8 - Introduction to NHPs Flashcards
What falls under the umbrella of NHPs?
- probiotics
- traditional medicines
- homeopathic medicines
- herbal remedies
- vitamins and minerals
- other products (essential fatty acids, amino acids)
Are NHPs considered CAM therapies?
No - they are considered a subsection of drugs in Canada’s food and drug act
Define NHPs
- naturally occurring substances that are used to restore and maintain health
- made from plants, animals and microorganisms
- variety of forms
List 4 things about NHPs
- safe for consideration as OTC products
- available for self-care
- available for self-selection
- does not require a Rx to be sold
What is a functional food?
- similar in appearance to, or may be, a conventional food
- consumed as part of a usual diet
- demonstrated to have a physiological benefit or provide protection against a chronic disease (beyond basic nutritive function)
- regulated as a FOOD
What is a nutraceutical?
- a product isolated or purified from foods
- generally sold in medicinal forms not usually associated with food
- demonstrated to have a physiological benefit or provide protection against a chronic disease
- regulated as a DRUG (NHP)
What % of Canadians use NHPs?
71%
Why do people take Canadians?
- maintain or promote good health
- better or safer than conventional medications
- upon recommendation from someone
- treat illness
How do Canadians learn about NHPs?
- family or friends
- pharmacist
- internet
- physician
What do Canadians want to know?
- recalls of NHPs
- side effects
- drug interactions
- uses/benefits
- understanding of NHP labels
- NHP regulation
What are the 10 most commonly used NHPs?
1) glucosamine
2) echinacea
3) garlic
4) fish oils/w-3 fatty acids
5) evengin primrose oil/GLA
6) ginkgo biloba
7) ginseng
8) flaxseed oil
9) St. John’s Wort
10) apple cider vinegar
What is it used for?
glucosamine
osteoarthritis
What is it used for?
echinacea
immune stimulator
What is it used for?
garlic
reduce cholesterol
LOL
What is it used for?
fish oils/w-3 fatty acids
CV health
What is it used for?
evening primrose oil/GLA
menopause
What is it used for?
ginkgo biloba
memory
What is it used for?
ginseng
immune stimulator
What is it used for?
flaxseed oil
CV health
What is it used for?
St. John’s Wort
depression
What is it used for?
apple cider vinegar
general health
Who take more NHPs?
women
What are other predictors of NHP use?
- race (white > non-white)
- non-smokers > smokers
- active > non-active lifestyle
- health status (non-perfect health > perfect health)
- use of conventional or OTC medication
- vitamin, mineral or multivitamin usage
- consultation with a CAM practitioner
What do some people use NHPs for?
- fibromyalgia
- IBD
- urinary incontinence
- COPD
- arthritis
What are NOT predictors of NHP use?
- education
- annual income (personal nor household)
What are the fat soluble vitamins?
A D E K
What is a botanical?
plant or plant part valued for its medicinal or therapeutic properties, labor and or scent
What is a Tea/Infusion?
- adding boiling water to fresh or dried botanical and steeping
- cold or hot
What is a decoction?
- for botanicals that need more forceful treatment to extract desirable components (ex. bark, root)
- simmered longer in boiling water than tea/infusion
- cold or hot
What is a tincture?
- soaking botanical in a solution of alcohol and water
- concentrates botanical
- sold in liquid form
What is an extract?
-soaked with the goal of capturing specific components
Intrinsic adverse effects arise from ?
the herb itself
Type A reactions
predictable toxicity, overdose, drug interactions
Type B reactions
idiosyncratic reactions (ex. allergy, anaphylaxis)
What are Extrinsic Adverse Effects?
Unrelated to the herb; likely due to a problem in commercial manufacture or extemporaneous compounding
What are Type A and B reactions?
intrinsic adverse effects
List some types of extrinsic adverse effects ?
- misidentification
- lack of standardization
- contamination
- substitution
- adulteration
- incorrect preparation and/or dosage
- inappropriate labelling and/or advertising
What are the 4 different names that products go by?
1) common english
2) transliterated name
3) latinized pharmaceutical name
4) scientific name (genus and species)
What is the name that product should go by?
4 - Scientific name (genus and species)
Why are there challenges in standardizing herbal medicines?
- crude vs. purified ?
- hard to identify which one
- even if you know which it is, hard to tell which is better
- the goal that chemical consistency means therapeutic consistency does not always work
Some ayurvedic medicines have contamination with _____
metals
How can substitution cause a problem?
ex. stephania tetrandra substituted to aristolochia fangchi
- caused irreversible nephropathy
What is adulteration ?
When Rx items are present but are not indicated on the label of NHPs
List 3 examples of adulterants that have been found in traditional Chinese medicines
- acetaminophen
- diazepam
- diclofenac
What is the working definition of probiotics?
live microorganisms that when ingested in appropriate quantities, have a beneficial effect in the prevention and treatment of specific medical conditions by improving the host’s intestinal microbial balance
MOA of probiotics
- colonization resistance - limit the potentially harmful bacteria in the digestive tract
- supply enzymes or influence enzyme activity in the GI tract
What are some accepted criteria for the use of probiotics?
- indigenous to humans
- resistance to acidity and bile toxicity
- adherence to human intestinal cells
- colonize in the human gut
- antagonism against pathogenic bacteria
- clinically proven health effects (dose-response data)
- history of safe use in humans
How do probiotics improve gut health?
- increase healthy bacteria
- decrease the population of pathogenic microorganisms
How do probiotics reduce the risk of colon cancer?
- alter the metabolic activities of intestinal microflora
- alter the physicochemical conditions in the colon to discourage growth of pro-carcinogenic microflora
- bind/degrade potential carcinogens
- enhance the host’s immune response
How do probiotics modulate the immune system?
Lactobacillus acidophilus and bifidum augment humoral and cellular immunity
When asking if probiotics are safe, what issues need to be considered?
- antibiotic resistance gene profile
- production of antibiotic modifiers
- pathogenic potential (should have demonstrated to be free of virulent factors and toxin production)
- metabolic activities (no production of any byproducts or enzymes that may adversely affect human physiology)
Efficacy considerations of probiotics?
- minimum daily dosing
- acid and bile stability
- intestinal mucosal adhesion properties
- viability through the product shelf life
What are probiotics affected by?
- heat
- oxygen
- moisture
- light
What are some special technologies used to preserve the microorganisms?
- freeze-drying
- enteric coating
- microencapsulation
What is the goal of probiotics?
Healthy maintenance of intestinal microflora
-depends on the extent of microbial depletion and the presence of harmful bacteria.
10-100 billion or higher CFU’s per day
What is an essential fatty acid?
fatty acids that cannot be synthesized in the body (must be supplied through diet or supplement)
According to NNHPD, what are the only 2 established EFA’s?
LA = linoleic acid (OMEGA 6)
ALA = alpha-linolenic acid (OMEGA 3)
All other fatty acids (DHA, EPA) are considered _______.
derivatives
Describe EFA’s
- components of cell membranes that increase membrane fluidity - cell membrane function
- proper function of the brain and nervous system
Describe OMEGA 3
- CV benefits (anti-platelet, anti-inflammatory, pro-vasodilatory)
- evidence used for/in hyperglycaemia, depression, cancer, lupus, asthma, and RA
What ratio of LA:ALA is needed to get the benefits?
LA:ALA ratio of under 5:1
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Food sources of ALA
- flax-based oil (55%)
- canola oil (10%)
- flaxseeds
- walnuts
Food sources of EPA/DHA
- fatty fish
- fish oil
Food sources of LA
- vegetable and plant oils
- leafy vegetables
- seeds
- nuts
Food sources of GLA
-evening primrose oil
What are essential amino acids? List 3 examples
They cannot be made by the body - need to be obtained in diet
- histidine
- valine
- leucine
What are non-essential amino acids? List 3 examples
They can be made by the body
- alanine
- asparagine
- aspartic acid
What are conditional amino acids? List 3 examples
Not essential except in times of illness or stress
- proline
- serine
- glycine
_____ chain amino acids are the most common essential amino acids. (40% of daily requirement of essential AA)
Branched
What do branched chain amino acids do?
- thought to help increase carbohydrate bioavailability in muscles and prevent muscle breakdown during rigorous exercise
- may reduce fatigue in both anaerobic and endurance sports
List 3 things that branched chain amino acids are used for
- anorexia
- burn patients
- diabetes
_____ is essential for children up to 5 yrs old and the elderly (over 60)
Arginine
______ is essential for children up to 5 yrs old
Histidine
Arginine is synthesized by the body but not at rates sufficient to support ____. Also, most arginine is cleaved to form urea.
growth
If ______ is not adequately provided in the diet, then methionine is required in high amounts
cysteine
If ______ is not adequately provided in the diet, then phenylalanine is required in high amounts
tyrosine
List examples of complete protein sources that provides all of the essential amino acids?
animal sources: meat, poultry, eggs, fish, milk cheese
plant sources: quinoa, buckwheat, hempseed, amaranth, soybean
What defines a complete protein source?
provides all of the essential amino acids
What defines an incomplete source?
low in one or more of the essential amino acids
What defines a complementary protein source? Examples?
two or more incomplete protein sources that together, provide adequate amounts of the essential amino acids
- mac and cheese
- peanut butter sandwich
