L10-Anti-oxidants & Immunomodulators Flashcards
Part 1: Antioxidants!
What are reactive oxygen species?
- highly reactive molecules due to the presence of unpaired valence shell electrons (examples: O2• , H2O2, free radicals like –OH)
- form as a natural byproduct of the normal metabolism of oxygen
- have important roles in cell signaling
T/F: Free radical cell is important part in cell signalling.
TRUE
T/F: A diet rich in antioxidants is important and supplementation is straightforward.
FALSE!
First part is true and second part is FALSE.
List 6 Antioxidant NHPs.
- Vitamin C
- Vitamin 5
- B-carotene
- Grapeseed
- Pycnogenol
- Green tea
Vitamin C.
List name, common names, natural sources.
Proper name:Vitamin C, Common names: Ascorbic acid, Vit C
Sources: fruit and vegetables (kiwifruit, broccoli, strawberry, orange, lemon)
Vitamin C.
General use of Vit C is that it is a “factor in the maintenance of good health”
Describe what that means specifically (3).
- helps wound healing
- helps metablize fats and proteins
- an antiox for the maintance of good health
Vitamin C.
State the evidence for these claims.
- abundant for all the monogrpah claims
- lacking for use in common cold
What is the natural medicines database?
- each product is rated based solely on scientific evidence
- 3 components: safety, effectiveness and product quality w safety being the 1st concern
- gives a NMBER (natural medicines brand evidence-based rating)
List the possible effectiveness ratings of the Natural Medicine Database.
Block 1
Effective OR likely effective (i.e. evidence supports the efficacy)
-Generally appropriate to recommend
Block 2 Possibly effective (i.e. evidence is inconclusive) -not enough evidence to recommend or advise to avoid, respectively
Block 3
Likely ineffective, ineffective, insufficient evidence
-Advise to avoid
Vitamin C.
State whether effective or ineffective for the following:
1. Tx scurvy
2. Tx or Px of the common cold
3. Px of the common cold in extreme environments (e.g. stress, marathon runners)
- Effective
- Possibly effective (decrease by 1d)
- Likely effective b/c in these cases Vit C supplementation can reduce the risk by 50%.
Vitamin C.
State dosing considerations.
(hint: breast milk)
State risk info.
- generally safe at normal doses
- breast milk may reduce the risk of developing childhood allergies
- NNHPD monograph dosing recommendation during lactation is slightly higher [~120 vs. 75 mg/d]
-no risks listed in the monograph
Vitamin E.
List natural sources.
Vegetable oils, nuts, green leafy vegetables
Vitamin E.
List specific uses.
- Antioxidants
2. Helps Px deficiency
Vitamin E.
T/F: There is an abundant for NNHPD claims.
TRUE
- well-accepted diets rich in Vit E reduce the risk CV disease & cancer
- Benefit does NOT occur w/ supp
Vitamine E.
T/F: In Canada, vitamin E is not authorized for sale for preventing disease including heart disease & cancer.
FALSE.
Vitamine E.
Dosing.
- from 1.5 - 1500 IU/day
- the normal dose is considered to be about 40 IU/day
- therefore a dose of 1500 is unecessary (although at least safe)
Vitamin E.
List some drug interactions.
- anti-coagulant/anti-platelet drugs, warfarin
- chemotherapy (anti-oxidants vs. chemotherapy drugs)
- statins/niacin (blunts rise in HDL)
Vitamin E.
List risk information.
risk of cancer, cardiac events, and mortality, especially in high risk patients
Vitamin E.
According to the HOPE-TOO study, vitamin E _____ risk of ______
Increase, CHF
Vitamin E.
According to the HOPE-TOO study, vitamin E _____ risk of ______
Increase
B-carotene.
List natural sources.
deep orange or yellow fruit/vegetables (eg. sweet potato, carrot, cantaloupe, mango, apricot)
B-carotene.
List specific uses.
(as a provitamin A or source of Vit A)
- maintain eyesight (and night vision), skin, membranes, immune fxn
- maintenance and development of bones and teeth
B-carotene.
There is no supporting as an anti-oxidant. In fact, _______ may _____ mortality.
Long-term ~12 yrs, increase
B-carotene.
I smoke !!! What are my risks re: B-carotene?
- At higher risk for lung and prostate cancer, intracerebral hemorrhage, and cdv and total mortality
- > on packages there is a warning saying that smokers taking over 6mg/day should consult HCP
B-carotene.
What is the dosing?
1800 μg/d maintains adequate vitamin A levels. Consuming 5 servings of fruit and vegetables daily provides 6 mg of β-carotene.
min 130 - max 6000 ug/day
no need for supp
B-carotene.
Is beta carotene use advised in beta carotene?
no (risk C)
B-carotene.
We find the dietary source superior than supp. Why?
-Risk in diet phytonutrients is superior than in sup. This is because:
>other substances present in same foods
>other dietary factors
>other lifestyle choices that coincide w consumption
B-carotene.
What is the French Paradox?
-region is S france was “paridoxical than other counterparts”
->diets of more fat, smoked more (had high lipid levels, ect) YET their incidnece of CAD was 40% less
->this was found to be because of the consumption of red wine (that was also consumed lots here)
THIS IS WHAT WAS THOUGHT BUT THE DATA WAS FABRICATED AND NOT TRUE
T/F: Resveratrol was found to increase the lifespan of worms.
FALSE - another fabrication of evidence, which was misinterpreted by the media.
Grape seed.
List the active components (3).
- oligomeric proanthocyanidins (OPCs)
- flavonoids
- pycnogenol (which is NOT to be confused w Pycnogenol (R).
* found in the skin of red grapes only.
Grape seed.
List the use.
-helps to relieve Sx-related to non-complicated chronic
venous insufficiency (CVI)
>such as sensation of swelling, heaviness and tingling of the legs
Grape seed.
List the evidence.
- no rating: anti-oxidant (theoretical; a few studies)
- possibly effective: chronic venous insufficiency
Grape seed.
State the dosing consideration.
Relief of symptoms related to non-complicated CVI: use for a minimum of 1 month to see beneficial effects.
Grape seed.
List risks!
NONE.
Pycnogenol®.
______ are other names.
Pinus maritima (proper name) Pine bark extract
Pycnogenol®.
What are the 2 active components?
- oligomeric proanthocyanidins (OPCs)
2. flavonoids
Pycnogenol®.
List USES + efficacy.
- Antioxidant= no rating (theroretical)
2. Tx of chronic venous insufficiency (possibly effective).
Pycnogenol®.
Risks for WHOM?
-Consult a health care practitioner prior to use if you have multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis, or other autoimmune disorders.
>has immunomodulating effects.
Grape seed v Pycnogenol®.
Compare rating of efficacy!
grape seed= A (strong scientific evidence)
pycnogenol= B (good scientific evidence)
>Both listed as possibly effective
Green tea.
List ingredients.
caffeine, catechin polyphenols
Green tea.
List uses + efficacy.
- Antioxidants - no rating
2. Weight management (via reduced caloric intake & increased phys activity) - insufficient.
Green tea.
List common risk information.
- Effects of caffeine**: insomnia, diuresis
- Allergic reactions
- Hepatotoxicity with GTE
- Lead contamination
Green tea.
List risks/cautions specific to pregs (2).
- Large doses of caffeine associated with spontaneous abortions, intrauterine growth retardation, and low birth weight
- Anti-folate actions (inhibits dihydrofolate reductase, which activates folic acid)
Green tea.
State dosing considerations.
End of PART 1 - U GOT THIS BISH!
- Beverage: 3 cups/day might confer health benefits
- GTE: standardized to contain 80% total polyphenols and 50%
epigallocatechin gallate (EGCG); 100-150 mg, 3 times daily - NNHPD:
- antioxidant: GTE providing <690 mg catechins and <150 mg
caffeine/d
- weight maintenance: GTE providing 136-300 mg EGCG and 75-150
mg caffeine/d
Part 2: Immunomodulators.
Define immunomodulators.
Substance that is used for its effect on the immune system.
Immunomodulators.
What are the 2 types?
- Immunosuppressent: substance that suppress IS
2. Immunostimulant: substance that stimulates the IS by activating any of its components.
Immunomodulators.
What are the 2 types of immunostimulants?
- Specific: antigenic specificity in IS response (e.g. vaccine)
- Non-specific: augment immune response w/out antigenic specificity.
Immunomodulators.
List the 4 examples.
- Echinacea
- Ginseng
- Cold-FX
- Oil of oregano
Echinacea.
List other names.
List active components.
(purple) coneflower.
UNKNOWN - polysaccharide? alkylamides?
Echinacea.
List uses & evidence for each.
- Relieve Sx & shorten duration of Upper respiratory tract infections - possibly effective (B)
- Sore throat - possible effective (C)
Echinacea.
What is the mechanism at which this product works by?
- Increases macrophage proliferation, phagocytosis, cytokine secretion
- Activates T-cell & NK cells
Echinacea.
List the risk information.
- allergies & cross-sensitivity to Asteraceae/Compositae families (ragweed, chrysanthemum, marigold, daisies), ana risk
- immunosuppressants?
- in children?
Echinacea.
State the dosing considerations.
-prevention – pretreat for 7-10 days prior to intentional infection; benefit
was lost with 8-week pretreatment (tolerance)
- usually taken at the first sign of a cold for 7-14 days
- preferred preparation is E. purpurea (above-ground preparations) [only traditional claims are approved for E. angustifolia]

Ginseng.
State active component.
Ginsenosides.
Ginseng.
List uses & evidence.
- possibly effective: cognitive function & influenza (P. ginseng)
- possibly ineffective: athletic performance (P. ginseng, P. quinquefolius)
- insufficient evidence: common cold &blood glucose (P. ginseng); cognitive performance (P. quinquefolius)
> immune stim B
mental performance B
exercise performance C
hyperglycemia C
Ginseng.
List risk info.
Consult HCP prior to use:
>taking antidepressant meds (P. ginseng has caused manic episodes)
>taking blood thinners or digoxin (alters effectiveness)
>diabetes
(according to TCM, do not use in cases of yin deficiency with heat signs, heat excess, or in the absence of significant qi deficiency)
Ginseng.
Dosing is standardized to ______.
Ginsenosides.
Cold-FX: non-ginsenoside extract.
What is the active component?
poly-furanosyl-pyranosyl-saccharides
Cold-FX: non-ginsenoside extract.
State uses.
-Helps reduce the frequency, severity and duration of cold and flu Sx by boosting the immune system
Cold-FX: non-ginsenoside extract.
State the mechanism of A,
- large polysaccharides remain in the g.i. tract
- bind to macrophages, stimulate cytokines which further activate macrophages, T-cells, and NK cells
Cold-FX: non-ginsenoside extract.
How did this product come to be?
from bullshit
- combined 2 studies that actually showed that it did not reduce sx but that 9% of ppl w placebo had virus in the bloodstream while only 1% of those w cold fx did-> then combined this to say that it reduced risk of colds, flu and resp illness by 89%-> lawsuit on this
- but then CEO and don cherry went to this lunch in ottawa and made a presentation how products were hard to get onto market and essentially pity approved
Cold-FX: non-ginsenoside extract.
Evidence.
possibly effective:
- 3-4m tx, modest reduction in risk, sx severity, and duration
- perhaps not the first cold, but repeat colds
- doesnt preclude vaccine - in 65 years or older, both are required
Oil of Orgeno.
proper names: Origanum minutiflorum, O. vulgare
- no actual active ingredient
- claimed that it could be used in H1N1
- misleading product, acts as a non-medicinal dumping ground
- has all these claims but essentially dif vitamins are added and that is what gives the benefit (ie A or D)
