L8-Intro to NHPs Flashcards
Define NHP.
List e.g. of
Naturally occurring substances that are used to maintain or restore health.
List the 6 categories of NHPs.
- Vitamins and minerals
- Herbal remedies
- Homeopathic medicines
- Traditional medicines
- Probiotics
- Other products (efa, aa)
T/F: NHPs are apart of CAM regulations.
FALSE.
-while they can be considered as such, here in Canada they are not as they are listed under drugs in the Food and Drugs Act
List some gucci properties re: NHP’s.
- safe for consideration as over the counter products
- available for self care
- available for self selection
- does not require a prescription to be sold
- can include even shampoos and soaps
Function food v nutraceutical.
1. Definition.
- FF: similar in appearance OR may be conventional food
- Nutraceutical: prod isolated/purified from foods
Difference between function food v nutraceutical.
2. Where is it sold?
- FF: as part of usual diet
- Nut: sold in med forms not usually ass w/ food
Difference between function food v nutraceutical.
3. Benefits?
BOTH - demonstrated to have a physiological benefit or provide protection against a chronic disease
Difference between function food v nutraceutical.
4. What category is it regulated under?
- FF: food
- Nut: drug
What percentage of Canadians use NHPs?
71%
Why do Canadians use NHPs?
52% maintain or promote good health
29% better or safer than conventional medications 20% recommendation (physician or other)
Do Canadians think NHPs are safe?
52% yes (b/c made from natural ingredients)
37% if for public sale, then safe
How do Canadians learn about NHPs?
- fam and friends
- pharmacist
- internet
- physician
What do Canadians want to know?
- recalls of NHPs
- side effects
- DIs
- uses/benefits
- understanding NHP labels
- NHP regulation
List the most commonly used NHPs & their indications.
1) glucosamine - OA
2) echinacea - immune stimulator
3) garlic - (reduce cholesterol)
4) fish oils/ w-3 fa - cdv health
5) evening primrose oil/ GLA - menopause
6) ginkgo biloba - memory
7) ginseng - immune
8) flaxseed oil - CDV health
9) St. John’s wart - depression
10) apple cider vinegar - general health????
List predictors of NHP users.
- race (Caucasian > minority)
- non-smokers > smokers
- active > non-active lifestyle
- health status (non-perfect health > perfect health)
- use of conventional or OTC medication…(>57%!!!)
- vitamin, mineral, or multivitamin usage
- consultation with a CAM practitioner (esp. ND/HDs)
- Vitamins and minerals.
T/F: Education & annual income is NOT a good predictor of NHP use.
TRUE!
- Vitamins and minerals.
T/F: All vitamins are a factor in the maintenance of good health.
TRUE!
- Vitamins and minerals.
Which 3 vitamins are involved in helping to form RBC?
folate, niacin, vit B12
- Herbal remedies.
This category includes botanical therapy. Define botanical.
- plant or plant part valued for its medicinal or therapeutic properties, flavour and/or scent
- > herbs are a subcatagory of this
- Herbal remedies.
List the 3 NHPs included in the botanical category.
- Herbal remedies/products
- Botanical remedies/products
- Phytomedicines
- Herbal remedies.
List 4 e.g. of botanicals.
- tea/infusion
- decoction
- tincture
- extract
- Herbal remedies.
How does one prepare tea/infuson?
- adding boiling water to fresh or dried botanical and steeping
- cold or hot
- Herbal remedies.
How does one prepare decoction?
- for botanicals that need more forceful Tx to extract desirable components (e.g. bark, root)
- simmered longer in boiling water than tea/infusion
- cold or hot
- Herbal remedies.
How does one prepare tincture?
-soaking botanical in a sol’n of
alcohol and water
-concentrates botanical
-sold in liquid form
- Herbal remedies.
How does one prepare extract?
-soaked with the goal of capturing
specific components
- Herbal remedies.
What are the 2 types of AE effects?
- Intrinsic AE: arise from herb itself
2. Extrinsic AE: unrelated to herb; likely due to prob in commercial manufacture or extemporaneous compounding
- Herbal remedies.
List the 2 types of intrinsic AEs.
- Type A: predictable toxicity, OD, DIs
2. Type B: idiosyncratic Rxns (e.g. allergy, ana)
- Herbal remedies.
List 7 e.g. of extrinsic AEs.
- Misidentification
- Lack of standardization
- Contamination
- Substitution
- Adulteration
- Incorrect preparation and/or dosage
- Inappropriate labeling and/or advertising
- Herbal remedies - extrinsic AEs.
W/ regards to misidentification (1), it is important that plants are referred to as their ____.
Why?
- binomial Latin names/scientific name (genus & species).
- b/c they have many different names!
- Herbal remedies - extrinsic AEs.
List 3 challenges in standardizing (2) herbal medicines.
- No bioassay identified
- Active ingredient(s) of a herb often unknown
- If AI(s) are known, may be unknown which is better - crude herb or purified active principle
- Herbal remedies - extrinsic AEs.
How are we trying to set better standards (2) for knowing the active ingredients?
- how and where they are grown; how it is harvested or extracted
- target values for several of its constituents following extraction
- goal is chmemical consistency w the hope of therapeutic consistency
- Herbal remedies - extrinsic AEs.
Does the goal of chemical consistency means therapeutic consistency always work out? (2)
no
- ie st john’s wort
- > for years, this herbal med was standardized to its hypericin content but was never confirmed as the herb’s active ingredient
- it is now known that hyperforin is the more potent inhibitor of neuronal 5HT uptake
- Herbal remedies - extrinsic AEs.
How can herbal remedies become contaminated (3)?
- Via pesticides, etc
- note that consumption of excessive amounts of heavy metals, such as lead, mercury, and arsenic, pose serious health risks because they may accumulate in vital organs of the body.
- Herbal remedies - extrinsic AEs.
Substitution is the 4th extrinsic AE. Explain how this could be a problem.
-you cannot just switch to another plant species that is close to the same.
- Herbal remedies - extrinsic AEs.
Provide an example of substitution.
-ie Chinese fang chi can accidentally be switched for Aristolochia fangchi root.
>Chinese: used as agent to control BP, fever and pain, edema, eliminate stagnant bronchial mucous, and detoxify.
>Substituted (accidentally) to aristolochia fangchi root: nephrotox, carcinogenic, and mutagenic
- Herbal remedies - extrinsic AEs.
Describe adulteration.
- sometimes companies put in ACTUAL meds into a NATURAL product and then make claims (wo indicating that they added this to the product)
- ie acet, caffeine, ccs, diazepam
- Probiotics
Define.
-culture of live microbes that when ingested improves host’s intestinal microbial balance
>Non-pathogenic microbes
>Dose forms: capsules or supps
>Beneficial effect in Px & Tx of certain medical conditions.
- Probiotics
Probiotics works by colonization resistance. Explain what that means.
- limit the potentially harmful bact in the digestive tract
- supply enzymes or influence enzyme activity in GIT
- Probiotics.
List the accepted criteria for use.
- Indigenous to humans (already present in our gut)
- Resistance to acidity and bile toxicity (survive stomach)
- 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
- Probiotics.
What is it used to Tx? List 3 examples.
- improve gut health
- reduce risk of colon cancer
- immune modulation
- Probiotics.
Probiotics are used to improve gut health. Explain!
- increase healthy bact
- decrease pop of pathogenic microbes (using Lactobacillus rhamnosus GG, L. reuteri, Saccharomyces boulardii, Bifidobacteria sp.)
- more commonly used to decrease diarrhea (try to get balance back btwn healthy and pathogenic bact)
- Probiotics.
Probiotics are indicated to reduce the risk of colon cancer. Explain!
-alter metabolic activities of intestinal microflora, ie suppress bact enzymes such as β-glucuronidase&
nitroreductase, which increase the levels of procarcinogens
-alter the physico-chemical conds in colon to discourage growth of pro-carcinogenic microflora
-bind/degrade potential carcinogens, ie mutagenic pyrolyzates found in red meat
-enhance the host’s IR
- Probiotics.
Probiotics are indicated to modulated the immune system. EXPLAIN.
-Lactobacillus acidophilus and Bifidobacterium bifidum augment humoral and cellular immunity
- Probiotics.
What is the body’s most important immune function related organ?
intestine (60% of immune cells located here)
- Probiotics.
Re: safety, list some issues to consider.
- 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)
- Probiotics.
List 3 promising strains.
- Lactobacillus: acidophilus, johnsonii, casei, gasseri, plantarum, rhamnosus
>most common: friendly bact found in guts; used in yogurt; used to treat AB-induced diarrhea - Bifidobacterium: longum, breve, bifidum, infantis, lactis
- Enterococcus: faecalis, faecium
- Probiotics.
List some efficacy considerations.
-min daily dose
-acid and bile stability
-intestinal mucosal adhesion properties
-viability through the product shelf life
>ie microtechnology-> trying to maintain the viability of the probiotics -> may be sensitive to heat, light, pH, moisture
- Probiotics.
List the 2 goals of therapy.
- Healthy maintenance of intestinal microflora
2. Therapeutic
- Probiotics.
State the dosing when the goal is to maintain a healthy intestinal microflora.
-depends on the extent of microbial depletion and the presence of harmful bacteria
-1-2 billion cfu viable organisms/day of L. acidophilus or B. lactis
(cfu=colony forming unit)
- Probiotics.
State the dosing when the goal is therapeutics.
10-100 billion or higher
- Others.
List 2 e.g. in this category.
- EFAs
2. AAs
- Others.
Define EFAs.
-fatty acids that cannot be synthesized in the body (must be supplied through diet or supplement)
- Others.
List the 2 cases of polyunsaturated FAs.
- Omega-6: linoleic acid (LA)
2. Omega-3: alpha-linolenic acid (ALA)
- Others.
T/F: All other fatty acids, including docosahexaneoic acid (DHA) and eicosapentaenoic acid (EPA), are considered derivatives
TRUE!
- Others.
List 2 functions of EFAs.
- Components of cell membs that increase memb fluidity - cell memb function
- Proper function of the brain and nervous system
- Others.
List the benefits of Omega-3s.
- cdv benefits (anti-platelet aggregation, anti-inflam, pro-VD)
- evidence used for/in hyperglycemia, depression, cancer, lupus, asthma, and rheumatoid arthritis
- Others.
What ratio of LA:ALA is needed to reap the benefits of a dietary sup of EFAs?
<5:1.
- Others.
The ratio of LA:ALA in a western diet, can be as high as?
30:1
6. Others. List some food sources of: 1. ALA 2. EPA/DHA 3. LA 4. GLA
- ALA: flaxseeds, walnuts, canola oil
- EPA/DHA: fatty fish, fish oil
- LA: veg/plant oils, leafy veg, seeds, nuts
- GLA: evening primrose oil
- Others.
List & define the 3 types of AAs.
1) essential: obtained from diet
2) nonessential: produced by liver enzymes
3) conditional: not essential except in times of stress
- Others.
___ AAs are the most common essential AAs.
Branched!
-40% of the daily requirement of the essential amino acids
- Others.
Branched aa - list benefits.
- Increase carbohydrate bioavailability in muscles &
prevent muscle breakdown during rigorous exercise - Reduce fatigue in both anaerobic and endurance sports
- Others.
Branched aa - used to Tx?
- Allow proper synthesis of proteins, energy source, preserve/restore muscle mass after surgery or trauma, cancer
- Amyotrophic lateral sclerosis
- Anorexia
- Burn patients
- Protein metabolism (in COPD patients)
- Muscle fatigue and soreness
- Exercise performance
- Cirrhosis
- Diabetes
- Others.
Essential AAs - list rules.
- Arginine is essential for children up to 5 yrs old and the elderly (60+ yrs)
- Histidine is essential for children up to 5 yrs old
- Arginine is synthesized by the body but not at rates sufficient to support growth. Also, most arginine is cleaved to form urea.
- If cysteine is not adequately provided in the diet, then methionine is required in high amounts.
- If tyrosine is not adequately provided in the diet, then phenylalanine is required in high amounts.
- Others.
List & define the 3 types of Pr sources.
- Complete: provides all essential AAs
- Incomplete: 1+ low in
- Complementary: 2+ incomplete sources together to provide adequate amount of EAAs.
