Supplements in practice Flashcards
What are the three classifications of supplements and who are they regulated by
- licensed medicines:
the Medicines and healthcare products Regulatory Agency (MHRA) licenses medicines used in the UK.
Food supplements are covered by food laws.
DIETARY SUPPLEMENTS ARE CONSIDERED SAFE UNTIL PROVEN OTHERWISE
- Unlicensed preparations
The DoH has responsibility for national and EU legislation of food supps in England. Local trading standards monitors and enforces. Anything pharmacologically active sent to MHRA for assessment - Herbal products.
Regulated by the Traditional Herbal Medicines (THM) directive, administered by the MHRA.
What are you not allowed to claim on a supplement label
No claims that it can prevent, treat or cure human disease
No reference to rate or amount of weight loss
no recommendations of dr or health professional
No health claims on alcohol
Can’t claim that health could be affected by NOT consuming the food.
Animal based supplements - what body must approve them
The European Commission
What checks are carried out on animal based supplements
where the animal was caught, farmed, manufactured, handled, extracted and packaged.
Contaminants (heavy metals etc) must be within acceptable EU levels.
What are the regulations on GM food in supplements
Ingredients from GM organisms are only permitted in supplements if authorised under a Regulation on GM food and feed. - Must declare the presence of GM materials on teh label
What is the name of the minimum standard that a medicines manufacturer must meet in its production processes
Good Manufacturing Process (GMP)
To meet “Good Manufacturing Practice”, what standards must medicines meet
- be of consistent high quality
- appropriate to their intended use
- meet the requirements of teh marketing authorisation (MA) or product spec
Unlike Australian or American companies, supplement companies in the UK do not have to be GMP approved (Good manufacturing practice). What does it mean to be GMP compliant
companies are required to manufacture with ‘due dilligence’ and can be GMP compliant
How can manufacturing processes affect the quality of supplements and provide 2 examples
Fish and omega plant oils need to be COLD pressed to minimise oxidation.
Whey protein needs to be specially filtered to remove lactose, hormones etc
What is “overage”
extra ingredients added to the supplements so the amount left at the end of its shelf life still meets the label claim
Name 4 different types of supplement forms and why that type might be preferable, and any drawbacks
tablets - cheap, easy to produce in large quantities. Generally contain more excipients
capsules - fewer excipients but not efficient for large dose
powders - good fo bigger doses, eg glutamine
liquids - excellent absorption but more expensive and less stable. Fish oils need antioxidant such as vit E added to prevent odxidation
enteric - Excipient (eg shellac or cellulose) used to ensure tablets surive stomach acid and don’t release until the SI.
spore form - enables Probiotics to survive the stomach and reactivate in the SI
chewable
slow release - cheaper slow release tables contain hydrogenated fats to to hold the tablet together for longe
Liposomal - protective phospholipid bilayer protects the active ingredients - high bioavailability and absorption, increased uptake into target cells, easier to take, suitable for water and fat soluble nutrients.
Why are liposomal supplements so effective
they have a protective phospholipid bilayer protecting the active ingredients.
high bioavailability and absorption, increased uptake into target cells, easier to take, suitable for water and fat soluble nutrients
Liposomal vit C is significantly higher absorption rate.
Provide examples of why excipients are used in supplements
The therapeutically active component of a supp can be as low as 2% of the total content.
- Excipients and fillers are the glue which bind and stabilise and keep nutrients active
Provide examples of what excipients might be
- capsule shells - made from gelatine or plant cellulose
- Flow agents - help formulation flow through machinery. Avoid Mg Stearate
- Binding agents - bind to make tablet
Fillers - esp when only small amount of nutrient needed
natural fillers
Emulsifiers - to mix oily and watery ingredients
Flavours - avoid MSG
Colours - beetroot
Sweeteners - glycerine
Preservatives - Vit E
Provide examples of which nutrients are absorbed in the :
Duodenum
Jejunum
Ileum
Duodenum: Ca, Se, Mg, Ch, Fe, Mn, Zn
Jejunum: Bs, biotoin, Vit C, Choine, Ca, Mg
Ileum: B12
How should water soluble vitamins be taken (b/c)
with food.
Why should Bs not be taken in the evening and with what exception
B6 can be taken in the evening as it stimulates melatonin synthesis
Bs can trigger insomnia
How should fat soluble nutrients be taken (adek and CoQ10) and what guidance should be given for EFAs
with food containing fat
EFAs - don’t take with high amounts of opposing fat.
How should amino acids be taken, specifically protein shakes
Ideally with Carb food/drink or on empty stomach
Protein shakes - any time of day. Good fo post surgery or after extreme exercise. Takes 30 mins to reach muscle after ingestion.
What does the absorption of amino acids depend upon
transit time through gut
stomach acid
proteolytic enzymes
etc
How should minerals be taken
When should Mg and Ca be taken
with food as adequate stomach acid is needed
Mg and Ca - in evening to aid sleep
When working out dosage of supplements, what factors should be taken into consideration
age of client (higher dose with increasing age)
Digestive capability (constipated?)
State of health (for optimum health or disease)
Therapeutic dose
Dietary deficiency or insufficiency
Lab test results
Safe therapeutic range (age group of client)
What does the “elemental” amount of a mineral mean when stated on a supplement label
the amount of mineral available for absorption when it has been freed from its carrier molecule. This is the amount USED by the body.
Just how “natural” are supposed natural supplements
10%+ must be natural
May contain synthetic nutrients
can involve synthetic nutrients being biochemically incorporated into yeast or algae
what is drawback of creating a supplement from a natural source
although they may have better efficacy, they are generally not available in higher doses
What is a food cultured supplement
Nutrient supplements that are often grown in yeast or algae.
culturing makes nutrients that are more bioavailable.
Natural vs synthetic supplementation - which is best. Use vit C as example
It depends on the client and the reason for supplementing.
Natural have better bowel tolerance and retained longer in the body. With VIt C it’s good to build collagen. But if using it for detox, then ascorbic acid will be rapidly excreted taking free rads with it.
When are high quality clean synthetic supplements recommended
Food-state supplements may not be enough to supply the optimal dosage for someone with high nutritional requirements - eg chronic health condition/poor diet/lifestyle
Sensitivities to foods or fillers
As a naturopath - what is our philosophy on using supplements
Use formuations that have a scientific but holisitic approach
Use phytonutrient rich food combined with vits, minerals, enzymes, co enzymes or amino acids
Avoid preservatives, colourants, fillers, binding agents, GMO and irridated products
Mineral supplement - what dose of macro minerals is required and what might cause a mineral imbalance in the body
macro minerals require an intake of over 100mg/day
Imbalances are usually caused by overloads from supps, not food sources
Mineral carriers:
organic acid salts
- where are they found
- are they more or less effectively absorbed than inorganic salts
- name 3
found in living organisms
The bond between a mineral and organic acid is generally weak - therefore more effectively absorbed than inorganic salts.
Citrate
malate
ascorbate
gluconate
picolinate
aspartate
succinate
orotate
fumarate
Mineral carriers:
inorganic salts
- what are they important for the balancing of
- are they more or less effectively absorbed than inorganic salts
- what adverse effects are they likely to have
- name 3
Important for the balancing of electrolytes
less effectively absorbed than organic acid salts
Adverse effects on the GIT
Oxide
sulphates
chloride
phosphates
nitrates
carbonates
What are the best form of mineral carriers for absorption
amino acid chelates - specific minerals chelate best with specific amino acids
What minerals are picolinate carriers best for
superior carrier for chromium, zinc, manganese
High absorption in gut giving high serum levels
What three mineral carriers are used in the krebs cycle so can be used by the body
citrates
malates
fumarate
Why are citrates recommended as a mineral carrier
more bioavailable - the positive acidic form requires less stomach acid to break bonds and free the mineral for absorption
Why are citrate mineral carriers helpful for post-menopausal women/elserly/stressed
Low stomach acid is often present in these groups resulting in absorption problems if a strong inorganic supp is used.
Ca Citrate is 2.5 times better than calcium carbonate with doses of 500mg in post menopausal women.
Name three minerals bound to citric acid/citrates
Ca2+, Mg2+, Zn2+
What is a chelator
a substance that binds tightly to mineral atoms and forces the mineral to go wherever the chelator goes.
Makes it more readily absorbed by the body
What is a mineral acid chelate
chelator + mineral atom = chelate
What are the advantages of using amino acid chelates
bypass competitive absorption that can occur between different minerals (amino acids disguise) - absorbed as a protein instead of a mineral.
Body treats it as a peptide and is efficient at absorbing amino acids
Extends length of absorption sites to large portion of SI
Most minerals are available in chelated form - what chelates do they typically use and provide examples of minerals that are available in chelated form
amino acid or organic acid chelates
Mg, Ca, Zn, Cu, K,
Provide 3 examples of minerals bound to amino acid chelates
Aspartic acid - zinc aspartate, Mg aspartate
Methionine - Cu methionine, Zn…
Lysine - Ca lysinate
Glycine - Mg glycinate
Provide 3 examples of minerals bound to organic acids
Acetic acid - Zn acetate, Ca acetate
Citric acid - Mg citrate
Orotic acid - Mg orotate
Gluconic acid - Fe gluconate
Fumaric acid - Fe fumarate
Picolinic acid - Chromium picolinate
What are the possible drawbacks of amino acid chelates
the complexes might be too tightly bonded and minerals may not be released if cellular energy is poor, eg chronic fatigue
Amino acid chelate complexes often too large for capsules so dosage can be too low - it’s beneficial to combine with other forms of minerals
Quality and price limitations as expensive
What does “dl” in front of a supplement mean
it’s synthetic
why should orotates be used with caution
they bypass the normal regulatory controls and therefore may be easy to absorb too much
Who are citrates good for
those with low levels of stomach acid - eg post menopausal, the elderly, high stress
It requires less stomach acid
Calcium - what nutrients should it be taken with
Mg, D3 K2
What can calcium supplementation cause if over prescribing
kidney stones
soft tissue calcification, esp if low vit D
What is the max absorption of Ca
500mg at any one time
If dietary intake of calcium is sufficient, what health concerns can calcium supplementation cause
kidney stones and soft tissue calcification
What are the preferred forms of calcium supplementation - name 3
Ca glycinate - these are organic forms and reduce the potential for gastric upset. Most bioavailability and soluble.
Ca citrate - easily assimilated. Most nutritional companies use this form.
Ca citrate malate - new inorganic form but provides exceptional absorption. Can be consumed with or without coke.
What forms of Ca supplementation are not recommended
Ca aspartate - no credible studies yet
Ca carbonate - lack of bioavailability and can’t use with low HCl
ca ascorbate
Ca oxolate
What nutrients should Ca be taken with
D3, K2, Mg
What is the max absorption of Ca
500mg at one time
What nutrients does Ca interact with
Mg - leave two hours between
Zn and Fe - may reduce absorption
Lysine - enhances absorption
Excess fibre and salt
Excess of phosphorous and caffeine
What drugs does calcium interact with
corticosteroids - long term use leads to reduced absorption
Levothyroxine - competes for absorption
Oestrogen and progesterone therapy - may increase absorption
Quinolone (abtibiotic) - take 4-6 hours apart.
Magnesium - is it best taken on empty stomach or with food
with food to aid absoprtion
What is Mg inhibited by an excess of
fibre, phytates, alcohol, sat fat
What drugs may decrease MG levels
OCP, HRT, diuretics, penilillamine
What is the cheapest form of Mg supplementation
Oxide
What is Mg chloride good for
transdermal application
What is Mg citrate good for
maintenance dose
What is Mg gluconate good for
good absorption, not laxative
What is Mg malate good for
good for energy production
What is Mg Glycinate good for
insomnia
What is Mg sulphate/epsom salts good for
laxative and rleaxing
What is Mg orotate good for
enhances energy production in the heart. Good for CV support.
Iron - What are the recommended forms of iron supplementation and what is the most common prescribed
ferrous salts - fumarate, sulphate, gluconate are the best absorbed
Citrate also well absorbed and tolerated. Bisglycinate highly bioavailability without adverse side effects of sulphate.
Ferrous sulphate is the orthodox and most studied form but causes nausea and constipation. Higher dose given, may interfere with vit E absorptive.
What drugs can iron supplementation interfere with
thyroxine
levodopa
tetracyclines
penicillamine
FluroQUINOLONES
What is the preferred supplemental form of chromium and for diabetics
picolinate - readily absorbed
Chromium malate for diabetic clients - improves action of insulin
What is Chromium GTF and how bioavailable is it
Cr + nicotinic acid + glutamic acid + cysteine + glycine
it’s not as readily available as using the nutrients separately
What drugs should be cautioned with chromium supplementation
diabetic drugs may have an additiive effect
Oral corticosteriods my deplete chormium levels
Zinc - which should be recommended for colds
Zinc gluconate
Zinc Acetate
Why would zinc pilolinate be recommended
for those with absorption issues
WHen should zinc be taken
on empty stomach at night,
1 hour before or 2 hours after meal
When should antibiotics be taken if supplementing with zn
2 hours before or 4-6 hours after taking zn
What medications might reduce zn absorption
PPIs and aspirin (3g/day)
What zinc supplement is not recommended
sulphate - may cause stomach irritation and nausea
What is the TUL for zinc
40mg day
If over 100mg may inhibit cu absorption
What effect might excess potassium have on the body
tachycardia - if dose greater than 15mg/day
TOxicity - hyperkalaemia
What Vitamin C might be prescribed for maintenance
low dose food form such as rose hip, acerola
What vit C might be prescribed for detox and why
high dose ascorbic acid - it’s excreted quickly taking free rads with it
Name supplemental forms of vitamin C
ascorbic acid - naturally in food, good bioavailability but may be harsh on GIT
bioflavonoids - beneficial plant compounds are added, working synergestically to increase bioavailability
why are liposomal vit C supplements beneficial
increased bioavailability due to phospholipid outer casing
Why are mineral ascorbates a beneficial Vit C supplement. Name one that has been patented
eg Ca, Mg, Na, K
called buffered vit C as gentler and better tolerated. The mineral is also absorbed
Ester-C - better tolerated by those who can’t eat acidic foods/can’t tolerate vit C
Vitamin A - why should Vit A supplementation not be recommended to smokers
some evidence that it can trigger lung cancer
What is the recommended dose of Vit A
varies greatly - 750-3000mcg RAE
100,000 long term may be toxic, especially to the liver where it is stored
What type of vit A is found in multi vitamins
both pre and pro formed vitamin A
What are the preformed vitamin A called
retinol acetate and retinyl palmitate
both are stable and highly bioavailable
What is the most common synthetic form for vitamin A
beta carotene/pro vitamin A. It’s converted as needed therefore reducing possibility of toxicity
What might cause vit D def
lack of sunlight
excessive sunscreen
what is the most effective form of vit D supplementation
D3 - cholecalciferol
Active form
what is the inactive vegetarian form of vit D
D2 ergocalciferol
What for of D3 is suitable for vegetarians
D3 from lichen
Vitamin E - what is the natural form available in supplements
D-alpha-tocopherol
1.4 times more biologically active than synthetic form
Vitamin E - what is the synthetic form available in supplements
dl-alpha tocopherol
may inhibit natural form from entering cells
what are selenium supplements used for
immune system
T3 production - hypothyroidism
Which selenium supplement has the greater bioavailability - the food form: selenomethionine, or inorganic selenite
selenomethionine (selenium chelated to methionine) is 90% compared to 50% from selenite.
What is the optimal form of selenium supplementation
a combination of selenomethionine (food form), selenodiglutathione and sodium selenate
B1 - how common is thiamine deficiency
very rare and easy to reverse with supplementation
What are the B1 supplements
thiamine hydrochloride
thiamine mononitrate
B2 - what are the best form of supplementation
modified release capsules. High doses have lowered bioavailability
when should riboflavin be taken
between meals
B3 - what reaction can B3 supplementation cause
niacin flush, prickly heat sensation
Name the B3 supplement forms
Niacin
Niacinamide
Nicotonic acid
What is niacin used for
cholesterol and triglyceride levels. Raynauds
what is Niacinamide used for
diabetes and blood sugar control
Niacin and niacamide
cognitive and mental health
When should niacin be taken
with meals to avoid stomach irritation
B12 - what are the active forms of B12
methylcobalamin - used for methylation
adenosylcobalamin - form in mitochondria
what form are most B12 supplements and are they active or inactive
cyanocobalamin - inactive. Need activating in the body
What B12 supplement might be recommended for those who don’t tolerate methyl groups or if both folate and B12 deficiency
Hydroxycobalamin - it’s inactive but with high affinity for plasma proteins
What form of B12 is needed if digestive issues
sublingual
How much EPA/DHA is required as a therapeutic dose
4g/day for minimum four months for arthritis
How are the oils prevented from oxidising
antioxidants are added
WHy is krill oil a better form of Omega 3
its more efficiently absorbed as carried into the cells in phospholipid form.
Where is vegan forms of EPA/DHA derived from
plant marine algae
Name a good plant source of omega-3
flaxseed oil (high in ALA).
