choline are found in PC

Question 25

Q

Phosphatidylcholine (PC) is major part of cell membranes, maintaining in

Therapeutic uses?
LIVER HEALTH?

Answer

A

prevents fat accumulating in liver and hepatoprotective reducing chemical and oxidative damage.

95% of body tissue stores of choline are found in PC

dose 800mg/d

Question 26

Q

Phosphatidylcholine (PC) is major part of cell membranes, maintaining in

Therapeutic uses?
NEUROLOGICAL health?

Answer

A

PC has neuro-protective role as an essential part of neuronal membranes and supplies choline for making ACETYLCHOLINE

acetylcholine is a neurotransmitter for memory and prevents cognitive decline and dementia.

95% of body tissue stores of choline are found in PC

Dose 1-9g/d divided

Question 27

Q

Phosphatidylcholine (PC) is major part of cell membranes, maintaining in

Therapeutic uses?
Ulcerative colitis?

Answer

A

PC protects mucosal barrier and forms vital part of intestinal mucus.

enterocyte membranes influence signalling cascades and reduce inflammation

95% of body tissue stores of choline are found in PC

dose 1-6g/d divided
possible effect when combined with cholinergic drugs which increase acetylcholine.

Question 28

Q

MYO-INOSITOL is most predominant of 9different steroisomer forms of inositol

What does myo-inositol do?

Answer

A

Provides STRUCTURE to body cells,
acts as INTRAcellular meSSenger,
regulates hormones including INSULIN

it’s synthesised in the body and can be sourced from diet

Question 29

Q

MYO-INOSITOL is most predominant of 9different steroisomer forms of inos

Food sources of myo-inositol?

Answer

A

PLANT beans
fresh fruit
(melon, prunes, oranges),
veg (okra, aubergine)

ANIMAL Grass fed meats and eggs

Question 30

Q

MYO-INOSITOL is most predominant of 9different steroisomer forms of inositol

Therapeutic uses
PCOS?

Answer

A

PCOS is characterised by Insulin resistance and ↑ androgens.
it improves insulin sensitivity as its a secondary messenger of insulin signalling and
promotes GLUT4 vesicles.

It increases SHBG to reduce bioavailable testosterone.
it improves menstrual cycle regularity
oocyte quality
overall female fertility

dose 2-3g/d (use with folate)

Question 31

Q

MYO-INOSITOL is most predominant of 9different steroisomer forms of inos

Therapeutic uses

T2DM?

Answer

A

It improves ability of cells to respond to INSULIN and helps regulate blood glucose

dose 4g/d

Question 32

Q

MYO-INOSITOL is most predominant of 9different steroisomer forms of inos

Therapeutic uses?

ANXIETY and Depression?

Answer

A

Inositol is linked to CNS receptors signalling systems including neurotransmitters SEROTONIN and DOPAMINE

decreases anxiety and panic attack frequency.

Decreases depression symptoms including PMS related.

dos 12-18g/d

Generally well tolerated up to 12g. 5% have GI symptoms
no adverse effects in pregnancy (up to 4g)

Question 33

Q

Who coined the term ‘orthomolecular’?

What are orthomolecular compounds?

Give two examples

Answer

A

Linus Pauling coined the term ‘orthomolecular’ in the 1960s to mean “the right molecules in the right
amounts” (ortho- in Greek implies ‘correct’).

Orthomolecular compounds are highly beneficial for health, and although they are naturally synthesised by the body, additional amounts can be sourced from the diet or from supplementation.
These compounds do not fit into the category of other nutrients such as vitamins or minerals.
Examples of orthomolecular compounds include: CoQ10, alpha-lipoic acid, glucosamine and chondroitin sulphate.

Question 34

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

What is accelerated aging caused by?

How might you slow it down or reverse it using orthomolecular therapy?

What else might you consider?

Answer

A

The ageing process is typically accelerated as a result of
free radical exposure, chronic inflammation and toxic exposure.

Reversing or slowing it down is one goal of orthomolecular therapy.
This might involve using CoQ10, ALA or antioxidants.
Be sure to address an individual’s overall diet and lifestyle with the
guidance of core naturopathic nutrition principles. Supplements
alone will not single-handedly support healthy ageing.

Question 35

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

What is it also called?

What form does it exist in the body?

What reduces CoQ10?

Answer

A

CoQ10 also called UBIQUINONE.
It exists in an oxidised form (ubiquinone) and a reduced form (UBIQUINOL) - the two forms interconvert.
usually synthesised in sufficient amounts
CoQ10 is reduced by:
Ageing,
drugs (statins),
smoking and
certain diseases (CVD)

Question 36

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Food sources?

How much CoQ10 is lost if food is fried?

Answer

A

Dietary intake contributes around 3 to 6 mg per day.

Plant Nuts (e.g. peanuts, pistachios),
sesame seeds,
olive oil,
fruit and vegetables i(oranges, strawberries, avocado, broccoli, cauliflower)
Animal Meat,
poultry,
fish (e.g. herring, sardines, mackerel, trout) and
eggs

Approx. 14%‒32% of CoQ10 is lost if foods are fried.

Question 37

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Therapeutic Uses
in energy production?

Answer

A

CoQ10 is needed for the electron transport chain (for complex 2 of 4 in this process)
supports mitochondrial function and energy production.
* The highest quantities are found in muscle cells (including skeletal and cardiac muscle) due to the high ATP demand for muscle contraction.

Therapeutic uses: Fatigue, Fibromyalgia. Daily use

(300 mg in divided doses; i.e. 3 x 100mg/d

Question 38

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Therapeutic Uses
Antioxidant.?[

Answer

A

CoQ10 is a potent fat-soluble antioxidant that inhibits the peroxidation of cell membrane lipids. It neutralises free radicals produced by mitochondria.
CoQ10 naturally decreases with age; the ageing process involves ROS and impaired mitochondrial function.
Depletion of CoQ10 can result in mitochondrial dysfunction, which is associated with conditions including fibromyalgia, Type 2 diabetes, CVD, neurodegenerative diseases and cancer.

Therapeutic Uses:
* Healthy ageing: 100–200 mg per day.
* Preventative measures or for directly addressing mitochondrial dysfunction (e.g. fibromyalgia etc.)

Question 39

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Functions and therapeutic uses for
periodontal health?

Answer

A

Diseased gum tissues have significantly lower levels of CoQ10 in comparison with healthy gum tissue. This is thought to be a result of the lipopolysaccharides from the bacteria Porphyromonas gingivalis, triggering oxidative stress and mitochondrial dysfunction.

Therapeutic Uses:
* Periodontitis. Daily 50–80 mg
* Combine with periodontal care routine.

Summary
Diseased gum tissue has less coq10
Lipopolysaccharides impact with Pgin causing Ox damage

Question 40

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Functions and therapeutic uses for
male & female fertility?

Answer

A

Male fertility
* CoQ10 protects sperm from oxidative stress
(as they are vulnerable).
* 200–300 mg for 6 months increases sperm health.

Female fertility
* Impaired mitochondrial performance (low CoQ10) can drive age-associated oocyte (egg cell) deficits and lead to infertility.
* 100–600 mg for ovarian health.

Question 41

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

Functions and therapeutic uses for
cardiovascular health?

Answer

A

Crucial for cardiac muscle function.
Protects against endothelial dysfunction and hence atherosclerosis.
CoQ10 reduces LDL oxidation.
It inhibits the NF-kB activation that is secondary to ROS.
Increases superoxide dismutase activity (an anti-oxidant) which is known to preserve the activity of nitric oxide (NO) as a potent vasodilator.

THERAPEUTIC USES
* Hypertension, angina pectoris, congestive heart failure, post myocardial infarction.

*

Typical dosage: 60–300 mg / day.

please note - NF-κB = a protein that controls inflammatory cytokine production

Summary
Cardiac muscle fx
Protects endothelial
InH NF-kB activity
Increases SOD(saves NO)
Reduces LDL ox damage

Question 42

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

How do statins and CoQ10 interact?

What are the risks of low CoQ10 levels?

Answer

A

Statins and CoQ10:
* Statins reduce -
1) cholesterol synthesis
2) CoQ10
As both compounds are synthesised via the same pathway.
Both have vital functions in the body.
Their loss contributes to ADVERSE effects caused by statins.

Low CoQ10 levels = increased risk of CVD, myopathy
depression.

90–300 mg / day of CoQ10 greatly reduces this risk

Question 43

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

What is the Mevalonate Pathway?

Describe the Mevalonate Pathway.

Answer

A

The Mevalonate Pathway:
* This metabolic pathway is required for the production of cholesterol and CoQ10 — two crucial molecules for health.
* Statins act on this pathway

Acetyl-CoA → HMG-CoA → (HMG-CoA reductase inserts here & is broken by a statin) → Mevalonic acid → Cholesterol
or → CoQ10

( slide 13 image below)

Question 44

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

There is a debate about which is better, ubiquinol or ubiquinone, describe.

Answer

A

ubiquinol MIGHT be a better supplement
for CoQ10 status enhancement than ubiquinone. However:
* Results are mixed - not much evidence.
* Bioavailability is influenced more by the composition of the raw
material, which for supplemental purposes is generally synthesised using a yeast-fermentation method.
* This produces a crystalline form which is difficult to digest.
* The crystals needs to be dissociated into individual CoQ10 molecules and remain in the shelf-life of the product.
* Thus solubilised products appear to have the greatest bioavailability.

Solubilised supplements most bioavailabilty.

Summary

Question 45

Q

Coenzyme Q10 is in each cell’s mitochondria and is key in ATP production

What is the safety profile of supplementing with CoQ10?

What are the adverse effects of supplementing with CoQ10?

Are there any drug interactions with CoQ10?

Answer

A

Supplementation:
* Safety: CoQ10 is remarkably safe.
* No reports of significant adverse side effects of oral CoQ10 supplementation at doses as high as 1200 mg / day for up to 16 months. no safety studies in pregnant and lactating women.

Mild adverse effects: GIT symptoms such as nausea, diarrhoea, appetite suppression, heartburn, and abdominal discomfort have been reported. These may be minimised if daily doses higher than 100 mg are divided into two or three doses.
Interactions: CoQ10 may decrease the effects of warfarin.

Question 46

Q

Alpha lipoic acid (ALA) is an organosulphur compound that is synthesised

What is Alpha lipoic acid (ALA)?

How is it also known?

Do humans synthesise enough alpha lipoic acid to meet basic needs?

Answer

A

ALA is also known as ‘α-lipoic acid’ or ‘lipoic acid’ (LA).
Two forms of ALA: R-form (natural) and S-form (synthetic). The R-ALA variant is nearly 10 x more potent.
Humans generally synthesise enough to meet basic needs.
Additional ALA (as supplement) has clear therapeutic benefits in certain health conditions.

Question 47

Q

Alpha lipoic acid (ALA) is an organosulphur compound that is synthesised

Food sources?

Answer

A

Plant Brassicas (e.g. broccoli, Brussel sprouts),
spinach,
potato,
carrots,
beets,
tomatoes,
peas,
brewer’s yeast.
Animal Red meat (lamb, beef) and
organ meats.

Question 48

Q

Alpha lipoic acid (ALA) is an organosulphur compound that is synthesised

FUNCTIONS and THERAPEUTIC USES OF
ANTIOXIDANT?

Answer

A

ALA is a potent fat-soluble and water soluble antioxidant. Exogenous forms scavenge free radicals intra- and extra-cellularly. It is anti-inflammatory.
* Regenerates other antioxidants such as vitamin E, C, glutathione and CoQ10. It also up-regulates the expression of glutathione.
* Improves the motility of spermatozoa and provides antioxidant protection

Therapeutic uses:
* Infertility (600 mg daily)
* Diabetes, diabetic neuropathy
* Alzheimer’s disease — slows the cognitive decline (600 mg daily for one+ year).
* Multiple sclerosis.
* Healthy ageing.

Question 49

Q

Alpha lipoic acid (ALA) is an organosulphur compound that is synthesised

ALA Function and therapeutic uses of
Energy production?

Answer

A

ALA is one of the key coenzymes
required to convert dietary
carbohydrates into energy in
mitochondria in the Krebs cycle.
Fuels cells such as spermatozoa.

Therapeutic uses:
* Fatigue, chronic
fatigue syndrome,
mitochondrial
support, sperm
health

Question 50

Q

Name a way that Alpha lipoic acid (ALA) is useful for insulin sensitising

Answer

A

ALA supplementation improves
insulin sensitivity,
insulin resistance,
fasting blood glucose and
HbA1c
which are all markers of diabetes severity.
Diabetes mellitus: 300–1200 mg per day.

Question 51

Q

Alpha lipoic acid (ALA) functions and therapeutical uses for

metal chelating?

Answer

A

ALA can chelate iron, mercury, copper, lead and zinc.

Therapeutic uses:
* Infertility.
* Alzheimer’s.
* Peripheral neuropathy.

Question 52

Q

Alpha lipoic acid (ALA) functions and therapeutic uses for peripheral neuropathy?

Answer

A

ALA supplementation reduces oxidation of the myelin sheath.
ALA improves neuropathic sensory symptoms including pain, burning, numbness, prickling of the feet and legs.
Dosage: 600 mg per day.

Question 53

Q

Alpha lipoic acid (ALA) functions and therapeutic uses for weight loss?

Answer

A

ALA is thought to promote weight loss via various mechanisms:
* Reducing the oxidative stress that promotes fat storage.
* Suppressing appetite and hence food intake through its
influence on the enzyme ‘AMPK’ (AMP-activated protein
kinase) in the hypothalamus (where appetite is regulated).
* Increasing energy expenditure and reducing fat synthesis.
* Dosage: 1800 mg daily.

Question 54

Q

When supplementing with Alpha lipoic acid (ALA) how should supplements be taken?

Are there any adverse effects to be aware of?

What are the drug interactions with ALA?

Answer

A

Supplementation:
* Supplements should be taken on an empty stomach to optimise bioavailability, i.e. one hour before, or two hours after food.

Rare adverse effects: Allergic reactions affecting the skin (rashes, hives) and GI symptoms (abdominal pain, diarrhoea).

Interactions:
- Biotin and ALA may compete for transport across cell membranes due to similar chemical structures.
Be mindful of biotin deficiency when using high doses of ALA.
- Increased risk of hypoglycaemia in medicated diabetic patients due to additive effect. Monitor blood glucose closely.

Question 55

Q

Glucosamine is an amino sugar naturally present in most body tissues, wi

What is glucosamine?

Where is glucosamine found in high concentrations in the human body?

Answer

A

Glucosamine is an amino sugar naturally present in most body tissues, with high concentrations in joints and cartilage.
* Glucosamine is required for the synthesis of glycoproteins, glycolipids, and glycosaminoglycans (GAGs), also known as mucopolysaccharides.
* These compounds are an important structural component of tendons, ligaments, cartilage, synovial fluid, mucous membranes and structures in the eye, blood vessels and heart valves.

Question 56

Q

Glucosamine is an amino sugar naturally present in most body tissues, wi

Name 2 supplemental forms of glucosamine

Answer

A

Glucosamine can be supplemented in two different forms.
All supplemental forms are highly bioavailable.
* Glucosamine-6-Phosphate (G6P) and N-Acetyl-Glucosamine
(NAG) are naturally present within the human body.
- NAG is converted to hyaluronic acid (HLA) as needed.
HLA is an important component of synovial fluid.
* Glucosamine sulphate is sourced from marine exoskeletons
(so not suitable for vegetarians, vegans and those with
seafood allergies). It appears to be absorbed better and
hence result in higher tissue concentrations. Sulphate is
found in synovial fluid and is required for GAG synthesis.
* Glucosamine hydrochloride is created synthetically from corn.

Question 57

Q

Glucosamine is an amino sugar naturally present in most body tissues, wi

glucosamine functions and therapeutic uses for osteoarthritis?

Answer

A

Stimulates metabolism of chondrocytes in the articular cartilage and synovial cells in the synovial tissue. This slows joint degeneration and prevents joint space narrowing.
Decreases inflammation by inhibiting the formation of cytokines such as interleukin-1.
Pain reduction is comparable to NSAIDS. NSAIDS provide relief after two weeks compared to four to eight weeks for glucosamine sulphate.
Less effective for severe, long-standing osteoarthritis.
More effective combined with chondroitin and MSM.
Dosage: 1500 mg daily or in three divided doses.

Question 58

Q

Glucosamine is an amino sugar naturally present in most body tissues, wi

How is glucosamine useful in IBD?

Answer

A

NAG supports the GI epithelial barrier by enhancing mucin functionality, which is dramatically altered in those with IBD. Mucins are a group of proteins found in mucus that form a barrier and prevent microbial overgrowth.
* NAG also reduces biofilm formation associated with IBD.
* NAG can be also used in intestinal permeability.

Dosage: 3–6 g daily for children; 6 g daily for adults in three divided doses. Administered orally or rectally.

Question 59

Q

Glucosamine is an amino sugar naturally present in most body tissues, wi

When supplementing with glucosamine what precautions should be taken?

Are there any adverse effects to be aware of?

What are the drug interactions with glucosamine?

Answer

A

Supplementation:
* Caution: Glucosamine supplements can be synthesised in the laboratory, however most are produced from the shells of crustaceans — so can be problematic for those with a seafood allergy.

Mild adverse effects: GIT symptoms such as nausea, heartburn, diarrhoea, constipation as well as drowsiness, skin reactions and headaches.
Interactions: Potential increase in the anticoagulant effect of warfarin, leading to increased risk of bleeding and bruising.

28/301

Question 60

Q

Chondroitin sulphate is a type of glycosaminoglycan (GAG).

What is chondroitin sulphate?

Where can it be found in the human body?

Answer

A

Chondroitin sulphate is a type of glycosaminoglycan (GAG).
* It is a major component of the extracellular matrix of many
connective tissues. Most notably, this includes cartilage
and joint connective tissue.
* Chondroitin provides resistance to compression, partially by thickening synovial fluid.

Question 61

Q

Chondroitin sulphate is a type of glycosaminoglycan (GAG).

chondroitin sulphate
functions and therapeutic uses
osteoarthritis?

Answer

A

Protects cartilage from degradation by:
- Reducing degradative enzymes.
- Decreasing inflammation — reduces inflammatory intermediates such as COX-2. This is also seen by reductions in the inflammatory marker ‘CRP’.
- Increasing hyaluronic acid synthesis — enhancing joint lubrication.

Dosage: 200–400 mg two to three times a day or 1000–1200 mg daily as a single dose.

Question 62

Q

What is dimethyl glycine (DMG)?

Answer

A

Dimethyl glycine (DMG) is trimethyl glycine (betaine) after it has donated one methyl group during the methylation of homocysteine and only exists for seconds at a time.

Question 63

Q

What is Mycotherapy?

How many species are there and how many are considered medicinal?

Answer

A

The kingdom Fungi is one of the seven kingdoms of living
organisms. About 20,000 of fungal species are mushrooms,
with around 1000 of them considered medicinal.

Mycotherapy is the use of mushrooms and their compounds as medicines or health-promoting agents.
Fungi are believed to have survived the meteor hits that extinguished many other species, and helped to renew the planet.
Fungi create a mycelial (root-like) network that releases enzymes and acids to externally digest dead organisms. They move the nutrients back into the life cycle (i.e. into soil).
Fungi compensate for their inability to move by growing quickly and branching their filaments and threads in any direction

Question 64

Q

What are Beta-glucans?

What are they useful for?

Answer

A

Medicinal mushroom compounds:
* Medicinal mushrooms produce compounds that can be harnessed therapeutically. The most useful medicinal compounds are:

Beta-glucans:
* Beta-glucans are polysaccharides that sometimes contain protein.
* 1,3 and 1,6 beta-glucans are the most common forms.
* Their most important action on the body is on the immune system, where they can support optimal immune function, promote immunomodulation and exert anti-tumour activity.
* They are captured by various cells in the lymphatic tissue of the intestines and stimulate macrophages, neutrophils, monocytes, natural killer (NK) cells and dendritic cells.

Answer 65

A

Triterpenes:
* Mushrooms such as reishi are composed of over 120 different triterpenes which have various medicinal properties, e.g. hepato-protective, anti-tumour.

Answer 66

A

Sterols:
* Mushrooms contain sterols such as ergosterol (a precursor of vitamin D). Studies have shown that these mushroom-derived sterols can have anti-cancer properties.

Answer 67

A

Lectins:
* Those in certain medicinal mushrooms agglutinate tumour cells, preventing their proliferation. They are also immune-modulatory.

Answer 68

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Medicinal mushrooms and drug interactions.
* Research has explored the possible interactions of the most common medicinal mushroom strains with drugs that are metabolised by CYP450 enzymes.

The results have highlighted that the mushrooms demonstrate no appreciable inhibition, and so the possibility of a drug interaction by inhibition of CYP450 is extremely unlikely.
This means that unless there is an interaction via another mechanism, the medicinal mushrooms covered can be used alongside other drug treatments.

Answer 69

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Reishi is referred to as “the mushroom of eternal youth” and has been used for over 2000 years in the traditional medical systems of China, Japan, Korea and other Asian countries for its
health-promoting effects.

It is considered a ‘tonic’ in Chinese medicine, or an ‘adaptogen’ in Western medicine.
Important constituents include primarily polysaccharides (e.g. beta-glucans) and triterpenes (ganoderic acids), but also lectins, sterols and B vitamins.

Answer 70

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Immune boosting
* Increases the number and activity of numerous immune
cells including T-lymphocytes, macrophages and NK cells.

Antiviral
* The triterpenes inhibit the replication of the Epstein-Barr
and hepatitis B viruses.
* They also inhibit reverse transcriptase in HIV.

Answer 71

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*It induces apoptosis (programmed cell death) in cancer cells) and inhibits angiogenesis.
* Evidence suggests it can inhibit tumour metastases by limiting attachment to endothelial cells.
* The beta glucans strengthen the immune system contributing to its anti-cancer properties.

Answer 72

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Anti inflammatory
* Triterpenes provide an anti-inflammatory (reduces the activity of NF-kB) and anti-histamine action. The anti inflammatory and antioxidant properties of reishi are thought to provide it with its healthy ageing properties.

Anticoagulant
* Ganoderic acids inhibit platelet aggregation, thinning the blood. Supportive in cardiovascular disease.

Answer 73

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Benign prostatic hyperplasia
* It is a 5α-reductase inhibitor meaning that it blocks the conversion of testosterone to dihydrotestosterone (DHT), preventing abnormal prostate growth.

Stress and sleep
* Triterpenes have a sedative action and calm nervous system activity, supporting sleep and relaxation.

Answer 74

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Blood-sugar regulating
* Ganoderic acids increase insulin secretion and decrease cellular resistance to insulin.
* Useful in cases of insulin resistance such as Type 2 diabetes and PCOS.

Answer 75

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Reishi dosage range: 3–9 g / day (doses of up to 15 g / day are used in some circumstances). Start at the lower of the dosage range and gradually increase with tolerance. Use as a powder in food, tea or capsules for higher dosages. It is a bitter, woody-tasting mushroom that is considered non-edible.

Reishi interactions: Combining high dose reishi with anticoagulant drugs may increase the risk of bleeding.

Answer 76

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Shiitake is a common edible mushroom. Its Japanese name comes from the words ‘shii’ (species of chestnut) and ‘take’ (mushroom), since it grows on chestnut wood.

Important constituents include the beta-glucan Lentinan, choline, zinc, provitamin D, iron, B vitamins and unsaturated fatty acids.
Large-scale clinical trials have confirmed significant anti-cancer activity from Lentinan.
Lentinan (injected) is a licensed pharmaceutical in Japan and is the third most widely prescribed anti-cancer ‘drug’ in the world today.
In Traditional Chinese Medicine (TCM), shiitake is used to replenish Qi and nourish the blood.

Answer 77

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Immune modulating
* Increases phagocytes, T-lymphocytes and NK cells.
* Increases interferon synthesis (anti-viral proteins).
* These properties are useful for general immune support, immune support in cancer patients and HIV.
* Shiitake is also a good anti-candida agent.
* Has antibacterial activity on bacteria resident in the oral cavity that cause gingivitis and periodontitis.

Also prevents dental plaque formation.

Answer 78

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Cardiovascular diseases
* Shown to lower LDL by increasing faecal excretion, and increase HDL levels.
* Inhibits platelet aggregation and is anti-thrombotic.

Answer 79

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Cancer
* Shiitake is anti-proliferative and anti-angiogenic.
* Studies have demonstrated life-prolonging effects of Lentinan in those with gastric, pancreatic, colorectal and liver cancer receiving chemotherapy.

Gout
* Has an alkalising effect and lowers uric acid levels.
Note: The deposition of uric acid crystals in joints such as the big toe is a key feature of gout.

Benign prostatic hyperplasia
* The high zinc levels act to block the conversion of testosterone to dihydrotestosterone (DHT), preventing prostate growth.

Answer 80

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Shiitake dosage range: 1.5–10 g / day (up to 16 g / day used in some circumstances).
Safety: Taking a high dose long term can lead to rare side effects such as abdominal discomfort, shiitake dermatitis, photosensitivity and asthma.
Caution with anticoagulant drugs.

Answer 81

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Lion’s mane is a white-flesh, edible fungus, noted for its lobster-like flavour.
* Important constituents include beta-glucans, erinacines, high protein, selenium and zinc.

Answer 82

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GI disorders
* Promotes regeneration of the gastric and intestinal mucosa. As a result, it is especially therapeutic in cases of: Increased intestinal permeability, inflammatory bowel disease, peptic ulcers, gastritis and

GORD.
* It also acts as a prebiotic to support the intestinal flora and can be used in cases of dysbiosis.

Answer 83

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Nervous system disorders
* The erinacine in Lion’s mane has a stimulatory effect on the production of nerve growth factor (NGF), a protein required in order to regenerate and repair nerve tissue.

Powerful anti-oxidant effects.
Use in cases of Alzheimer’s, concussion recovery, multiple sclerosis, Parkinson’s disease, peripheral neuropathies (e.g. diabetic) and general cognitive decline.
Nerve injuries heal progressively and often slowly over time. Longer-term supplementation (months to years depending on the extent of disease) may be necessary.
Lion’s mane dosage range: 1–6 g / day.

Answer 84

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Turkey tail (Coriolus Versicolor) is a mushroom that is found in most parts of the world and tends to grow on dead logs. The English name of the species is derived from its coloured patterns, which look similar to the tail of a turkey.

Turkey tail is probably the most-studied medicinal mushroom and its extracts are commonly used in Japan as part of official cancer treatment protocols.
Two polysaccharide extracts from turkey tail — polysaccharide K (PSK) and polysaccharidepeptide (PSP) were approved as drugs in cancer patients. In 1990, PSK accounted for 25% of drugs in cancer treatment in Japan

Answer 85

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Cancer
* Anti-proliferative, anti-metastatic and anti-angiogenic properties. It can induce apoptosis of cancer cells.
* The anti-cancer properties are due to the action of PSK and PSP. Improves survival in some cancer cases when combined with conventional therapies and minimises side effects. It protects against mutations caused by radiotherapy.
* It is especially indicated in hormonally-driven cancers such as breast, prostate and ovarian, although it has also been used in a number of other cancer types such as oesophageal, gastric, lung, hepatic and colorectal.

Answer 86

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Immune modulatory
* Increases the activity of macrophages, T-lymphocytes and NK cells.
* Has an anti-viral action against viruses such as HIV, EBV, HPV and the hepatitis B virus.
* Normalises an overactive immune system, which is especially useful in autoimmunity.
* Studies have shown that whilst it can upregulate the immune response in immunocompromised individuals, it has no effect in those considered ‘healthy’.

Turkey tail dosage range: 1–9 g / day.
Turkey tail side effects: Nausea, loss of appetite, diarrhoea.

Answer 87

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Maitake is often found among chestnut trees. It is crowned by the Japanese as the ‘king of mushrooms’ and is valued for its effect as a tonic and an adaptogen.

Maitake grows mostly in Japan. The mushroom has a porous structure and is made up of brown and grey clusters of overlapping caps.
Important constituents include beta-glucans, metalloproteins, lectins, enzymes and ergosterol.

Answer 88

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Immune regulatory
* The beta-glucans regulate the immune system — causing an increase in Th1 lymphocytes. They stimulate macrophages and NK cells.
* The fatty acids in maitake inhibit the COX-1 and COX-2 pathways, subsequently reducing inflammation.

Cancer
* The immune-boosting effects of beta-glucans provide an anti-cancer benefit.
* Alleviates side effects of chemotherapy including loss of appetite, vomiting, hair loss and leukopenia.
* Anti-metastatic action and inhibits tumour growth.

Answer 89

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Cardiovascular disease
* Contains a protease which prevents clot formation.
* Reduces LDL cholesterol and regulates the reninangiotensin-
aldosterone system (normalising blood pressure).

Metabolic diseases
* Contains a proteoglycan that improves insulin sensitivity. Useful in cases of insulin resistance — especially Type 2 diabetes. It can also help to induce ovulation in polycystic ovarian syndrome.
* Recommended for fatty liver issues due to its hypolipidemic effects.

Answer 90

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Maitake dosage range: 3–7 g / day.

Interactions: Potential additive effect when combined with blood glucose lowering medications (such as metformin) or supplements.
Monitor blood glucose to prevent hypoglycaemia.

Answer 91

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Chaga grows mainly on birch trees in coolerclimates where it develops a woody growth that has the appearance of burnt charcoal.
* The inside of the hardened clumps reveals an orange-coloured, soft centre.
* Chaga has a long traditional use for certain cancers, heart disease, diabetes mellitus and to increase endurance.
* Key constituents include beta-glucans, triterpenoids and sterols including ergosterol.
* It is rich in antioxidant compounds and reduces inflammation by down-regulating inflammatory mediators

Answer 92

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Immunity
* Acts as an immunomodulator that can support bone marrow activity and the proliferation of immune cells including T-lymphocytes.
* Anti-viral activity — e.g. against hepatitis C.
* Helps to prevent ‘cytokine storms’, where the immune system over-responds and damages healthy tissue.
* The immune-modulatory and anti-inflammatory actions can be used in diseases such as ulcerative colitis.

Cancer
* Antioxidant and induces cancer cell apoptosis.
* Offsets bone marrow-suppressing effects of chemotherapy.

Answer 93

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Chaga dosage range: 1–4 g / day.
Safety:
* Appears to inhibit platelet aggregation. Caution with antiplatelet medications and use before surgery is advised.
* Safety in pregnancy and lactation has not been established

Answer 94

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Cordyceps is a fungal species that acts as a parasite in insects. It infects the insect, killing and mummifying it, then grows from the insect’s body!

Cordyceps originated in Tibet — growing at an altitude of over 3500 m, but is now cultivated elsewhere in the world.
Important constituents include polysaccharides, cordycepin acid, nucleosides, ergosterol and sterols.
In Traditional Chinese Medicine, it is said to support the energy-stimulating capacity of the kidney, playing an important role in rejuvenation during convalescence.

Answer 95

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Kidney diseases
* Supports renal health — decreases proteinuria, improves creatine clearance and has been shown to promote regeneration of kidney tubular cells.
* Protects kidney from damage due to immunosuppressants.
* Stimulates the formation of erythrocytes, which is often decreased in kidney failure.
* Traditionally used for chronic kidney disease.

Liver diseases
* The cordycepin acid in cordyceps improves hepatocyte function and decreases the formation of fibrotic tissue in liver cirrhosis.
* Improves liver function in hepatitis B and C.

Answer 96

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Cardiovascular diseases
* Contains polysaccharides with strong anti inflammatory activity.
* Acts as a cardiotonic — helping in cases of arrythmias. In addition, it increases nitric oxide production and relaxes vascular walls (lowering BP).
* Anti-thrombotic properties.

Respiratory diseases
* Improves respiratory function in asthma, chronic bronchitis and chronic obstructive pulmonary disease.
* Reduces inflammation and airway remodelling.
* Strengthens the immune system and is anti-viral.

Answer 97

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Fatigue and concentration
* Adenosine content provides extra energy, reducing fatigue. Also improves learning capacity and memory.

Reproductive diseases
* Enhances fertility and libido in men and women.
* Increases testosterone production in men and can be used in cases of impotency.
* Up-regulates ovarian hormone production in women, helping to regulate the menstrual cycle.

Depression
* MAO inhibitor leading to increased dopamine and serotonin which improves mood.

Answer 98

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Cordyceps dosage range: 2–5 g / day.

Safety:
* Immunostimulatory effects may interfere with immunosuppressant drugs.
* Caution in hormone-dependent cancers due to influence on reproductive hormones.
* Safety in pregnancy and lactation has not been established and caution is advised due to hormonal effects.

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15. ORTHOMOLECULAR Flashcards

This module covers: • The dietary sources, bioavailability and interactions of orthomolecular compounds and medicinal mushrooms. • The therapeutic uses and safety considerations. • Appropriate dosage levels and preferred forms for orthomolecular compounds and medicinal mushrooms.

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