THE USE OF SUPPLEMENTS

1. THE USE OF SUPPLEMENTS “Let food by thy medicine and medicine be thy food” Hippocrates

2. Refer to the handout from Jamison titled ‘Towards Nutritional Health: choosing food or supplements’ and come up with your own explanation of what dietary supplements are.

3. Now draw up your list of reasons why people should consider taking supplements as opposed / in addition to relying on food for their nutritional balance.

4. What do you understand by the term nutraceuticals? • Why are supplements also known as nutraceuticals? • Refer to the handout and make a list of the 4 ways that nutraceuticals can exert a physiological effect.

5. With your knowledge of Nutritional medicine do you agree with the following statement  “It is much more problematic to deliver nutritional magic bullets than to generally increase consumption of plant foods”? Think carefully about the implications of both – there is no hard and fast answer. • Then, at the end of the class, go back to this discussion and see if your thinking is the same.

6. Legislative Standards

7. Although it may be tempting to simply believe what you read and hear about vitamin supplementation (and many of your clients will do just that), it is important to be able to determine whether claims regarding vitamin supplements and their effect on health are accurate. • The following tips for buying and using dietary supplements come from the Office of Dietary supplements which is part of the National Institutes of Health in the USA. (McGuire & Beerman p 415)

8. Safety First: Some supplement ingredients can be toxic – especially in high doses. • Think twice about chasing the latest headline: sound health advice is generally based on research over time, not a single study touted by the media. Be wary of results claiming a ‘quick fix’ • Learn to spot false claims: remember that if something sounds too good to be true, it probably is.

9. More may not be better: Some products can be harmful when consumed in high amounts, for a long time. Do not assume that more is better – it might be toxic. • The term ‘natural’ does not always mean safe: The term natural simply means something is not synthetic or human-made. Do not assume that this term ensures wholesomeness or safety.

10. Now refer to the first handout and discuss and draw up summaries of the issues involved in: • legislating standardisation and safety in the supplementation industry; • Supplement claims; • Is it a supplement or is it a food?

11. TGA AND SUPPLEMENT REGULATION • Refer to the article “ The Development of US and Australian Dietary Supplement Regulations” and • draw up a timeline summarising this for Australia; • discuss and list the implications of this for the public in Australia.

12. FACTORS TO CONSIDER WHEN CHOOSING A SUPPLEMENT

13. EXCIPIENTS: other ingredients that take up space (known as fillers), hold the ingredients together (known as binders), assist in disintegration (disintegrates) and mask the taste and odour of the original product (coatings). • Other ingredients such as lubricants, colourants, flavours and plasticizers may also be used. • These days, with the majority of medications being in the form of tablets, capsules, pills or soft gels, it is important that you understand these “inactives” that are a part of most of the products that we consume.

14. Therefore, excipients play a role in the quality of the final product: • They assure that the blended powder has a constancy of flow needed for proper encapsulation and tableting, and that all the ingredients can be combined with uniformity and consistency in appearance. • They also assure that the tablet or capsule disintegrates properly. • The excipients also have to assure that the tablet does not turn into powder in the bottle and that the coating improves stability and makes it easy to swallow.

15. Excipients, therefore, make up a good part of the product and have very important functions. Because of this, the quality of excipients is crucial. • Synthetic excipients have been shown to irritate the gastrointestinal tract. This might be responsible for some peoples' inability to tolerate supplements.

16. Inert, nontoxic excipients are available, but of course, more expensive. • Reputable manufacturers will use these expensive excipients, but this will be reflected in the cost – the old adage ‘you get what you pay for’ rings true here.

17. Excipients are also responsible for the Disintegration Times (DT) of the final product. This is the time it takes for a tablet or capsule to dissolve in the digestive tract. • DT has a large impact on absorption and consequent bioavailability.

18. Individual variations in digestive function can also complicate the DT. • High quality products are usually manufactured with shorter DTs. • The manufacturer should be willing to give data on DT. If not, check why!

19. A simple test to try on your multi – or any other tablet: • place approximately one cup of white vinegar in a small bowl and warm it to 98 degrees or so by placing it inside a larger bowl of water that you ‘top up’ several times with warm water from the tap. (The goal is to keep the vinegar reasonably close to 98 degrees for half an hour)

20. Drop your multi vitamin (or other pill) into the vinegar, and jostle it every 5 minutes or so by gently shaking or swirling the cup. While you can also stir the mix with a wooden stick or toothpick, make sure not to touch the tablet itself. • The tablet should dissolve within 30 minutes. (This is the USP standard for all pharmaceutical tablets). If it doesn’t dissolve within 45 minutes, you are paying a high price for fillers and is unlikely to be doing any good.

21. fillers • Take up space as the product must be large enough for human fingers to readily handle. In multi vitamin preparations, where oil and water based ingredients don’t mix well, fillers help hold the product together. Some common fillers are: • Lactose (milk sugar) a problem for those who are lactose intolerant

22. Cellulose Starch: A starch made from plant material that is used as filler, binder and disintegrant. Starches processed from corn contain free glutamate (MSG), resulting from processing. MSG is a known neurotoxin. (http://quantumnutritionhome.com/educationals/Excipients.html) • Corn starch typically from cheap GMO corn; can invoke allergic responses. (http://quantumnutritionhome.com/educationals/Excipients.html

23. Dicalcium Phosphate: A mineral complex of calcium and phosphorous that is commonly used as a tableting aid, filler or bulking agent. Phosphates can induce the same symptoms as MSG in those who are extremely sensitive to MSG. (http://quantumnutritionhome.com/educationals/Excipients.html) • Maltodextrin: A refined sugar obtained by the hydrolysis of cornstarch. It is used for flavor, as a texturizer and bulking agent. Maltodextrin may contain free glutamate (MSG), which occurs as a result of processing. MSG is a known neurotoxin. (http://quantumnutritionhome.com/educationals/Excipients.html)

24. Sugars (including sucrose, mannitol, sorbitol, fructose and dextrose) • Whey • Yeast • Rice • Tapioca powder • Some even add salt

25. BINDERS • These do what the term implies, they are sticky or gluey substances that make the components stick together when the ingredients are compressed. They prevent breakage and give cohesive qualities to powdered materials. • Common binders are: • Povidone (see next slide) • Xanthan gum

26. Resin: Resins are used as binders and aid in water resistance. They may be of plant or synthetic origin and are used in lacquers, varnishes, inks, adhesives, synthetic plastics and pharmaceuticals. Synthetic forms include polyvinyl, polystyrene, and polyethylene. Toxicity is dependent on the ingredients used in the manufacture of the resin. (http://quantumnutritionhome.com/educationals/Excipients.html)

27. DISINTEGRANTS • Facilitate the break up of the tablet in the stomach. Some manufacturers have claimed that many brands are so hard that they go through the body undissolved. Some nurses have actually quoted cases of finding vitamin pills in bedpans. • Some of the common disintegrants are:

28. Povidone:(polyvinylpyrrolidone or PVP): PVP is a synthetic polymer used as a dispersing and suspending agent in virtually all encapsulated nutritional supplements; considered to be a potential carcinogen. (http://quantumnutritionhome.com/educationals/Excipients.html) • Croscarmellose sodium • Gellan gum

29. EMULSIFIER • A surface-active agent that promotes the formation and stabilization of an emulsion. Helps to keep raw material in formula in suspension. • Polysorbate 80: A non-ionic surfactant that is a polymer containing oleic acid, palmitic acid, sorbitol, and ethylene oxide and is formed by microbial fermentation. It is used as an emulsifier, dispersant, or stabilizer in foods, cosmetics, supplements and pharmaceuticals. (http://quantumnutritionhome.com/educationals/Excipients.html)

30. Polyethylene Glycol 3350: This excipient is used as an emulsifier, binder, and surfactant. It improves resistance to moisture and oxidation. (http://quantumnutritionhome.com/educationals/Excipients.html)

31. COATINGS •  Help hold the tablet together and prevents it from dissolving too soon and breaking up in your mouth. They also mask unpleasant tastes and smells and often also contains colorants. • A common coating is shellac – the same as that used on wooden floors and boats!!! Otherwise known as Pharmaceutical Glaze: Shellac is insoluble in stomach acid and supplements coated with shellac are difficult for the body to break down and assimilate 

32. LUBRICANTS • These assist in the manufacturing process by helping the tablet to compress more readily without sticking to the wall of the mould. The moulds may also be sprayed with a releasing agent such as polyethylene glycol, which is another form of wax or grease to allow the pill to drop out of the mould. • Other commonly used lubricants include:

33. Magnesium stearate: This commonly used excipient can be made from animal or vegetable sources. It is used as a flowing agent and lubricant. It is insoluble in water and may hinder the absorption of nutrients. Research shows it suppresses the immune system. (http://quantumnutritionhome.com/educationals/Excipients.html) • Silicon Dioxide: Silica is a transparent, tasteless, powder that is practically insoluble in water. It is the main component of beach sand and is used as an absorbent and flow agent in supplements. It may hinder digestion or the uptake of other nutrients and deplete HCL. (http://quantumnutritionhome.com/educationals/Excipients.html)

34. Talcum powder: a suspected carcinogen, is used in many capsules for vitamins and other nutritional supplements today when they are manufactured with a high-speed encapsulator.  It makes the ingredients flow faster and therefore is much cheaper to make vitamins and other nutritional supplements when the talc is included. This is often not listed on the label – check with the manufacturer.

35. Stearic acid • Sodium stearylfumarate • Hydrogenated vegetable oil

36. COLOURANTS AND PIGMENTS • These are used depending on the colour of the tablet and include: • Titanium Dioxide: This is an inorganic, white, opaque pigment made from anatase (metallic mineral) that is often used in supplements as a whitening agent. Titanium dioxide is a pro-oxidant. It is also used in paints and coatings, plastics, paper, inks, fibres, food and cosmetics. (http://quantumnutritionhome.com/educationals/Excipients.html) • Iron oxides (red or yellow)

37. PLASTICISERS • These are used to improve the flexibility of coatings so that they don’t crack or chip. You may have noticed how small amounts of material will rub or chip off uncoated tablets, simply through handling the pill bottle.

38. Be aware that ‘Natural flavours’ is the new term used for MSG, or monosodium-glutamate.

39. VEGETARIANS / VEGANS • Should investigate the excipients in their supplements as they come from a variety of sources: • Gelatine is an animal based products used in the manufacture of capsules • Carbohydrate gum and glycerine are naturally derived products that are used in the manufacture of “vegicaps” • Lactose comes from milk • Cellulose comes from plants • Magnesium stearate may be manufactured from either plant or animal sources • YOU MAY NEED TO RING THE MANUFACTURER IF THE LABEL IS NOT SPECIFIC ENOUGH

40. THE CHALLENGE • With all of this in mind, combined with your understanding of phytoequivalence from your Materia Medica and Herbal Therapeutics studies, discuss: • The challenge that faces consumers of supplements in the market place in the 21st Century; • The challenge that CAM practitioners face in the treatment of their clients; • What can be done from our perspective to ensure that our clients are given the best, most up-to-date treatments available?

41. COMPARISONS • So far, we have studied functional foods and nutraceuticals as well as the use of whole foods and fortified and enriched foods. • Now, draw up the following chart and do a comparison of the 4 approaches to treatment of your clients:

42. Supplements in sport • For your own information and knowledge, read through the article on Supplements in Sport.