Supplements Flashcards
What is a food supplement defined as?
Concentrated source of vitamin, mineral or other substance with a nutritional or physiological effect, alone, or in combination, sold in dose form.
Do herbal products have food supplement status?
No. Classed as medicines.
Why use supplements?
- Deficiency (eg vitamin D)
- Insufficiency (therapeutic eg vit C - bleeding gums)
- Preventative (eg orthomolecular to maintain health)
NB Most disease starts and progresses due to an insufficiency of specific vitamins or minerals.
FIVE reasons why supplements being needed.
- Soil depletion due to intensive farming
- Pesticides and fertilisers reduce phytonutrients (secondary metabolites)
- Food processing kills nutrients esp additives, often toxic.
- Weakened digestion eg IBS
- Stress depletes minerals and vit C and reduces gastric secretions.
- Long-distance transport: Crops lose much of their nutritional value.
Which organisation is responsible for licensing medicines in UK?
MHRA
Medicines and Healthcare Products Regulatory Agency
NB We do not prescribe these products. We prescribe supplements covered by food laws ie unlicenced.
Which organisation regulates medicinal products, medical devices and cosmetics?
HPRA
Health Products Regulatory Authority
How are herbal products regulated?
Many herbal ingredients classified as medicines. Herbal products are regulated by Traditional Herbal Medicines Directive, administered in UK by MHRA.
What claims are prohibited on food supplement labels?
- Medicinal claims: we cannot say it will prevent, treat or cure - not allowed.
- Weight loss.
- Individual doctors or health professionals endorsements
- Health claim on alcoholic beverages.
- Claims which suggest that health could be affected by not consuming supplement.
Name TWO animal-based supplements
- Fish oils as anti-inflammatory
- Collagen for gut integrity (bovine)
Carefully regulated for contamination, traceability. EU. Receive an approval number.
GM ingredients allowed in supplements?
Yes but only if authorised under Regulation on genetically modified food and feed.
Needs to be included on label.
NB accidental presence of GM material may still occur in a non-GM crop via transference eg windborne pollen.
Are companies required to be GMP-approved?
Supplement companies required to manufacture with due diligence ie guidelines.
Legal requirement that all products must be fit for purpose.
Many companies are GMP compliant (self-regulated) but not GMP approved (very few).
NB Herbals are required to be approved.
Tests carried out by regulatory agencies to check supplements?
High or unacceptable levels of:
1. Heavy metals
2. Solvent residue
3. Aflatoxins
4. Herbicides
5. Pesticides.
Regular testing required.
What is overage?
Overage = ingredients may degrade over a supplement’s shelf life.
Reputable supplement companies will add extra so that amount left at end of its shelf life still meets label claim.
Fish oil supplementation guidance?
Fish oil and omega plant oils need to be cold-pressed to minimise oxidation.
Cheaper extraction and processing methods reduce effectiveness of supplement and affects its safety profile.
Why protein suppplementation guidance?
Needs to be specially filtered to remove lactose, hormones, etc.
Cheaper extraction and processing methods reduce effectiveness of supplement and affects its safety profile.
What are considerations when choosing between tablets to capsules in terms of supplementation.
Tablets: cheaper, easier to produce large quantities. Generally contain more excipients so try to avoid esp for IBS or elderly reduction in digstive power.
Capsules: Fewer excipients but not efficient for large doses - fewer ingredients in there so will need many capsules.
Excipients bind ingredients together
Compare powders to liquids as forms of supplementation.
Powders: Good for bigger doses eg glutamine or protein powders.
Not suitable for sticky ingredients, ones that attract moisture eg phosphatdylserine or fruit powders, where there is a toxicity risk, or where ingredients are unstable.
Liquids: excellent absorption but more expensive and less stable.
Many, such as fish oils, need antioxidants such as vitamin E added to prevent oxidation.
Why put Vit C in with fish oil supplement?
Great antioxidant and prevents oxidation. Also vit E.
Fats put in with vitamin A to aid absorption (dropper)
What are advantages of enteric formulations?
Excipients, such as shellac or cellulose acetate phthalate (CAP) ensure tablets survive stomach acid so that they don’t release contents until small intestine. Commonly used for good garlic capsules in SIBO clients so reach small intestine.
Spore form?
Probiotics to survive stomach acid and reactivate in intestines - dysbiosis.
Why do we need chewable formulations of supplements?
As vitamins and minerals may taste unpleasant, most vitamin and mineral powders are coated before they are compressed into tablets. Great for clients with compliance issues, elderly, children!!
Cheaper slow-release tablets contain ______________ to hold tablets together longer.
Hydrogenated fats.
What are liposomal supplements and their advantages?
Liposomal supplements have a protective phospholipid bi-layer protecting active ingredients.
- High bioavailability and absorption (good for elderly clients with lower gastric juices, meds and B12 a big issue so liposomal will get there).
- Increased oral uptake in mouth.
- Increased uptake into target cells (body recognises it)
- Easier to take than large tablets.
- Suitable for water- and fat-soluble nutrients.
What are excipients and why are they used in a supplement?
Excipients are INACTIVE additives used in forming tablets and capsules to bind active ingredients together and keep them active (potentially harmful).
Give FIVE examples of excipients in supplements.
- Capsule shells: Made from gelatine or from plant cellulose. NB Beware for vegans if gelatine.
- Flow agents: Help formulations flow easily through machinery but no nutritional benefit. Avoid magnesium stearate.
- Binding agents: Help to bind ingredients together to make a tablet eg maltodextrin (IBD, IBS).
- Fillers. Help to fill capsules, particularly when small amounts of an active nutrient is needed eg B12 or vit D.
- Natural fillers: fossilised seaweed; vegetable powder; new form of rice flour that is inert.
- Emulsifiers. Used to mix oily and watery ingredients together.
- Flavours. Avoid MSG or sugar (could be the supplement that is driving or causing the issue!).
- Colours: riboflavin, beet extract, turmeric.
- Sweeteners: glycerine, xylatol.
- Preservatives: vitamin E, ascorbic acid.
What does naturopathic approach to supplementing involve?
- Addressing underlying cause of any dysfunction ie individual basis.
- Treating whole person, rather than disease.
- Vital that supplements are taken under best conditions to achieve maximum absorption, assimilation and utilisation.
- Everyone is unique and that many factors must be considered to ensure that appropriate supplements are used in correct dosage for optimal efficacy. Why we do a full case study.
Where does absorption occur?
Mostly occurs in duodenum and jejunum
Chemical bonds are broken in stomach.
Give THREE examples of nutrients absorbed in duodenum and jejunum. What nutrient is absorbed in ileum?
Both: Ca, Mg
Duodenum: Fe, Zn, selenium, chromium, imanganese
Jejunum: B and C viits , choline, inositol,
Ileum: Vitamin B12.
Best way to take water-soluble vitamins ie with or without food?
(Vits B and C)
Most B vitamins and vitamin C: take with food otherwise travel through digestive tract quickly and won’t be absorbed.
B vitamins: Contraindicated in evening as they may trigger or exacerbate insomnia (B6 is exception) due to ATP role.
Why B6 in the evening?
Facilitates synthesis of melatonin so take at night. Also co-factor in Mg absorption.
Best way to take fat-soluble nutrients.
Take with food containing fat: need bile salts for absorption.
Eg vitamins A, D, E, K and CoQ10: Take with food containing fat as they transport it via micelles to enterocytes.
Best way to take EFAs?
With food. Preferable not to take with high amounts of their opposing fat; if taking omega-3 then avoid high amounts of omega-6 in same meal.
Best way to take amino acids
Ideally on an empty stomach for max absorption.
But if have client with weak digestion take with carbohydrate food - if take with protein-rich will have absorption competition.
When are protein shakes useful?
Protein shakes: take any time of day, Can pack in lots of protein.
1. Children: to build strength and way of getting nutrients in if difficulty chewing and swallowing.
2. Often used post-surgery to repair and rebuild tissue.
3. Exercise: Protein shakes take about 30 minutes to reach muscle after ingestion so are quicker to digest than solid food.
4. Absorption of amino acids in liquid shakes depends on transit time through gut, stomach acid, proteolytic enzymes, etc. NB proteins can be difficult to digest.
What is best way to take minerals and what is their digestion dependent on? What time would you recommend taking Ca, Mg and Zn?
Minerals are best taken with food.
Adequate stomach acid is needed for their digestion.
Ca and Mg [insomnia, relax]
Take in evening to aid restful sleep.
a) Ca required for synthesis of melatonin from tryptophan.
b) Mg binds with GABA receptors in brain which leads to inhibitory effect… parasympathetic state for optimal night’s sleep.
Zinc:
Take on an empty stomach before bed - Zn can complete with Cu and Fe for absorption.
Caution: Some people may suffer stomach discomfort after taking zinc.
What should we consider to work out dosage for a client?
-
Age: May need a higher dose with increasing age - lower HCL and enzymes.
Kids much lower. - Digestive capability: Ability to absorb and excrete? Constipated?
- State of health: Dosing for optimum health (maintenance) or for disease state? Keep on top of clinical trials for dosage. Boullardi for candida.
- Therapeutic doses: Evidence of dosages that are shown in clinical trials to be effective for certain disease states.
- Dietary deficiency or insufficiency: What symptoms are there?
- Lab test results: What do these indicate? Fe have to get iron levels tested first.
- Safe therapeutic range: Age group of client?
What is an ‘elemental mineral’ in a supplement?
Amount of mineral available for absorption ie when it has been freed from its carrier molecule. Elemental mineral is amount of mineral that is actually used by body.
Proteins slightly different: look at amount of protein per 100g
Fish oils: focus on amount of EPA/DHA.
What is a natural supplement?
Natural or synthetic? Word natural can be deceptive: can be used even if only 10% of product is natural. Other 90% could be synthetic isolates.
a) Food paste and grown into a more nutritious food matrix.
b) Synthetic nutrients being biochemically incorporated into yeast or algae.
Why is it better to choose vitamins from whole foods over manufactured synthetic isolates?
- Body recognises when nutrients are derived from food and includes necessary co-factors. May not recognise synthetic isolates.
- Natural supplements usually have better bowel tolerance than synthetic ones so they are retained longer in body.
NB Food labelling very confusing… need to look for active ingredients that are from wholefood stage eg acelerola cherry. Grown from a paste with all the co-factors.
Give an example of a supplement from a natural source.
Nutrients from vegetable, animal or mineral sources.
1. Vitamin D from fish liver oils,
2. vitamin E from vegetable oils,
3. natural betacarotene.
4. Vitamin K.
What forms can supplement be grown in?
Algaes or yeasts
Give an example of a supplement from a synthetic source.
Vitamin C: As this is a weak acid, many supplements use salt forms (calcium or magnesium ascorbate) to decrease acidity.
Sometimes used preferentially by practitioners when trying to use higher doses.
Give an example of a supplement from a food cultured source. How are they made?
Whole food multivitamins, minerals and other nutrients.
CULTURING can make nutrients more bioavailable. Often grown in yeast or algae and contain nutrients they are fed in a whole food complex form.
Same process behind cultured foods like yoghurt, kefir, miso, and sauerkraut.
What is hydroponics?
Growing of plants in nutrient solutions with or without an inert medium (such as soil).
Downside of natural food supplements?
Natural may have better efficacy than synthetic forms, although are generally not available in higher doses.
Natural examples:
a) Vit D from fish liver oils
b) Vit E from vegetable oils and
C) Natural beta-carotene
d) Natural vitamin K
Give an example of when a synthetic form of a supplement can be more useful or / and a natural form cannot be used.
Ascorbic acid = most common synthetic form of vitamin C.
Rapidly excreted from body but will take a significant amount of ROS (free radicals) with it. Ideal if detoxification is desired outcome.
Vitamin B9 labelling laws insist that companies use folic acid or methylfolate as product descriptor. Food state folate is not same as traditional folic acid. It’s not methylfolate either as this does not occur in plants.
Methylation only takes place in human body or in a laboratory process - hence methylfolate, only can be made in lab, can be very helpful.
Name TWO reasons why synthetic supplements may be preferential to food-state.
- Food-state supplements may not be enough to supply optimal dosage when someone has a high nutritional requirement due to:
a) poor dietary habits and lifestyle
b) environmental factors
c) chronic health conditions eg psoriasis and needed to reduce symptoms quickly. -
Sensitivities to foods or fillers in food-based products eg gluten or nightshades can cause mild to severe reactions. Goji berries part of nightshades. Can excacerbate an arthritic conditon.
Isolated, synthetic nutrient products may work better for some sensitive people.
What is a naturopathic approach to supplementation?
Backed up by science, research and trials but with an holistic approach.
- Favour use of whole, unadulterated botanicals and phytonutrient-rich foods optimally combined with vitamins, minerals, enzymes, coenzymes and amino acids.
- Try to avoid preservatives, colourants, fillers or binding agents to allow activity of, and synergy between, vitamins, minerals, plant enzymes, phytonutrients without physiological or biochemical interference.
- avoid GMO and irradiated products.
What letters indicate a synethetic form of a vitamin?
dl
eg dl-alpha tocopherol
Why is it better to avoid irradiated (ionised radiation) supplements? Is there an alternative?
- Used to destroy pathogens.
- Destroys nutrients and disrupts their natural frequencies.
- Less damaging technologies include dry steam sterilisation.
Give THREE examples of what supplement types may contain GM organisms in supplements.
Low-quality supplements are often filled with GMOs - often added to compensate for poor-quality ingredients. Choose organic. Often in cheaper products.
May be GMO:
1. citric acid
2. corn syrup or corn starch
3. maltodextrin
4. MSG (flavour)
5. soy lecithin
6. xanthan gum (binder)
Which vitamin use for constipation?
Vitamin C can speed up the bowel ie ascorbic acid.
Example of macro and micro mineral?
Ca (macro = >100mg per day). Ca citrate (carbonate is cheap form). Lower dose but way more bioavailable. Carbonate can produce IBS although looks like higher supplement.
Selenium
NB Fe for heavy menstruation
Mineral carriers: what is difference between organic and inorganic **acid salts **? Give THREE examples of each.
A. Organic acid salts
Natural, found in living organisms.
1. Bond between mineral and organic acid generally weak.
2. Cleaved apart more easily
3. More effectively absorbed than inorganic salts
4. Body can also use carrier molecule.
5. Eg citrate, picolinate, ascorbate, malate,
Also: fumarate, gluconate, glycinate, acetate, lactate, , aspartate, succinate, orotate (some feed into Krebs cycle so can be used by body).
Eg GALA: gluconate (or glycinate), acetate, lactate, aspartate
B. Inorganic acid salts
Simple mineral compounds important for electrolyte balance.
Inorganic supplement forms tend to cause more adverse effects (esp. GI).
Eg. CON: carbonate, oxide, nitrates
Also: sulphates, chloride, phosphates, nitrates, carbonates.
Which forms of organic acid salts used in Krebs?
- Malate: Malic acid
- Citrate: Citric acid
- Fumarate: fumaric acid
What is best form for mineral absorption?
Amino acid chelates.
Specific minerals chelate best with specific amino acids.
Survives stomach where absorbed in small intestine through dipeptide channels.
