Non Herbal Supplements – Feb 13, 2013 – Mod 2

Integrating Herbs with Vitamins and Minerals

Most are completely compatible with herbs.  There are very few, if any, negative interactions.

Magnesium – avg. middle aged woman gets slightly more than 2/3 of recommended 320 milligrams.  Second most common deficiency.

Fiber – Most Americans get half of ideal daily 25-30 grams.  In primitive societies, they consume 10-15x of what average American does.

Vitamin D – 85% of Americans are deficient.  Number one deficiency in US.

Calcium – Avg American diet supplies 500 mg daily.  Half of what most adults need.  Only 1/3 of what experts recommend for post-menopausal women. 

Folic Acid – more than 1/4 of population consumes less than 75% RDA folate.  Two main groups are important:  women of child bearing years, and elderly.  Women need it to prevent birth defects like autism.

Vitamin C – Megadose vitamin C not for scurvy.  (Can treat scurvy, a bioflavanoid deficiency, with minute doses of vitamin C).  RDA is approx. 100 mg/day.

B Complex – B100 stress tabs not for Beriberi or Pellegra (deficiencies of thiamin and niacin).  It is to optimize health, not treat disease.

Vitamin A – psoriasis & warts – superdoses to treat.

summing – Vitamin B complex – almost everything can be helped by it, but can’t target most things with it.  Vitamin C – detox, immune, and asthma.  Vitamin E – burns, injuries, scars.  Treat these in high doses.  Lysine – to treat herpes virus.  When given in high doses, herpes virus can’t reproduce. . .  We can tell when we need a vitamin b/c reproducable set of symptoms that can be tied to a vitamin deficiency.

Tryptophan – amino acid for sleep.

Tyrosine – for fatigue

Quercetin – flavanoid.  It’s the most abundant flavanoid in plants.  For inflammation.  Mainly extracted from Eucalyptus and Onions.

Vitamin D – levels declining in Americans. – Michael Murray ND – wrote Textbook of Natural Medicine.  Advocate of extracts, mainstream guy trained at Bastyr.  Has a Vitamin D Council Website.  Vitamin D is a pro-hormone that we make out of cholesterol in our skin.

Herb Therapy – different than supplements.  Herbs are not isolated substances.  Largely non-toxic pharmacology.  We’re not consuming herbs for their nutritive bldg blocks.

Nutrient Pharmacology – Vitamins are building blocks.  They are essential.  But we can target something and use them like drugs.

Vitamins – organic compounds.  They come from life, from plants and animal flesh.  They are the group of essential organic compounds.  Needed in minute quantities for normal tissue activity.

Advantage of modern day food – we get large sampling of food from all over the place.  Broad spectrum ensures better access to the vitamins we need.  Today, most people get adequate supplies of food.

14 to 20 vitamins have been identified.  (debatable).  Definition of “vitamin” is outdated.

Vitamins activate highly specific metabolic functions.  Many act as co-factors, co-enzymes, enzymes.  Most derived from diet.  No calories are derived from vitamins.  They usually don’t become part of the product they create.  (like skin, mucous membranes, etc.)

Definition is very antiquated & fuzzy.  Many more essential nutrients.  Not all vitamins have proven defiency.  Example – Scurvy is a defiency of bioflavanoids, not vitamin C.  Many categories of phytochemicals appear to be needed.

Vitamin – vita – “substance needed for life.”  First one discovered was thiamin (B1).  Thiamin happened to be an “amin” – nitrogen containing compound.  However, not all vitamins are amins.

Vitamins are micronutrients as opposed to macronutrients (proteins,carbs & fat . . . water).

Structure – individual units.  They are NOT building blocks like glucose, fatty acids & amino acids.

Function – do not yield energy when broken down.  Assist enzymes, assist other biological factors that release energy from carbohydrates, proteins, fats = coenzymes.  (Example – all B vitamins assist body in releasing energy).

Amounts needed: measured in micrograms or milligrams.  Tiny amounts per day.  (Vitamins can usually be stored.)

Fat soluble – stored in liver and adipose. (fat tissue).  Body has no way of removing them until used.

Water soluble – not stored in tissues.  Excess voided in urine.  (Even though they’re not stored formally, there is a vitamin pool in the fluid).  Vitamin Pool – B12 and Folic Acid – stored for months at a time in body fluid.

Vitamin Comparisons:

                               Water Soluble (B &C)                          Fat Soluble (A,D,E,K)

Absorption                   Directly into blood                                   Lymph, then blood/protein carrier

Storage                         Short term                                                 Long term

Excretion                      Kidneys detect & remove in Urine          Less readily excreted. Remain in

fat storage sites.

Toxicity                         Possible                                                      Likely, but we’re too worried

Requirements              Daily intake                                                Regular intake

 

Multiple Vitamin/Mineral:

KP supportive of multiple vitamins.  Great for maintenance.  Science on it is equivocal.  They do take up space in pill swallowing capacity & in wallet.  It gives a wide spread general nutritional assurance.  They are not targeted.

Typical Formula:

Vitamin A                                                                   25,000 IU

B Complex                                                                 100 mg each major B

Vitamin C                                                                    1,000 mg

Vitamin D3                                                                  2,000 IU

Vitamin E                                                                     400 IU

Calcium (elemental)                                                   1,000 mg

Magnesium                                                                 1,000 mg

Zinc                                                                               15 mg

Trace minerals                                                              assorted

 

Calcium takes up huge space proportionally compared to others.  Commercial brands skimp on calcium b/c the calcium requirement is so high.  Takes many capsules to fit it in.

Many brands market to “special” populations like seniors or men.  Usually just marketing.  Rainbow Light is a Rolls Royce company – very expensive, but quality is very good.

Vitamin Forms:  Liquid – most absorbable, but packaging is an issue – shipping water is very expensive, and quantities have to be high.

Tablets – may not digest/disintegrate properly.

Capsules – dissolve quickly in tummy.  Way to go., but cost is 10x per unit to produce.

Powder – is also suitable.  Look to PureBulk.com for good deals.

Water Soluble Vitamins:

Vitamin C (for skin, bones, infections)

B Vitamins: Thiamin (B1), Riboflavin (B2), Niacin (B3),  Vitamin B6, Folic Acid, Vitamin B12, Pantothenic Acid, Biotin.  — All of these release energy from macronutrients.

Some vitamins fell out of nomenclature: Vitamin P – Permeability – now called flavonoids.  Also Vitamin F – essential fatty acids.  Stearic Acid – saturated fat.

These B vitamins are used in the whole body.  Act as co-enzymes to convert energy from carbohydrates.  Required for metabolism.  Nutrient pathways for whole body – they are indispensable for metabolism.

Vitamin B Complex (actually a group of 8):

Thiamin (B1), Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5), Pyridoxine (B6), Folic Acid (B9), Cyanocobalamin (B12), Biotin.

B vitamins come in and out of group.  Disagreements about it.  B17 for laitril – cyanide based substance to treat cancer.  Fell out of group.

Vitamin B Complex is essential for breakdown of carbohydrates into glucose (energy for body), breakdown of fats and proteins (aids normal functioning of nervous system), and muscle tone for stomach and intestinal tract (skin, hair, eyes, mouth, and liver).

General anti-stress effect – up to 300 mg each of major B qd as complex (3-B100).

Daily % Value (not distributed equally)                                 Amt per serving       % of Daily Value

Vit B1 (as thiamin HCl, USP)                                                        100mg                  6,667%

Vit B2 (as riboflavin, USP)                                                             100mg                 5,882%

Niacin (as niacinamide, USP)                                                        100mg                   500%

Vit B6 (as pyridoxine HCl, USP)                                                    100mg                 5,000%

Folic Acid (USP)                                                                              400mcg                   100%

Vit B12 (as methylcobalamin, USP)                                             100mcg                 1,667%

Biotin (USP)                                                                                     100mcg                     33%

Pantothenic Acid (as D-calcium pantothenate, USP)                  100mg                   1,000%

Choline Bitartrate, USP                                                                  100mg                        *

Inositol (FCC)                                                                                                                       *

PABA (para aminobenzoic acid, USP)                                                                              *

Distributions don’t have to be in equal amounts.  Choline, Inositol, and PABA are no longer established as B vitamins.  **Don’t have to take B vitamins together.  This is an urban myth.

For B-Complex, take B-100 – good option across the board.  B-50 is also good.

Pyridoxine (Vitamin B6) – underused vitamin therapeutically.  Functions:  Protein & Fatty Acid metabolism, amino acid metabolism.  Need it to make seratonin from tryptophan – need B6 to digest food with tryptophan.

-function of more than 100 enzymes, metabolism, immune system function, hormone function, iron biosynthesis, making of neurotransmitters.

-good for colorectal health, morning sickness, heart health, mental health, brain health, movement health.

-recommended intake: 1.3 mg/day.  UL: 100mg/day (upper limit by govt.)

B6 Food sources (It is destroyed by heat): meat, fish, poultry, legumes, seeds & nuts, liver, non-citrus fruits

B6 controls inflammation.  Study – 1205 Mass. residents, age 45-75 found association of vitamin B6 with inflammation, oxidative stress & chronic inflammatory conditions: The Boston Puerto-Rican Health Study.  Highest 25% of vitamin B6 had lower cardio vascular inflammation, better homocysteine levels, insulin levels, blood sugar levels.

B6 dosage 1-2 grams/day.  Heals inflammation, allergy (especially with combination of vitamin C and magnesium).

With 2 grams/day, one may experience peripheral neuropathy (finger tingling).  This is rare, and it’s reversible.  Only occurs in a small percentage of people.  Never studied.

Vitamin C – cheap, well tolerated, people know it & like it.

ascorbic acid – means “against scurvy”

ascorbates (calcium, magnesium, sodium).  Ester C,ascorbyl palmitate.  Best sources:  fresh fruits, citrus fruit, strawberries, cantaloupe, currants, fresh veggies (brussel sprouts, collards greens, lettuce, cabbage, peas, asparagus.)

Clinical application:  antioxidant, atherosclerosis, hypercholesterolemia, viral infection, detoxification, allergy (inhibits histamine), connective tissue (collagen production), cataracts, and asthma.

Bowel tolerance doses 10,000 mg/day for most (may increase during an infection.  People with HIV can tolerate up to 30 grams/day).

Administer large doses for the nutrient pharmacology effect.

Fat Soluble Vitamins

Vitamin A – available in two forms:

1. Preformed Vitamin A – we have in our bodies.  In animal flesh, they ate grass & their body converted it to A.  Accumulated in tissues.  So when you eat the meat, your body absorbs the A directly.

2. Provitamin A – (Carotenes) – precursor to vitamin A.  Liver makes the conversion to vitamin A.  It’s in carrots.  Not everyone can make the conversion properly.

Vitamin A – Retinol or Retinal – True Vitamin A.  Carotene (provitamin A) – can be converted to retinol in the body.  Vitamin A and carotenes are fat soluble.  Must be broken down by pancreatic digestive enzymes in intestine to be absorbed.  Breaks down to micelle size (microscopic sized droplet of fat).  Dispersed in aqueous environment of small intestine.  After being micellized, A + carotenes diffuse passively into intestinal mucosal epithelial cells.

Vitamin A – good food sources: (from all animals) liver, kidney, butter, egg yolk, whole milk, cream, cod liver oil.  Food sources of beta carotene (pro-vitamin A) – yellow & dark leafy green vegetables, carrots, collards, spinach, sweet potatoes, squash.  Yellow fruit – apricots, peaches, cantaloupe.

Vitamin A is necessary for human nutrition.  Versatile functions.

vision – retinal pigment – without it – night blindness.  Healthy skin, mucous & connective tissues, reproduction & development, immunity, growth & growth regulation.

Clinical Applications – Nutrient Pharmacology Doses: 100,000 IU and as appropriate.  Less toxic than we think and our need for it is higher than we think.  People don’t eat polar bear liver today and drop dead.  Over dose symptoms – characteristic temple chronic head-ache, flaky skin around the eyebrows.

Osteoarthritis, Skin & Epithelial Tissue (acne), Liver, Eye and Vision, Growth & Bone Development, Immune Function, Cervical Dysplasia, Cancer.

Diseases of Vitamin A deficiency: night blindness & xerophthalmia (dry eye), skin disorders, lack of growth, immune weakness.

Hypervitaminosis – serious potential problem.  (CNS disorders, birth defects) – don’t give a pregnant woman vitamin A.

Vitamin A deficiency is a serious worldwide problem leading to blindness.  That kind of problem in Africa, India.  Masses of poor people-nothing but white rice with no vitamin A.  1 capsule of 25,000IU – enough to carry them through for a lifetime – prevents a lifetime of blindness. .10 cents per capsule.

Vitamin A toxicity – Highly toxic in large amounts.  Acutely or chronically.  May occur with 666,000 IU in adults. (half that in children).  Headache, nausea, vomiting, blurred vision.

Natural healing – 100,000 IU or more is common.  Warts respond to doses of 500,000 IU.

Vitamin D – health breakthrough of the century.  Most common nutrient deficiency.  Extremely low toxicity.  The sunshine vitamin.

Humans move out of Africa.  Over 40,000 years, lightening of the skin occurs.  thought to be one of the most rapid evolutionary changes of all of humanity.

Low Vitamin D leads to: cancer, fibromyalgia, SAD, Diabetes, Heart Disease, Cold & Flu.  Sunshine recommended: right up to point of getting color.  Portland is above the 45th parallel – from fall to spring – we can not produce vitamin D from the sun.

Epidemic of Vitamin D deficiency causes the following Immune disorders: Flu, cancer, arthritis, allergy.  Pain Disorders: Fibromyalgia, MS, colitis, migraine, PMS.

Two types of vitamin D: D2 (ergocalciferol) and D3 (cholecalciferol).  D3 is the type we have in our bodies.  D2 comes from plant resources.  D2 is converted in the body to D3.  Clinical applications: pain, neuromuscular disorders, bones, sensory functions (smell, hearing) and scleroderma.

75 mg/ml – optimal level in blood.  Can test it at home with kit called hydroxy Vitamin D.  Very accurate test.  In NW, 95% have vitamin D deficiency.  Most people need 5,000 to 7,000 units/day to maintain good D levels.  It’s stored in fat tissues.  A saturation dose which is often rejuvenating is 30,000 to 50,000 units/day for a month, then down to maintenance levels.  Take 3 tests at 6 month intervals.

Body requires magnesium to sustain Vitamin D levels.  Vitamin D is made from cholesterol.  Get it from the sun.  Sunshine – 20 minutes/day 3x per week with head and shoulders & arms uncovered.  They’ve found that it’s preventative of skin cancer.

Brand new type of vitamin D made from marine algae.

Vitamin E    (in almonds)

a vitamin in search of a disease.  Fat soluble.  Profoundly anti-oxidant.  Deficiency – rare.  Pre-mature infants & those who can’t absorb fats.  Toxicity – rare.  With huge amounts, blood has difficulty clotting.

Vitamin E helps: (spectacular healer at very high doses):

Burns, scars, neuromuscular disorders (like MS), leg cramps (intermittant claudication – clotting disorder that interrupts flow to tissues, usually legs), fibrocystic breast disease (lumpy breasts).

Therapeutic use – up to 4,000IU/day.  E-Complex.  Mixed natural proportions of tocopherols and tocotrienols.

Vitamin E family:

4 natural tocopherols and 4 natural tocotrienols.  (alpha-tocopherol is most potent isomer).

Alpha, Beta, Gamma, and Delta forms (of tocopherols and tocotrienols)

Synthetic Vitamin E – d,1-alpha-tocopherol.  The natural stereoisomer of vitamin E – d-alpha-tocopherol.  Natural Vitamin E is substantially more bioavailable than the synthetic Vitamin E.  Consensus – use natural form.

Tocopherol – a molecule in Vitamin E.  Vitamin E – family of molecules that occur together.

Clinical applications: MS, Antioxidant, connective tissue healing (internal – burns, scars, eczema, etc), immune enhancement, atherosclerosis (E retards LDL oxidation, inhibits proliferation of smooth muscle cells, decreases damage to vascular endothelial cells), cataracts.

Dosage of Vitamin E – 400-1200 IU qd (typical).  1 IU of vitamin E is defined as biological equivalent to .667 mg d-alpha-tocopherol or 1 mg dl-alpha-tocopherol acetate.

KP gives  1,000-3,000IU/day.  (Caution – headache with rapid dose increase.)  No known toxicities associated with vitamin E.  60-70% daily dose excreted in feces.  Most individuals studied taking large doses of vitamin E have not shown toxic effects.

However, a recent meta-analysis found that large doses of vitamin e was associated with an increase of over all mortality.  The dosage associated was greater than 400 IU daily.

Gamma-tocopherol, not alpha tocopherol, is the effective form to fight nitrogen free radicals.  These radicals are major culprits in arthritis, ms, brain disease (Alzheimer’s).  Metabolic product of gamma-tocopherol regulates amount of fluid & electrolytes that pass thru kidney to urine.

Could play major role in fine blood pressure control, congestive heart failure, cirrhosis.  Corresponding matabolite alpha -tocopherol not active in this regard.

Tocotrienols – occur with tocopherol.  Anti-cancer, decreases cholesterol.  Clinical study – mixture of tocopherols and tocotrienols decrease rate of narrowing  carotid arteries.  40% of patients actually appeared to reverse condition.

-Slow down growth: of breast, colon, leukemia cancer cells.

– Helps liver clear more bad cholesterol, LDL

Minerals for Health

Calcium – 2,000 mg/day.  Top choice: calcium citrate malate – new form.  Concocted in a lab.  Absorption better than anything else.  KP uses it.

2nd choice: Calcium hydroxyapatite – was number 1 for years.  Hard to find & expensive.

Calcium is metabolized and used in body slowly.

New bone density tests – show smaller changes & can test every 2-3 months.

Calcium citrate – decent compromise.  In middle for absorption.

Calcium carbonate – NOT a good choice.  Chalk.  Not well absorbed.  Difficult for body to break down bond between calcium and carbonate.  Very alkaline.  Need a lot of stomach acid to benefit.  Cheap.

Calcium forms: Ascorbate, Lactate, Phosphate.  Also various amino acid chelates – aspartate, glycinate, malate.

MAGNESIUM: really important.  2nd most common nutrient deficiency.  Co-factor of over 350 biochemical reactions.  Responsible for mood, energy production, bone formation, muscle function & relaxation, protein synthesis, cardiovascular health.

Magnesium – clinical applications: fibromyalgia, chronic fatigue syndrome, blood pressure, cardio-vascular function (decreases platelet stickiness, thins the blood, blocks calcium uptake, relaxes blood vessels, congestive heart failure), Migraines, allergy (especially combined with vitamin C & B6), asthma, diabetes, muscle cramps, PMS, Laxative effect.

Magnesium is profoundly anti-inflammatory, so it’s good for fibromyalgia, heart health, pain, mood, inflammation.

Magnesium content in foods varies greatly, as does the soil content of magnesium.  It’s what makes green veggies green.

Studies show 90-95% of US population deficient.  Most American adults do not get RDA 400-500 mg/day.

Stool loosening.  Lamberts Magnesium Citrate good brand for this.  You have to decide which you are taking it for – metabolic effect or stool loosening, to determine which to take.  Magnesium oxide – causes very loose stool.  Magnesium Glycinate.  Causes least loose stool.  Can get an extra 400-800mg/day in before client hits stool loosening.  Magnesium bowel tolerance dose – about 1200mg/day.  Take before bed to benefit from relaxation effect.

Magnesium Forms: Citrate (used as laxative), Hydroxide, Gluconate, Sulfate (Epsom salts), Chloride, Aspartate, Malate, Succinate, Fumarate, Ascorbate.

Allergies – some combination of vitamin C, B6, and magnesium will help just about every case of hayfever and other inflammation.  Use to bowel tolerance.

IRON – can be problematic b/c excess is a problem, deficiency is a problem.  Find out what people need.  Causes tummy problems.

HEME IRON – in your blood.  Obscure form, but superior.  Easily absorbable.

CHELATED IRON – (Glycinate new low nausea form).

FERROUS SULFATE – commonly prescribed medically.  Causes constipation, discomfort.

FERROUS FUMERATE – also common.  Better tolerated, but not as well absorbed.

AMINO CHELATES – ferrous gluconate, ferrous glycinate

FERRIC AMMONIUM CITRATE

Finding herb sources for iron is challenging.  They are usually low in iron, so you have to take large amounts.  Yellow Dock, Molasses.  Up to 100mg as tolerated.  Can cause stomach distress, constipation.

ZINC – Causes nausea.  Zinc glycinate causes less nausea.  300 mg/day is a good dose.

forms: Arginate, Ascorbate, Aspartate, Citrate, Gluconate, Glycinate, Histidinate, Methionate, Oxide, Picolinate (good record for being absorbable), Sulfate.

ZINC Clinical Applications: Immune (Zinc lozenge for common cold), Antioxidant, Increases insulin activity, sensory perceptions, serum Vitamin A levels (controls the release of stored vitamin A from the liver), Sexual function (necessary for maturation of sperm, ovulation, fertilization), Wound Healing, BPH (Zinc inhibits 5-alpha reductase activity), Mental functions (Schizophrenia), Skin Health.

Dose – up to 100-300 mg/day.  Powder in capsules.  Also could use liquid.  Anything but tablets, b/c they cause digestive distress in large doses.  Zinc lozenges treat viral infections.  Suck on them all day to treat respiratory virus.

AMINO ACIDS –

L-Tyrosine – starting material for epinephrine in adrenal glands.  Increases mood and energy.  Basis for thyroid hormone.

Dose – for energy.  500-3,000mg.  Don’t take late in day.  Affects sleep.

5 – HTP – form of trytophan that your body uses as metabolite.  Tryptophan goes to serotonin, which goes to melatonin.  Take as mood elevator or to enhance sleep.  10x more potent than tryptophan.  Sedating.  Available as food supplement.

Dose – 500 mg/day.

Toss up between L-Tryptophan and 5-HTP.  Some people do better with 5-HTP.

GABA – sedating.  Most abundant neurotransmitter in body.  Pain relieving, calming neurotransmitter that helps with sleep and pain.  For sleep & anxiety.  Available as dietary supplement.

Dose – 500-5,000mg/day.  GABA Calm – sublingual for absorption.  Doses lower, but gets better absorption.  KP likes it for autistic kids.

CO-ENZYME Q-10 – enzyme produced in your body, imparts energy to heart.  Study done in Japan showed that statint drugs cause CO-Q10 deficiency.  In Japan, they recommend it as soon as person has overt signs of cardio-vascular disease.  Cost is substantial.

For – Cardiovascular nutrient, energy, anti-aging.

Dose – up to 1-2 grams no problem.

 

Possible Drug interactions With Vitamins, Minerals or Herbs & FOOD: – 1). Reduces nutrient absorption – blocks nutrients. 2). Affects liver enzyme systems.  Nutrient blood level increases or decreases.  3). Urinary excretion increases or decreases.  4). Appetite increases or decreases.

Two examples:  Saint John’s Wort – Aids the drug “indinavir.”  Standard extract dose is 300mg three times/day.  Decreases blood levels of drug 57-82%, rendering it therapeutically ineffective.  C4P3A (an enzyme in the liver) is part of P450 Enzyme System, responsible for Phase 1 detoxification in liver.  Essentially, ST John’s Wort makes the liver better at detoxifying things, so it is bad for this AIDS drug.

Grapefruit – affects statins and benzodiazepines.  Increases the drug effects.  Grapefruit contains the compound naringenin (&others) which inactivates cytochrome P450 3A4 (in small intestine in this case).  Inactivates detoxification & causes drug levels to go up.

We don’t have a good handle on drug interactions with Food.  We know a couple of facts.