Dietary Supplements: Safe, Effective or Neither?

Transcription

1 Dietary Supplements: Safe, Effective or Neither? KEEP YOUR EDGE Hockey Sports Medicine 2015 August 28, 2015 Dr. Ashley James, B.A., N.D. Naturopathic Doctor

2 Disclosure I have no relevant non-financial relationships to disclose. I am neither employed by nor affiliated with any supplement companies. I carry a dispensary in my practice in which I resell professional products.

3 Objectives What is a Naturopathic Doctor Mass market vs Professional supplements Safety and Efficacy 2 dietary supplement examples

4 What is Naturopathic Medicine?

5 Naturopathic Medicine a distinct primary health care system that blends scientific knowledge with traditional and natural forms of medicine after a pre-med undergraduate degree Naturopathic Doctors (N.D. s) complete a 4 year full time Doctor of Naturopathic Medicine program and 2 sets of licensing exams patients undergo a full history and physical exam in addition to standard medical diagnostic investigations

6 Naturopathic Medicine individualized treatments draw from one or all of the following disciplines: clinical nutrition and supplementation botanical medicine acupuncture and Traditional Chinese Medicine lifestyle counselling most N.D. s work in multi-disciplinary practices with health professionals from other regulated professions N.D. s are regulated by the RHPA in Canada

7 Dietary Supplements

8 Professional vs. Health Food Store/ Mass Market Supplements

9 Consumer Grade Supplements found in drug stores and health food stores made from cheapest components to maximize profit made to maximize shelf life laundry list of artificial colours, flavours, fillers, excipients, binders, preservatives include minimum amount of active ingredient for label use

10 Professional Supplements full label disclosure, including nonmedicinals standardizations of herbal extracts to indicate primary active marker compounds therapeutic doses

11 Professional Supplements 3rd party testing for quality, stability, potency and purity at 3 stages: raw ingredients during manufacturing finished product

12 Dietary Supplements Safety and Regulation

13 Natural Health Product Labelling Laws in the USA and Canada

14 DNA Barcoding detects contamination and substitution in North American herbal products. BMC Med Newmaster SG et al. 1

15 Misleading Consumers 44 products tested from 12 companies 59% of the products contained plants not listed on the label 48% contained contaminants or fillers not listed on the label 32% of the samples contained product substitutions only 2/12 companies had products without substitutions, contamination or fillers

16 Urinary nandrolone metabolite detection after ingestion of nandrolone precursor. Med Sci Sports Exerc Watson P, et al. 2

17 Watson P, et al. unlisted anabolic and androgenic steroids found in dietary supplements adding just 2.5 mcg of 19- norandrostenedione to a creatine supplement ( % contamination) resulted in a doping violation in some individuals

18 NSF Certified for Sport

19 NSF Certified for Sport NHL league wide mandate helps take care of contamination issues in the locker room Players are still going to buy their own supplements! Educate, educate, educate BUT...does it ensure efficacy?

20 Supplements Efficacy and examples

21 Vitamin D

22 Vitamin D steroid hormone by some estimates one billion people worldwide have vitamin D deficiency or insufficiency geographic location, sun exposure, skin colour, intestinal absorption issues and kidney disease affect vitamin D status serum concentration of 25(OH)D best indicator of vitamin D status

23 Vitamin D emerging evidence to support a direct impact on athletic performance via enhancement of skeletal muscle function 3,4 good evidence to support that vitamin D deficiency indirectly affects athletic performance via immunity 5 : higher number of athletes presenting with URTI in deficient group increased number of URTI symptoms and severity of symptoms in deficient group

24 Vitamin D profile in National Football League players. Maroon JC et al. Am J Sports Med players who were released during the preseason because of either injury or poor performance had significantly lower vitamin D levels

25 Labs test serum concentration of 25(OH)D (not covered by OHIP in Ontario) severe deficiency < 12.5 nmol/l deficiency < 30 nmol/l inadequate nmol/l adequate > 50 nmol/l

26 Optimal dose to increase serum 25 (OH)D levels Controversial! Close GL (2013) showed 8 weeks of 5000 IU vitamin D3 daily raised serum levels from baseline 29 nmol/l to 103 nmol/l 4 Assess for intestinal absorption issues and test and retest

27 Probiotics What are they? Live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. (FAO/WHO 2001)

28 Probiotics Why? the human intestinal microbiota is a complex ecosystem contributes to maturation of the immune system provides a direct barrier against pathogen colonization digestion of essential nutrients potential cognitive and mood enhancing benefits 7

29 Probiotics Human or Cow? Human strains high survival rates through various stomach ph maximal intestinal tract exposure Cow strains weak adherence to epithelial cells

30 Probiotics Human or Cow? yogurt with lactobacillus cultures is just great marketing patients may be able to maintain a healthy microbiome with fermented foods and yogurt cultures once replaced with human strains

31 Probiotic Dosing research appropriate strain(s) for individual situation probiotic activity must be guaranteed throughout production process, storage period and shelf life best refrigerated

32 The Cambridge Probiotic/ Antibiotic Trial significant reductions of potentially harmful bacteria (coliforms, enterocci and S. aureus) minimized loss of lactobacilli bacteria significant reduction in antibiotic resistance 21 days of 100 billion CFU per dose

33 Conclusion It takes a village...

34 References 1. Newmaster SG et al. DNA Barcoding detects contamination and substitution in North American herbal products. BMC Med 2013 Oct 11: Watson P et al. Urinary nandrolone metabolite detection after ingestion of nandrolone precursor. Med Sci Sports Exerc 2009 Apr; 41(4): Todd JJ et al. Vitamin D: recent advances and implications for athletes. Sports Med 2015 Feb; 45(2): Close GL et al. Assessment of vitamin D concentration in non-supplemented professional athletes and healthy adults during the winter months in the UK: implications for skeletal muscle function. J Sports Sci 2013; 31(4): He CS et al. Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of winter training in endurance sport athletes. Exerc Immunol Rev 2013;19: Maroon JC et al. Vitamin D profile in National Football League players. Am J Sports Med 2015 May;43(5):

35 References 7. Owen L el al. A double blind, placebo controlled, randomized pilot trial examining the effects of probiotic administration on mood and cognitive function. Proceedings of the Nutrition Society 2014, 73 (OCE1), E29 8. Plummer NT et al. Effect of probiotics on preventing disruption of the intestinal microflora following antibiotic therapy: A double-blind, placebocontrolled pilot study. International Immunopharmacology : Shuler FD et al. Sports health benefits of vitamin D. Sports Health 2012 Nov; 4(6): Ogan D et al. Vitamin D and the athlete: risks, recommendations and benefits. Nutrients 2013 Jun 5(6): Tsiaras WG et al. Factors influencing vitamin D status. Acta Derm Venereol 2011 Mar;91(2): Close GL et al. The effects of vitamin D(3) supplementation on serum total 25(OH) D concentration and physical performance: a randomized dose response study. Br J Sports Med 2013 Jul; 47(11):692-6.

36 References 13. Pyne DB et al. Probiotics supplementation for athletes - clinical and physiological effects. Eur J Sports Sci 2015; 15(1): Haywood BA et al. Probiotic supplementation reduces the duration and incidence of infection but not severity in elite rugby union players. J Sci Med Sport 2014 Jul; 17(4): Hao Q et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev 2015 Feb 3;2.

37 Thank you!