Dietary Supplement : Review

Pasit Kanasirichainon (Dietitian)

Dietary Supplement : Definitions

A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet. Some countries define dietary supplements as foods, while in others they are defined as drugs or natural health products

Dietary Supplement : Objectives

Treat nutrient deficiency people Prevent deficiency Boost-up health conditions Beauty - Wellness Trends

Common Dietary Supplement

Purpose
Prevention & Daily use

Beauty

Fish Oil / Flax seed oil Calcium Vitamin D Vitamin B 1 2 3 5 6 9 12 Vitamin A, E, K

Collagen Co-enzyme Q10 Glutathione Vitamin C 1000 mg Zinc

Purpose
Health Problem

Chromium Coconut oil Glucosamine/Chondroitin Lecithin Selenium Lutein - Zeaxanthin

Omega-3 as EPA & DHA Mackerel Tuna Salmon Anchovy Sardine Indication

Fish oil

Anti-inflammatory : RA Prevent CVD : Stroke, Atherosclerosis Lowering hypertriglycerolemia Mental status Supplementary : 1000-2000 mg/d

Doses use

Healthy, T2DM, CHD

High TG : 1-4 g/day Prevent recurrent CHD : 300-6000mgEPA : 600-3700mgDHA

Contraindication

Can cause side effects : bad breath, heartburn, nausea, loose stool, rash, nosebleeds >> take with meals Up to 3 g/d >> increase risk of bleeding High dose (>3 g/d) >> reduce immune systems activity, ease to infected

Fish oil

Omega-3 as Alpha linolenic acid Convert to EPA & DHA Possibly have anti-inflammatory system Not determined appropriated dose Indications

Flaxseed oil

No data support for use as Omega-3 source Insufficient evidence for improve health status Alternated choice for Vegan

Form : -Carbonate, -Gluconate, -Lactate, -Citrate Biological Role

Calcium

Neurotransmitter release Muscle contraction Ricket Bone fracture, Osteoporosis Poor blood clotting

Deficiency

DRI : 1000 mg/d

Indication

Prevent bone loss Reducing phosphate level in renal pt Treat osteoporosis Possibly reduce BP Possibly prevent cancer : colorectal, breast

Calcium

Vitamin D help Ca absorption

2 major forms (From 5 forms)

D2 (Ergocalciferol) : Phytoplankton, Fungi D3 (Cholecalciferol) : Vertebrates Activated by UV, hepatocyte & proximal tubules
Increase Ca absorption Increase NO synthase, Glutathione Immune System : T-cell, B-cell

Vitamin D

Actived form : 1,25(OH)2D3

Biological Role

Deficiency

Rickets / Osteomalacia Risk of metabolic syndrome : T2DM PVD, Cancer, RA

Vitamin D

DRI : 600 IU/day (<=70) 800IU (>70) Sunlight exposure 10-15 min/d Megadose usage ??

5000-20000 IU dosage

Main factor for organs metabolism Water-solubled > Less toxicity Forms

Vitamin B

B-complex Thiamine (B1) Niacin Folic acid Cobalamin

Vitamin B-specific deficiency

Vitamin B Deficiency
Thiamine

Niacin

Beriberi Conditions

Alcoholism Stress

First 20 century Pellagra

Diarrhea Dementia Dermatitis

Lowering TG : 500mg or more

Medical use

Vitamin B Deficiency
Folic acid

Cobalamin

Pregnancy

400 mcg

Benefit

Prevent NTD in infant Lowering homocysteine Reduce methotrexate sideeffect

Strict-Vegan Supplement : 1-25 mcg Pernicious anemia : 300-10000 mcg

Vitamin : Not recommend for supplement

Vitamin A

Vitamin E

Vision, Cornea health High Toxicity (X)Pregnancy

Anti-oxidant DRI : 4-15 mg/d Food Source

Vitamin
Vitamin K

Biological role

Blood clotting factor Possibly help bone health Green leafy vegetables

Food

Fibrous Structural Protein : Strength & Elasticity (Cartilage, Tendons, Skin etc.) Sequence : Gly-Pro-Hyp/Hyl Spontaneous synthesis

Collagen

(+)Factors :Vitamin C, E, Beta carotene (-)Factors : Cortisol

Degradation lead to wrinkled Industrial Use

Gelatin : Food textures, Pharmaceutical Photography industry Fulfil wrinkle and make skin tighthen

Health claim

Dietary Supplement

Low Biological Value protein Not shown strong scientific evidence to support improve skin, fingernail and joint health claims No suggested dose

Collagen

Surgery Uses

Artificial skin : Severe burns management Subcutaneous injection

Mostly found in mitochondria : Electron transport system Antioxidant function & Prevent lipid peroxidation No report about deficient symptoms Factors affecting CoQ10 levels

Co-enzyme Q10

Statins usages : inhibit mavelonate Aging : CoQ Decrease after 1st 20 years UV exposure : skin Whitening, Brightening Muscle building

Health Claim

Indications

Treat limit energy production in body cells (Mitochondrial disorders) 200-300 mg per day > Treat CHF 200 mg > Decreasing cpx of recent MI pt, Myocardial preservation for Cardiac Surgery 100-200 mg > Lowering BP, Prevent migraine, Muscular dystrophy disorder Prevent DM, Cancer, Male infertility, Statin-induced myopathy, Fatigue

Co-enzyme Q10

Not use for

Consist of L-Cys, L-Glu & Gly 2 Forms of Glutathione functioning

Glutathione

GSH (reduced form) >90% of total pool

Reducing equivalent : ROS

Regenerating GSH by glutathione reductase

GSSG (oxidized form) <10% of total pool

Properties

Major endogenous anti-oxidant Detoxifies xenobiotic, carcinogen, heavy metals : direct conjugation properties Essential for immune system

Inhibits melanin synthesis : interrupt L-DOPA ability to bind to tyrosinase

No clinical symptom of deficiency Medical Use

Glutathione

600 mg IM : Adjunctive CMT in cancer patient - Reduce severity of complication 250 mg PO qid : may prevent atherosclerosis IV administration is preferred Research support that 3g of Glutathione take orally does not raise serum glutathione level

Properties

Biosynthesis : collagen, carnitine, neurotransmitter Anti-oxidant : Reducing agent Anti-histamine Synergistic iron absorption Scurvy treatment

Vitamin C (Ascorbic Acid)

Deficiency : Scurvy Medical use

60 mg : RDA & Scurvy prevention 1000-2000 mg : Treat extreme ascorbic acid deficiency IV : Treat tyrosinemia in newborn

Supplement (possibly effect)

Reduce risk of mouth and breast cancer Preventing sunburn (Taking with V.E) Prolong nitroglycerin effect in chest pain patient Prevent CVD, Atherosclerosis
2000 mg per day : caused of renal stone 1000mg : risk of renal stone recurrence in people have Hx DM pt : not > 300 mg/d (increase risk of death from heart disease)

Vitamin C (Ascorbic Acid)

Contraindication

Biological role

Need for proper growth Immune function, wound healing Found in many enzymes, DNA-RNA metabolism Growth retarded, Generalized hair loss Loss of appetite, Diarrhea, Nausea Rough-Dry skin, Slow wound healing Male infertility 11mg in male, 8mg in female 12-13 mg for pregnancy and lactation

Zinc

Deficiency

Requirement

Medical use

Diarrhea from Zn Def. in child :10-40 mg Anorexia nervosa : 100mg ZnGluconate Acne : 30-135 mg daily Skin apply : Acne Vulgaris, Herpes simplex >40 mg/d : NVD, Metallic taste >100 mg/d 10yr : Risk of Prostate CA Not recommend for HIV pt

Zinc

Contraindication

Have no verified biological role Cr3+ occurs in trace amount in cell Cr6+ : very toxic and mutagenic Biological Role

Chromium

Not been clearly Possible role for the regulation of gene expression that potentiating insulin action
Supplement for pt received TPN exhibited abnormal glucose metabolism

Indication

Supplement

200-1000 mcg per day in T2DM Should not use more than 6 mo. Not recommend for healthy

Chromium

Insufficient evidence for

Obesity & Weight loss Depression PCOS Lower blood sugar Pre-DM

Contains a large proportion of saturated fat (Lauric acid, Myristic acid) Composed mainly of MCTs > Not required bile for absorption Usage

Coconut oil

Diet : Oil, Hydrogenated fat Skin moisturizer Treat DLP Weight loss

Health Claims

Research

Female 20-40 yr 2 group 20 people each 30cc/d of Coconut oil VS Soy bean oil with 1000-1200 kcal/d diet Exercise 4 d/wk : F/U 12 wk
LAB BW TC LDL-c Coconut oil Not change Not change Not change Soy bean oil Not change Raised 10.45% Raised 23.48%

Coconut oil

HDL-c
TG

Raise 7.03%
Not change

Decrease 12.62%
Not change

Ref : Assuncao ML et al., Effects of dietary coconut oil on the biochemical and anthropometric profiles of women presenting abdominal obesity. Lipids 2009Jul;44(7):593-601

Summary

Can be usual intake but not more than energy requirement Not proper for heat cooking : not stabled Should monitor Lipid profiles when long-termed use

Coconut oil

Natural fluid occur around joint Form : Glucosamine Sulfate Indication (possibly)

Glucosamine

Relieve pain from knee OA Temporomandibular joint arthritis 500 mg PO tid (use at least 4wk) Warfarin : increase risk of bleeding

Doses

Drug reactions

Chemical substance occur in cartilage around joint Indication (possibly)

Chondroitin

Reduced pain from OA

200-400 mg tid 1000-1200 mg od Warfarin : increase risk of bleeding

Doses

Drug reactions

Glucosamine Chondroitin sulfate

Phosphatidylcholine Natural : Egg yolk, Soy bean Mechanism

Lecithin

Reduce fat and cholesterol absorption from GI Tract Emulsified properties

Indication

Lowering cholesterol, TG Raising HDL-c

NVD Fishy odour

Contraindication

Compositions of enzymes

Glutathione peroxidase Thyroxine deiodinase

Selenium

Deficiency in healthy is very rare Long-termed TPN pt DRI

Adult : 55 mcg Hashimotos disease : 200mcg + thyroid hormone Anti-Dandruff shampoo : Selenium sulfide

Indications

Found in green leafy vegetables Concentrated in human macula

Lutein - Zeaxanthin

Reduce oxidative stress in eyes

Reduce risk of chronic eyes disease

Age-related macular degeneration (AMD)

No RDA Suggestion

10 mg Lutein + 2 mg Zeaxanthin

Best way to Supplement yourself

Check

your status

Low fish intake > Omega-3

Alcoholism > B-Complex Stress > V.C, B-Co

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scientific information Variety of Diet Exercise & Enough rest Counseling dietitian

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Thanks For Your Attention