Basics

Question 1

What are functional foods?

Answer 1

Food consumed normally as part of the diet, but with additional benefits besides basic nutrition:
physiological benefits or ability to prevent disease

Question 2

What is responsible for the benefits of functional foods?

Answer 2

phytochemicals

Question 3

How can we recognize phytochemical composition?

Answer 3

chemical: taste, smell, pain
biological assays
chemical assay/instrumental analysis

Question 4

What is an essential oil?

Answer 4

concentrated hydrophobic liquid containing volatile compounds from plants

Question 5

How are plant extracts/essential oils obtained?

Answer 5

steam distillation (most common)
solvent or CO2 extraction

Question 6

What is “CAM?”

Answer 6

complementary alternative medicine

Question 7

What is aromatherapy?

Answer 7

form of alternative medicine

use plant materials + essential oil for aroma compounds -> improve psychological/physical well-being

Question 8

What are “NHPs?”

Answer 8

Natural Health Products

Question 9

What products are classified as NHPs? (6)

Answer 9

vitamins/minerals
herbal remedies
homeopathic medicines
traditional medicine
probiotics
Others (AAs, EFAs)

Question 10

True/False: some NHPs require a prescription.

Answer 10

False; all NHPs must be safe as over-the-counter

those requiring a prescription are under different regulation

Question 11

What is the approximate current sales revenue on herbal supplement sales in USA? How does that compare to the sales in 2000?

Answer 11

about 8 billion

nearly doubled

Question 12

the 5 products with the largest increase in sales in the past year (mainstream multi-outlet channel):

Answer 12

echinacea
turmeric
ivy leaf
fenugreek
elderberry

Question 13

2 products with enormous increase in sales in the natural channel:

Answer 13

cannabadiol

nigella

Question 14

What are some sources of information concerning nutraceuticals? (7)

Answer 14

• reference books
• scientific journals
• cochrane database of systematic reviews
• herbalgram
• popular literature
• promotional literature
• internet

Question 15

List the types of scientific papers:

Answer 15

meta-analysis
systematic review
randomized controlled trial

Question 16

What is a meta-analysis?

Answer 16

quantitative statistical analysis

pool data from similar experiments done by independent researchers

Question 17

What are the benefits of doing a meta-analysis?

Answer 17

increase population size:
increased power
improve estimates of size of effect
resolve uncertainty

Question 18

What is a systematic review?

Answer 18

focus on answering specific question in a clinical topic

research and assess findings of studies with sound methodology -> validate results -> summarize

Question 19

a good methodology in a study should be ___ and ____.

Answer 19

explicit; reproducible

Question 20

A scientific study must disclose any ____, otherwise the results are invalid

Answer 20

conflict of interest/bias

Question 21

What are some good resources for reliable scientific papers? (6)

Answer 21

MEDLINE
Cochrane Database of Systematic Reviews
CAB Abstracts
Web of Science
Google/Google scholar

Question 22

Why has use of NHPs increased in recent years? (9)

Answer 22

return to tradition
limitations of conv. medicine
aging population
scientific advances
healthier population
environmentalism
commercial promotion
cost of health care
control of information

Question 23

What criteria do we use to evaluate if a NHP works?

Answer 23

traditional reputation
chemical constituents
pharmacology (studies)
epidemiology (study health/disease in different populations)

Question 24

What are the types of pharmacology studies?

Answer 24

animal studies
in vitro/in vivo assays
clinical trials
mechanism of action

Question 25

When considering NHPs, it is important to consider ____ and ______

Answer 25

efficacy | mechanism of action

Question 26

The components of the therapeutic effect:

Answer 26

1. effect of drug/treatment 2. natural history/progression of disease 3. placebo effect

Question 27

Elements of the placebo response: (6)

Answer 27

``` anxiety conditioned/pavlovian response expectation culture doctor effect diagnosis/meaning ```

Question 28

What is a "nocebo?"

Answer 28

belief that something will cause harm -> actually creates negative effect in body

Question 29

How is gluten considered a nocebo?

Answer 29

Most people with non-celiac gluten sensitivity (NCGS) don't actually react to gluten (may be certain carbs); belief that gluten causes harm will trigger effects

Question 30

What is the doctrine of signatures? give examples:

Answer 30

idea that plants contain some "sign" from God towards the ailment they are meant to cure ex: ginseng, mandrake (shaped like body), bloodroot

Question 31

____ conditions are very susceptible to placebo response

Answer 31

chronic (back pain, arthritis, allergies, headache, anxiety, depression)

Question 32

What is an active placebo?

Answer 32

placebo with included "side effect" to make it seem more legitimate

Question 33

How can placebos modulate behaviour?

Answer 33

belief that they will get better -> healthier habits, less anxiety -> improvement in health

Question 34

True/False: the placebo effect is a barrier to effective treatment

Answer 34

False: placebo effect can be used effectively to enhance effects of treatment

Question 35

How are placebos used in clinical trials?

Answer 35

placebo controlled studies: one group receives fake treatment (placebo) - no real effect compare with group receiving treatment

Question 36

What is the "gold standard" for clinical trials?

Answer 36

Randomized double blinded placebo controlled

Question 37

Clinical trials must have a ___ group to compare against the _____ group.

Answer 37

control | intervention

Question 38

How are subjects assigned to test groups? What are the benefits of this?

Answer 38

randomization no investigator bias comparable levels of risk factors (known and unknown) valid significance levels

Question 39

What is a cross-over design study?

Answer 39

subjects receive intervention (A) and control (B) group 1 receive A then B group 2 receive B then A

Question 40

Define an unblinded vs single blinded vs double blinded study

Answer 40

unblinded: both subject/investigator know what treatment is assigned single blinded: investigator knows what treatment is assigned double blinded: neither investigator/subject knows

Question 41

What is a triple-blind?

Answer 41

neither investigator, subject, or committee monitoring responses knows the identity of groups

Question 42

What are the commonly improperly reported aspects of herbal clinical trials? (6)

Answer 42

``` allocation concealment/blinding randomization method intention-to-treat analysis % of active constituents type/form of herbal preparation conflict of interest ```

Question 43

What is publication bias?

Answer 43

trials with statistically significant BENEFICIAL results -> more likely to be published!

Question 44

What is ITT analysis?

Answer 44

intention to treat analysis: ALL patients analyzed, even those who did not complete the trial

Question 45

What is allocation concealment?

Answer 45

person doing randomization does not know how groups will be assigned create (secret) random groups first -> then assigned by someone else