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20/01/56
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ผลิตภัณฑเสริมอาหารDietary supplement
ภญ. นิชธิมา แพงนครNichthima Paengnakorn
ยาในชีวิตประจําวัน
Topics
1. What are dietary supplements?
2 Guidance for making informed decisions2. Guidance for making informed decisions about dietary supplement use.
3.Detail of dietary supplements
What are dietary supplements?
Dietary supplements are substances you eat or drink add to the diet and should not be considered a substitute for food.
They can be vitamins, minerals, herbs or other plants, amino acids, substances that come from a natural source
f h bor parts of these substances.
They can be in pill, capsule, tablet, or liquid form.
Recommended Dietary Allowances (RDA)
Dietary Reference Intake (DRI) Refer to the recommended daily levels of nutrients to meet the needs of nearly all healthy individuals in a particular age and gender group.
http://www.hpb.gov.sg/HOPPortal/article?id=2652
Thai Recommended Daily Intakes (Thai RDI)
Thai Recommended Daily Intakes for Thais ages of 6 years and up.
Uses with the consideration for healthy person not patients infants pregnant womenpatients, infants, pregnant women.
Based upon the demand energy of 2,000 kilocalories per day as basic or mean values in calculation for displaying of nutrition labeling only.
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Thai RDI
From : Notification of the Ministry of Public Health(No. 182) B.E. 2541 (1998)
Who can benefit from vitamin and mineral supplements?
Some groups of people, because of distinct nutritional needs, benefit most from taking a vitamin and mineral supplement:
Women of childbearing age (need extra calcium and iron).
Pregnant or lactating women.
hild d i h i l i h bi Children and teenagers with irregular eating habits.
Seniors.
Vegetarians or vegans.
Dieters or people avoiding certain food groups.
People with eating disorders or medical conditions (deficiency diseases, absorption problems, lactose intolerance, etc.)
People who often eat processed and fast food.
Medicine Dietary supplementGuidance for making informed decisions about dietary supplement use.
1. Research
Reliability, Sample size , Comparison of treatment and control groups, Funding may introduce biases.
2. Safety and Toxicity
Acute toxicity, Chronic toxicity, Drugs interaction.
3. Quantity and Dosage form
Different processes which yield different products, Quantity of each dosage form.
4. Price
Reasonable price, Liability.
5. Substitute products
Vitamin & mineral from food.
Types of dietary supplements
There are several methods of classifying such as by Pharmacological Action, By dosage forms ..etc.
By raw materials used to produce.
1. Vitamins and minerals
2. Oils
3. Plants and plant extracts
4. Animals and animal extracts
5. Other
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Vitamins and minerals
Micronutrients. The body needs only a small amount per day.
Used as an aid in the reaction within the cell.
Vitamins deficiency can cause symptoms or body's organs malfunction.
There are 14 kinds of Vitamins. A ,B(1,2,3,5,6,9,12),C,D,E,K,Choline and biotin
Vitamin A
Produces the pigments in the retina of the eye, helps form and maintain healthy skin, teeth, skeletal.
Thai RDA = 800 g RE* (2,664 IU) Source : Animal liver, Whole milk, and Cod liver oil.
Carotenoids, beta‐carotene…, are dark‐colored dyes , , y(pigments) found in plant foods that can turn into a form of vitamin A.
* RE = Retinol equivalent; 1 RE = 1 g retinol
Toxicity
Acute: more than 25,000 IU/kg a day dizziness, nausea, headaches, skin irritation, pain in joints and bones.
Chronic : 4,000 IU/kg of body weight daily for 6–15 months
pain in joints and bones, osteoporosis, hair loss, liver damage, coma, and even death.and even death.
Deficiency
night blindness, increases the severity and mortality risk of infections .
Vitamin B1 (Thiamine)
Thai RDI = 1.5 mg
a coenzyme in the catabolism of sugars and amino acids.Required by our bodies to properly use carbohydrates.
Source : yeast, cereal grains, beans, nuts, and meats.
Deficiency : beriberi, inflammation of the nerves, poor appetite.
Vitamin B2 (Riboflavin)
Thai RDI = 1.7 mg.
Metabolism of fats, carbohydrates, and proteins.
Source : Animal liver and kidney, leafy green vegetables, eggs, meat, milk, and cheese.
Deficiency : Anemia, mouth or lip sores (angular cheilitis), y , p ( g ),skin disorders.
Vitamin B3 (Niacin)
US RDA adult = 14‐16 mg
Important for converting food to energy, helps the digestive system, skin, and nerves to function.
Treatment option for low HDL cholesterol and high LDL cholesterol and triglyceride levels.
Source : Dairy products ,eggs, fish, Lean meats, Nuts.
Deficiency : PELLAGRA (Digestive problems, Inflamed skin,Mental impairment)
Toxicity: Large doses (> 2000 mg ) lead to side effects ; skin
flushing and itching, dry skin, peptic ulcers,nausea, increased blood sugar level , liver damage.
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Vitamin B5 (Pantothenic acid)
Thai RDI : 6 mg
Frequently used in combination with other B vitamins.
Pantothenic acid is used in the synthesis of coenzyme A, important in energy metabolism.
Source : Meat, vegetables, cereal grains, eggs, royal jelly , g , g , gg , y j yand milk.
Deficiency : fatigue, muscle cramps , hair loss.
Vitamin B6 (Pyridoxine)
Thai RDI : 2 mg
Important for converting food to energy and proper functioning of nerves.
Source: whole‐grain cereals fish vegetables beans Source: whole‐grain cereals, fish, vegetables, beans, and liver and other organ meat.
Deficiency : blood, skin, and nerve disorder, nervousness.
Toxicity: Large doses (>200mg/day) damage sensory nerves.
Vitamin B12 (Cyanocobalamine)
Thai RDI : 2 µg. Essential to the production of red blood cells.
Source : Animal products; eggs, milk, cheese.
Deficiency : anemia.
Vitamin C (Ascobic acid)
Thai RDI : 60 mg
Adults should not take more than 2000 mg vitamin C /day.
Preventing and treating the common cold, Anti‐ aging ,Improve wrinkles.
Source : citrus fruits, vegetable, tomatoes.
Deficiency : scurvy.
Toxicity: (Large doses) diarrhea, increase the risk of kidney stone.
Vitamin D (Cholecalciferol)
Thai Rdi : 5 g (200 IU) Used to treat and prevent bone disorders (such as rickets, osteomalacia).
Source : Vitamin D is made by the body when skin is exposed to sunlight, egg yolk, milk cod liver oil and fish.
Deficiency : bone pain and muscle weakness.
Toxicity: taking 1250 μg (50,000 IU)/day for several months : impaired kidney function.
Vitamin E (Tocopherol)
Thai RDI : 10mg ‐TE* (15 IU)
Act as antioxidant that protects body tissue from damage caused by substances called free radicals.
Source vegetable oils nuts Source: vegetable oils , nuts.
Deficiency : fragility of red blood cells and degeneration of neurons.
Toxicity : high doses ( > 1000 mg/day) might increase the risk for bleeding and serious bleeding in the brain.
* ‐TE = ‐Tocopherol equivalent , 1 ‐TE= 1 mg D‐ ‐Tocopherol
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Vitamin H (Biotin)
Thai RDI : 150 g Coenzyme of fat and carbohydrate metabolism.
Source : brewer's yeast, cooked eggs(especially egg yolk), mushrooms and nuts.
Deficiency : rarely (Intestinal bacteria produces biotin) It is also used orally for hair loss and brittle nails.
Vitamin K (Phytonadione)
Thai RDI : 80 g Produced by the intestinal flora.
Helping blood clot and important role in bone health.
Source : Green leafy vegetables, fish, liver,meat and eggs.
Deficiency : bruising and bleeding. Deficiency : bruising and bleeding.
Vitamin M (Folic acid/Folate)
Vitamin B9
Thai RDI : 200 g , pregnant women 400 g
The human body needs folate to synthesize and repair DNA.
Source: leafy vegetables, bananas, legumes, y g , , g ,yeast, mushrooms, and meat.
Deficiency : diarrhea, macrocytic anemia, depression.
Use in women of childbearing age in order to prevent neural tube defects.
Mineral
Macromineral. RDA more than 100 mg/day or body contains more than 5 g.
Ca ,P ,Mg
Micromineral or trace mineral. Micromineral or trace mineral. Less than 100 mg/day.
Fe, Zn, Se, Cr
Calcium
Calcium is required for development and maintenance of strong bones and teeth, vascular contraction and vasodilation, muscle function and nerve transmission.
Helping prevent osteoporosis.
source : Milk, yogurt, and cheese and sesame seeds.
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Recommended Dietary Allowances (RDAs) for Calcium
Age Male Female Pregnant Lactating
0–6 months* 200 mg 200 mg
7–12 months* 260 mg 260 mg
1–3 years 700 mg 700 mg
4–8 years 1,000 mg 1,000 mg 4 8 years 1,000 mg 1,000 mg
9–13 years 1,300 mg 1,300 mg
14–18 years 1,300 mg 1,300 mg 1,300 mg 1,300 mg
19–50 years 1,000 mg 1,000 mg 1,000 mg 1,000 mg
51–70 years 1,000 mg 1,200 mg
71+ years 1,200 mg 1,200 mg
Oil supplements
Extraction from Plants or Animals.
Usually filled in to soft gelatin capsule.
Frequently contained lipid ; including cholesterol, phospholipid and triglyceride.
Lecithin
Lecithin contains Phospholipid and choline ( 10‐20%).
Source : soy beans, eggs, milk, rapeseed, cottonseed and sunflower.
Choline improves transfer of nerve impulses to the brain and circulatory system.
Essential for normal liver function, lower cholesterol level.
Conjugated linoleic acid (CLA)
Essential fatty acids ; omega‐6 fatty acids.
Source : sunflower oil , Safflower seed.
Used for cancer, atherosclerosis, obesity, weight loss caused by chronic disease, bodybuilding, and limiting food allergy reactions .
Inhibits lipoprotein lipase .
Evening primrose oil
The oil from seeds contains around 7–10% gamma‐linolenic acid (GLA) , omega‐6 fatty acid.
Linolenic acid has anti‐inflammatory properties.
Use for eczema, rheumatoid arthritis and and premenstrual syndrome (PMS)such as breast pain.premenstrual syndrome (PMS)such as breast pain.
Fish oil
Fish oil is oil derived from the tissues of oily fish...
Fish oils contain the omega‐3 fatty acids.
eicosapentaenoic acid (EPA)
docosahexaenoic acid (DHA)
Treating hypertriglyceridemia, and possibly beneficial in preventing heart diseases , depression,attention deficit‐hyperactivity disorder (ADHD), Alzheimer’s disease, and other thinking disorders.
Caution : increase the risk of bleeding especially patients with bleeding disorders such as hemophilia.
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Plants and Plant extracts
Size reduction such as cutting or grinding.
Extraction by using solvent extraction.
Fiber
The parts of plant that do not break down in our stomachs, and instead pass through digestive system undigested.
Soluble fiber : delays the emptying of your stomach and makes you feelof your stomach and makes you feel full, which helps control weight.
Insoluble fiber : tend to accelerate the movement of food through the system, helping prevent constipation.
Garcinia Cambogia extract สมแขก Small fruit that resembles a miniature pumpkin. It is indigenous to India and parts of Asia.
The extract is hydroxycitric acid (HCA), claimed to suppress appetite and enhance fat‐burning. HCA inhibits an enzyme called citrate lyase that helps turns excess
b h d t i t f tcarbohydrates into fat.
Side effect : stomach ache, diarrhea
Green tea
From a tea plant, Camellia sinensis, native to Asia.
The difference is in how the teas are processed.
Green tea ‐ leaves are picked and then immediately fired and steamed or heated
Black tea ‐ Teas that have been rolled or broken to induce oxidation and then dried.
Green tea contains powerful antioxidants called polyphenols ; Catechins.
There are six types of catechins: EGCG, EGC, ECG, EC, GC and C. (EGCG and ECG are the most potent.)
The health benefits The health benefits
Prevent cancer.
Lowering cholesterol and triglyceride levels.
Lowering blood sugar lavel.
Boost metabolism and help burn fat.
Side effect : constipation, insomnia and heart palpitations
Grape Seed Extract, Pine bark Extract
The active ingredients are family of chemicals known Oligomeric proanthocyanidins complexs (OPCs). OPCs are strong antioxidants.
Treating chronic venous insufficiency by protect and strengthen collagen and elastin, hemorrhoids, and g g , ,melasma.
http://www.med.nyu.edu/content?ChunkIID=21765
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Ginkgo Biloba extract แปะกวย Chinese herbal medicine has used both the ginkgo leaf and seed for thousands of years
• Ginkgo leaves contain two types of chemicals flavonoids and terpenoids.
• Ginkgo has been used in traditional medicine to treat blood disorders and enhance memory. It also shows promise for enhancing memory in older adults.
• Laboratory studies have shown that ginkgo improves blood circulation by dilating blood vessels and reducing the stickiness of blood platelets.
• Caution : increase the risk of bleeding, it should be used cautiously in patients on anticoagulant therapy and those with known blood clotting disorders.
ANIMALS AND ANIMAL EXTRACTS
Chitosan
Chitosan is a sugar that is obtained from the hard outer skeleton of shellfish, including crab, lobster, and shrimp
Chitosan is used to treat obesity, high cholesterol, and Crohn’s disease
It is a fibrous substance that might block absorption of dietary fat and cholesterol.
Caution: people with allergies to shellfish might also be allergic to chitosan. Chitosan can prevent absorption of fat‐soluble vitamins.
Collagen
Collagen, the most abundant protein in mammals, is connective tissue, skin, bone, teeth, tendons, cartilage, and organs .
Used to reduce the symptoms of arthritis and bone pain, to promote healing, or to improve thepain, to promote healing, or to improve the appearance of the skin.
Low oral bioavailability.
Other dietary supplements
Brewer’s yeast
Brewer's yeast is made from a one‐celled fungus called Saccharomyces cerevisiaeand is used to make beer.
Source of minerals ‐‐ particularly chromium, selenium; protein, B‐complex i i d B lvitamins and Beta glucan.
Supporting the nervous system, help maintain the muscles used for digestion, and keep skin, hair, eyes, mouth, and liver healthy.
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Co‐enzyme Q‐10
Coenzyme Q10 is a substance that' s found naturally in the body and helps convert food into energy. It is a powerful antioxidant.
Helping with heart‐related conditions, because it can improve energy production in cells, prevent blood clot f i d i idformation, and act as an antioxidant.
Source : oily fish , liver, and whole grains.
Glutathione
Glutathione is a tripeptide consist of Cysteine, Glycineand Glutamic acid. It is an antioxidant. It can be
synthesized in the body from the amino acids.
Source : fresh fruits and vegetables and meats.
Reducing side effects of chemotherapy treatments for cancer, when given by injection into the veins.
Thai FDA allows food supplement to contain glutathione not more than 250 mg/tab.
Low oral bioavailability.
แหลงที่มาของขอมูล ประกาศกระทรวงสาธารณะสุข ฉบับที่ 182 พ.ศ. 2541 แนบทาย เร่ือง
สารอาหารที่แนะนําใหบริโภคประจําวันสําหรับคนไทยอายุต้ังแต 6 ปขึ้นไป (THAI RECOMMENDED DAILY INTAKES‐THAI RDI)
National Library of Medicine USA
http://www.nlm.nih.gov/medlineplusp g p Institute of Medicine of the National Academies
http://www.iom.edu
Office of Dietary Supplements. National Institutes of Health USA
http://ods.od.nih.gov
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