tag:theconversation.com,2011:/fr/topics/supplements-1831/articlesSupplements – The Conversation2024-02-29T17:41:19Ztag:theconversation.com,2011:article/2240182024-02-29T17:41:19Z2024-02-29T17:41:19ZDrinking olive oil: a health and beauty elixir or celebrity fad in a shot glass?<figure><img src="https://images.theconversation.com/files/578716/original/file-20240228-16-ys3r3k.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3594%2C2408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
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<p>Celebrities such as <a href="https://poosh.com/why-kourtney-kardashian-drinks-tablespoon-evoo/">Kourtney Kardashian</a>, Beyonce, Gwyneth Paltrow and <a href="https://www.womanandhome.com/life/news-entertainment/jennifer-lopez-credits-her-grandmas-crazy-beauty-secret-for-glowing-skin-and-chances-are-you-already-have-it-at-home/">Jennifer Lopez</a> all extol the virtues of swigging extra virgin as well as slathering it on their skin, crediting olive oil for their glowing complexions. </p>
<p>Lopez even based her JLo Beauty brand around the kitchen staple, claiming that her age-defying looks were not the result of botox or surgery but the family beauty secret: <a href="https://graziamagazine.com/us/articles/jennifer-lopez-skincare-routine/">moisturising with olive oil</a>. </p>
<p>And she’s in good company. Hollywood star <a href="https://jnews.uk/goldie-hawn-swears-by-olive-oil-for-perfect-skin-at-76-best-life/">Goldie Hawn reportedly drinks olive oil</a> before bed and uses it topically as a moisturiser, while <a href="https://www.redonline.co.uk/beauty/a31184313/julia-roberts-olive-oil-hair-skin/">beauty icon Sophia Loren</a> really goes to town by bathing in the stuff. </p>
<p>While these celebrities swear by the skin beautifying properties of olive oil, some skin types should <a href="https://scholarhub.ui.ac.id/cgi/viewcontent.cgi?article=1182&context=jdvi#:%7E:text=Background%3A%20Dry%20skin%20or%20xerosis,water%20in%20the%20stratum%20corneum.">give it a swerve</a>. Those <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.14436">prone to acne</a> or eczema, for example, might find the <a href="https://www.jacionline.org/article/S0091-6749(21)00813-7/fulltext">olive oil exacerbates their problems</a>. Some <a href="https://pubmed.ncbi.nlm.nih.gov/22995032/">dermatologists warn against</a> using it as skin care altogether – bad news for JLo.</p>
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<p>Thanks largely to celebrity promotion, drinking olive oil has now become a <a href="https://www.independent.co.uk/tv/lifestyle/tiktok-dua-lipa-ice-cream-olive-oil-b2479725.html">worldwide TikTok sensation</a>. Viral videos show influencers tossing back shots of cult olive oil brands, and proclaiming a wide range of health benefits from improving digestion to clearing up acne. </p>
<p>Celebrity and influencers are sold on liquid gold but what about the rest of us? Can drinking olive oil really work on miracles for our health? </p>
<h2>The benefits of olive oil</h2>
<p>There’s no doubt that olive oil is full of good stuff. It’s high in polyphenols and antioxidants, which have protective qualities for the body’s tissues. It’s also a rich source of essential fatty acids, including oleic acid, which is known for <a href="https://foodrevolution.org/blog/olives-and-olive-oil-benefits/#:%7E:text=Compared%20with%20olives%2C%20olive%20oil,in%20polyphenols%20and%20antioxidants%2C%20however">lowering cholesterol</a> so reducing the chances of heart disease. </p>
<p>Research has found that the inclusion of olive oil in the diet shows encouraging effects in a variety of <a href="https://doi.org/10.3390%2Fnu11092039">inflammatory and medical diseases</a> and can <a href="https://doi.org/10.3389%2Ffnut.2022.980429">support weight management</a> if used correctly. </p>
<p>Replacing butter, margarine, mayonnaise and dairy fat with olive oil has been linked to a <a href="https://doi.org/10.1016%2Fj.jacc.2021.10.041">lower risk of mortality</a>. There’s also evidence to suggest that the protective compounds in olive oil may help <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0261649">guard against cancer</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10376491/">dementia</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/29141573/">support the liver</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7916323/">and kidneys</a>.</p>
<p>But none of this is new information to health professionals. The health benefits of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466243/">extra virgin olive oil</a> are <a href="https://doi.org/10.3390%2Fnu11092039">well researched</a> and nutritionists have promoted olive oil as a swap for saturated cooking fat for years. </p>
<p>After all, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7536728/">Mediterranean diet</a> has been touted as one of the healthiest diets in the world for decades. The diet itself can vary from region to region, but <a href="https://doi.org/10.3390%2Fnu15092127">virgin olive oil</a> is a <a href="https://doi.org/10.3390%2Fnu11092039">consistent element</a>. It’s used as the <a href="https://www.themediterraneandish.com/cooking-with-olive-oil/">main source of cooking fat</a> and included in everything from salad dressings to bread.</p>
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<h2>Can fat be healthy? Yes and no</h2>
<p>Fats are crucial for a balanced diet, aiding in the absorption of fat-soluble vitamins A,D,E,K and enhancing the nutritional value of meals. </p>
<p>However, fat of any kind is also dense in calories and excessive consumption <a href="https://doi.org/10.1159/000336848">can lead to weight gain</a>. According to the <a href="https://www.who.int/news/item/17-07-2023-who-updates-guidelines-on-fats-and-carbohydrates">World Health Organization</a>, to prevent unhealthy weight gain, adults should limit their intake of fat to 30% of total energy intake with no more than 10% coming from saturated fats. </p>
<p>Two tablespoons of olive oil – the standard amount in the shots taken by celebrities and social media influencers – contain 28g of fat (238 calories) and 3.8g of saturated fat equating to <a href="https://fdc.nal.usda.gov/fdc-app.html#/food-details/171413/nutrients">19% of the recommended daily intake</a>. </p>
<p>That daily shot of extra virgin, then, might not be the best idea. Adding small amounts of olive oil to meals throughout the day is a more balanced – and appetising – approach to incorporating healthy fats into your diet.</p>
<p>But what about Kourtney Kardashian’s <a href="https://poosh.com/why-kourtney-kardashian-drinks-tablespoon-evoo/#:%7E:text=First%20things%20first%2C%20it's%20recommended,a.m.%20(every%20other%20day).">claim that</a>: “It’s recommended to consume extra virgin olive oil in the morning on an empty stomach so the oil can coat your system and neutralize your stomach walls for optimal benefits?” </p>
<p><a href="https://www.oliveoiltimes.com/briefs/consuming-olive-oil-on-an-empty-stomach-health-benefits/91503">Some brands</a> have also echoed the idea that consuming olive oil on an empty stomach offers unique health benefits. But no. There’s no scientific evidence to suggest this is true. </p>
<p>For a healthy but more satisfying snack, Kourtney might try including a handful of olives into her daily diet. Olives offer the same rich array of nutrients, including vitamins E, A and K, alongside essential minerals such as iron, calcium, magnesium, potassium and amino acids. </p>
<p>Unlike olive oil, olives have the added benefit of a high fibre content. The combination of fat and fibre enhances feelings of satiety, making olives a nutritious addition to the diet.</p><img src="https://counter.theconversation.com/content/224018/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Flight does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The benefits of consuming olive oil have been known for years – but the evidence about using it for skincare is fairly mixed.Hazel Flight, Programme Lead Nutrition and Health, Edge Hill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230612024-02-20T13:17:55Z2024-02-20T13:17:55ZNearly 2 million Americans are using kratom yearly, but it is banned in multiple states: A pharmacologist explains the controversy<figure><img src="https://images.theconversation.com/files/574217/original/file-20240207-16-58upgw.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C1989%2C855&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kratom products are sold online and at smoke shops and gas stations, like this one in Lone Tree, Colo.</span> <span class="attribution"><span class="source">Amanda Mascarelli</span></span></figcaption></figure><p><em><a href="https://nida.nih.gov/research-topics/kratom">The herbal substance kratom</a>, derived from the leaves of a <a href="https://doi.org/10.1093/ajhp/zxz221">Southeast Asian tree</a>, is used by <a href="https://doi.org/10.1016%2Fj.amepre.2021.02.004">nearly 2 million people</a> in the United States annually. It can be easily purchased at gas stations and convenience stores, smoke shops and online, and is marketed as an “herbal supplement.”</em></p>
<p><em>Proponents claim that kratom has many of the pain-relieving benefits of traditional opioids and that it can potentially be used as a treatment for opioid dependence.</em></p>
<p><em>The primary concern about kratom is that it can mimic how synthetic opioids work in the body, potentially causing overdoses, severe withdrawal symptoms and other serious health issues. As a result, the <a href="https://www.fda.gov/news-events/public-health-focus/fda-and-kratom#">Food and Drug Administration recommends against its use</a>.</em></p>
<p><em>The Conversation asked C. Michael White, a pharmacist at the University of Connecticut who has been <a href="https://doi.org/10.1080/17512433.2024.2305798">studying the science behind kratom</a> <a href="https://theconversation.com/the-dangers-and-potential-of-natural-opioid-kratom-87581">for many years</a>, to explain its potential benefits and why consumers should use caution with this product.</em></p>
<h2>How does kratom work in the body?</h2>
<p>Kratom doesn’t contain just one active ingredient; rather, it is made up of many substances that induce effects in the body. This is very common for <a href="https://theconversation.com/nature-is-the-worlds-original-pharmacy-returning-to-medicines-roots-could-help-fill-drug-discovery-gaps-176963">natural products</a>, since the cells of the plant make a variety of chemicals for different purposes.</p>
<p>When the body is experiencing pain, it releases hormones called endorphins that <a href="https://doi.org/10.1590/s0100-879x2010007500086">stimulate opioid receptors</a> to mildly reduce the transmission of local pain sensations to the brain. This same process also causes the release of the neurotransmitter dopamine, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104618/">inducing a feeling of pleasure</a> to neutralize the pain. </p>
<p>Traditional opioids, like morphine and fentanyl, stimulate these same receptors to such a degree that they more potently numb pain, induce a <a href="https://doi.org/10.3389%2Ffpsyt.2022.835816">euphoric feeling</a> that can lead to addiction, and suppress the <a href="https://theconversation.com/pain-and-anxiety-are-linked-to-breathing-in-mouse-brains-suggesting-a-potential-target-to-prevent-opioid-overdose-deaths-174187">drive to breathe</a>, which can result in death.</p>
<p>One of the key constituents of kratom is an <a href="https://doi.org/10.1021/acscentsci.9b00141">organic compound called mitragynine</a>. It interacts with the same opioid receptors as morphine and fentanyl, but does not recruit the beta-arrestin-2 (the reason for breathing suppression). As a result, kratom can provide pain relief with a lower risk <a href="https://doi.org/10.1021/acs.jmedchem.1c00726">of slowed or stopped breathing</a> compared to traditional opioids. </p>
<p>Kratom also contains a small amount of <a href="https://doi.org/10.1021%2Facscentsci.9b00462">7-hydroxymitragynine</a>, which is thought to more potently stimulate opioid receptors, leading to a greater risk of opioidlike adverse events. </p>
<p>One of the risks associated with kratom use is that products can <a href="https://www.tampabay.com/investigations/2023/12/09/tampa-bay-times-tested-20-kratom-products-heres-what-we-found/">differ dramatically in the doses</a> of 7-hydroxymitragynine. In other words, one kratom product could be more dangerous than another. When kratom is used in high doses, it <a href="https://doi.org/10.1093/ajhp/zxz221">can lead to seizures</a> and other issues. Since kratom products are not FDA-regulated, there is no uniformity to the products.</p>
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<h2>What is kratom’s legal status in the US?</h2>
<p>Kratom’s current legal status is complicated. Kratom is not a prescription or over-the-counter drug, and while it is derived from a plant, it does not meet the FDA’s definition of a <a href="https://www.fda.gov/news-events/public-health-focus/fda-and-kratom">dietary supplement, food or food additive</a>. </p>
<p>Natural products marketed in the U.S. <a href="https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements#">before Oct. 15, 1994</a>, were grandfathered in under the FDA’s list of dietary supplements. But since kratom came on the market later, the FDA would have to find, based on a history of use or other evidence, that when used under the conditions recommended or suggested in the labeling, the natural product can <a href="https://ods.od.nih.gov/About/DSHEA_Wording.aspx#sec8">reasonably be expected to be safe</a> – like the FDA does for all new dietary supplement ingredients. </p>
<p>In 2016, in response to increasing calls to <a href="https://www.tandfonline.com/doi/full/10.1080/15563650.2019.1569236">poison control centers,</a> the Drug Enforcement Administration sought to ban kratom by <a href="https://doi.org/10.2146/ajhp161035">making it a Schedule I drug</a>. This means the agency felt it had no currently accepted medical use and a high potential for abuse. But backlash from the public and <a href="https://www.usnews.com/news/articles/2016-09-23/45-congressmen-ask-dea-not-to-ban-kratom-next-week">support from congressional members</a> made the agency postpone a final decision. So kratom is currently listed as <a href="https://www.dea.gov/factsheets/kratom">a “drug of concern</a>.”</p>
<p>Seven states and some counties have <a href="https://www.redstormscientific.com/kratom-legality-in-the-u-s-by-state/">banned the sale of kratom</a>. But in 2023, the <a href="https://www.govtrack.us/congress/bills/118/hr5905/text">U.S. House</a> and <a href="https://www.congress.gov/bill/118th-congress/senate-bill/3039">Senate proposed legislation</a> to prevent the FDA from regulating kratom more stringently than they do a dietary supplement or a food additive, in order to keep the product accessible to consumers. </p>
<h2>Is kratom an effective pain reliever?</h2>
<p>A 2024 literature review concluded that <a href="https://effectivehealthcare.ahrq.gov/products/plant-based-chronic-pain-treatment/living-review">there are no clinical trials</a> evaluating the effects of kratom on chronic pain management. </p>
<p>Research on acute pain tolerance in people is limited to a 2020 study that found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309661/">participants who took a dose of kratom could endure immersion</a> of their arms in an ice bath for significantly longer than those who did not take a dose of kratom. However, this study was conducted on chronic kratom users, and their pain tolerance before they took their dose for that study was much lower compared to that of non-kratom users in other studies. This suggests that chronic kratom use is lowering people’s background pain tolerance. </p>
<p>This is similar to another study showing that when people tried to stop taking kratom after chronic use, they experienced significant <a href="https://doi.org/10.1080/02791072.2018.1443234">pain throughout their body</a>. This increased sensitivity and reactivity to pain, called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/hyperalgesia">hyperalgesia</a>, also occurs with traditional opioids and is one of the reasons why people who use them chronically find it so difficult to get off them. </p>
<p>Taken together, these studies suggest caution before starting kratom as a treatment for chronic pain, especially if safer methods such as acetaminophen, icing and heating, and physical therapy can suffice. </p>
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<h2>Does kratom effectively treat opioid use disorder?</h2>
<p>Some people also claim that kratom could be a natural treatment for withdrawal and other effects of <a href="https://www.cdc.gov/opioids/healthcare-professionals/prescribing/opioid-use-disorder.html#">opioid use disorder</a>, the clinical term for opioid dependence. </p>
<p>A few methodologically weak studies reported that <a href="https://doi.org/10.3389/fphar.2022.801855">participants were able to reduce or stop</a> their use of traditional opioids and that kratom reduced the severity of <a href="https://www.webmd.com/mental-health/addiction/opioid-withdrawal-symptoms/">opioid withdrawal symptoms</a>. These include diarrhea, runny nose and eyes, shaking, fast heartbeat and anxiety. </p>
<p>However, there are no clinical trials comparing kratom to methadone, buprenorphine or naltrexone, the FDA-approved <a href="https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat">treatment options for opioid use disorder</a>. So if patients have access to traditional FDA-approved therapies, these are the safest and best place to start. </p>
<p>If traditional options are not effective or patients cannot access them due to financial or logistical barriers, kratom may be a <a href="https://doi.org/10.1002/jcph.1860">potential alternative to illegal opioid products</a>, but it is certainly not risk free. Speaking with a health care professional is critical before making treatment decisions.</p><img src="https://counter.theconversation.com/content/223061/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C. Michael White does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Long-term use of kratom may actually reduce pain tolerance and cause physical dependence and withdrawal symptoms.C. Michael White, Distinguished Professor of Pharmacy Practice, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2159982024-02-14T13:24:03Z2024-02-14T13:24:03ZDon’t let ‘FDA-approved’ or ‘patented’ in ads give you a false sense of security<figure><img src="https://images.theconversation.com/files/557351/original/file-20231102-29-y77wkb.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C7156%2C4764&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is that really a stamp of approval?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/approved-concept-rubber-stamp-with-fda-and-pills-on-royalty-free-image/1186545957">iStock/Getty Images Plus</a></span></figcaption></figure><p>If you’ve ever reached for a bottle of moisturizer labeled “patented” or “FDA approved,” you might want to think twice. In a <a href="http://dx.doi.org/10.2139/ssrn.4366900">recent study</a> of hundreds of advertisements, I found that supplements and beauty products often misleadingly use these terms to suggest safety or efficacy.</p>
<p>As a <a href="https://law.indiana.edu/about/people/details/mattioli-michael.html">law professor</a>, I suspect this is confusing for consumers, maybe even dangerous. Having a patent means only that you can stop others from making, using, selling or importing your invention. It doesn’t mean the invention works or that it won’t blow up in your face.</p>
<p>“FDA approved,” meanwhile, means <a href="https://www.fda.gov/drugs/development-approval-process-drugs">a product’s benefits have been found to outweigh its risks</a> for a specific purpose – not that it’s of high quality or low risk in general.</p>
<h2>Led astray by the label</h2>
<p>I wanted to know whether companies exploit these sorts of misunderstandings, so I analyzed hundreds of ads from print, television and social media that mention patents or FDA approval. I found that advertisers throw these terms around in confusing ways. </p>
<p>For example, I found an ad for a probiotic supplement stating, “The proof is in the patent”; an ad for an earwax removal product stating its “patented formula is safe, effective, and clinically proven”; and an ad for a headache remedy that made the words “FDA approved” a bold visual focal point. </p>
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<p>Here’s the concerning part: I looked at all kinds of products and found that these terms appear most often in ads for things you eat or rub onto your skin, such as supplements, insecticides, toothpaste and lotions. </p>
<p>That’s probably no coincidence. Products like this aren’t tightly regulated, yet consumers want to know they’re safe. It seems likely that advertisers are name-dropping the government to make people think just that.</p>
<h2>Risks to consumers − and to innovation</h2>
<p>One danger is clear: Ads with vague references to government authorities could dupe consumers into thinking products are safer or more effective than they actually are. In fact, there’s some evidence <a href="https://doi.org/10.1001/archinternmed.2011.396">this is already happening</a>.</p>
<p>Another risk is that this creates perverse incentives for business. Companies could chose to forgo actual innovation, focusing instead on securing dubious patents or regulatory nods to <a href="https://www.voguebusiness.com/beauty/how-patents-became-the-beauty-industrys-secret-weapon">keep up in the advertising race</a>. </p>
<p>These practices could distort competition, burden government agencies with frivolous patent applications and deter new entrants from competing in markets where they can’t employ similar advertising tactics. </p>
<h2>Questions remain</h2>
<p>Even though my study has shed light on how often these tricky advertising methods are used, it leaves some big questions unanswered. What exactly makes consumers <a href="https://doi.org/10.1080/10810730.2016.1179367">respond so favorably</a> to terms like “patented” or “FDA approved”? And who is most likely to be confused by these tactics? </p>
<p>As a next step, I plan to conduct comprehensive surveys of consumers, along with in-depth interviews, to explore how these labels resonate emotionally. I hope to coordinate with researchers from psychology and media studies. Research along these lines could offer policymakers the robust evidence they need to make changes to the law.</p>
<p>What might those changes look like? For one thing, the law could make it easier for groups of consumers to sue in federal courts over misleading ads. The Federal Trade Commission could also place more of a burden on companies to prove their ads are honest. These changes could make a big difference in ensuring companies persuade shoppers without confusing them. </p>
<p>At a time when ads are everywhere and Americans are losing trust in institutions – and each other – the stakes for truthful product claims are high.</p><img src="https://counter.theconversation.com/content/215998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Mattioli does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most people don’t know what these labels really mean − and advertisers take advantage of that fact.Michael Mattioli, Professor of Law and Louis F. Niezer Faculty Fellow, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222802024-02-13T19:08:35Z2024-02-13T19:08:35ZA patch a day? Why the vitamin skin patches spruiked on social media might not be for you<figure><img src="https://images.theconversation.com/files/573945/original/file-20240207-18-9hjka6.jpg?ixlib=rb-1.1.0&rect=26%2C26%2C5824%2C4149&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/capsules-on-light-beige-top-view-2193561733">Shutterstock</a></span></figcaption></figure><p>Vitamin patches are <a href="https://www.tiktok.com/search?lang=en&q=vitamin%20patch&t=1707260917256">trending on social media</a> and advertised in <a href="https://www.instagram.com/reel/C0VBXJOrObo/">posts</a> and podcasts. </p>
<p>With patches marketed for sleep, detox, immunity and hangovers, they are being talked up as near magical fix-all stickers. Manufacturers claim they are easy-to-use, convenient and ethical when compared with other types of vitamin products. Some even come with <a href="https://www.vogue.com/article/barriere-vitamin-patches">cute floral designs</a>.</p>
<p>So do they work, are they safe, and why would you use one instead of just taking a vitamin tablet? </p>
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Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
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<h2>What are vitamin patches?</h2>
<p>Vitamin patches are adhesives designed to deliver vitamins or nutrients to your bloodstream directly through the skin.</p>
<p>You peel away the backing, place it on a hairless area of skin where it is less likely to be bumped, and then the patches release their vitamins over a period of 12 to 24 hours.</p>
<p>Two dominant <a href="https://thepatchremedy.com/">brands</a> that <a href="https://www.ultimatepatch.com.au/">market</a> in Australia sell patches that contain various chemical and plant ingredients. </p>
<p>There are patches for <a href="https://thepatchremedy.com/products/menopause">menopause symptoms</a> that claim to include plant extracts of gotu kola, damiana, black cohosh, valerian, skull cap, oat seed and ginger. Patches promising an <a href="https://www.ultimatepatch.com.au/products/energy-patch-vitamin-patches">energy boost</a> offer caffeine, taurine, gluconolactone, green tea extract and vitamins B3, B5 and B6. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-taking-vitamins-and-supplements-help-you-recover-from-covid-182220">Can taking vitamins and supplements help you recover from COVID?</a>
</strong>
</em>
</p>
<hr>
<h2>Do they work and are they safe?</h2>
<p>In Australia, vitamins are considered pharmaceutical products and are regulated by the Therapeutic Goods Administration. Vitamins are generally approved as listed medicines, meaning the ingredients have been assessed for safety but not for efficacy (whether they do what they promise).</p>
<p>Being a listed medicine also means vitamins are manufactured in a factory with <a href="https://www.tga.gov.au/how-we-regulate/manufacturing/manufacture-medicine/good-manufacturing-practice-gmp#:%7E:text=Good%20Manufacturing%20Practice%20(GMP)%20describes,into%20a%20batch%20of%20product">good manufacturing practices</a>, so you can be assured the ingredients listed on the packaging have been sourced properly and are provided at the correct concentration.</p>
<p>However, there are no items listed as vitamin patches on the Australian Register of Therapeutic Goods. This means they currently can not <a href="https://www.tga.gov.au/news/blog/how-are-vitamins-regulated-australia#:%7E:text=Depending%20on%20the%20vitamin%20and,their%20safety%20and%20quality%20only.">legally be supplied or purchased in Australia</a>. It doesn’t matter if they are being sold from a physical store or online within the country. The TGA won’t <a href="https://www.tga.gov.au/sites/default/files/australian-regulatory-guidelines-complementary-medicines-argcm.pdf">stop you from buying them from overseas</a>, but they advise you not to do so because you can’t be assured of quality and safety.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="clear capsules being produced by machine" src="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573949/original/file-20240207-30-751n5r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vitamins and supplements listed by the TGA are produced in factories with stringent quality standards.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fish-oil-gelatin-capsules-production-vitamins-2299877737">Shutterstock</a></span>
</figcaption>
</figure>
<p>There is also insufficient evidence that vitamins delivered in this way work. Not all drugs and chemicals can be delivered through the skin. Ordinarily, to be absorbed through the skin a chemical needs to be <a href="https://www.merriam-webster.com/dictionary/lipophilic">lipophilic</a>, meaning it likes fats and oils more than water. </p>
<p>So, the form in which the vitamins have been produced and supplied will dictate whether they will get into the skin. For example, a water extract of a plant is less likely to be absorbed when compared with an oil-based extract.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31302845/">A small 2019 study</a> of patients at risk of nutrient deficiencies after bariatric (weight-loss) surgery gave some of them a daily multivitamin patch for a year. Those patients had lower blood concentrations of several vitamins and were more likely to have vitamin D deficiency when compared with patients given oral vitamins. The study concluded transdermal vitamin patches were not as effective as oral supplements. </p>
<p>Another issue with vitamin patches is that they contain very low concentrations of ingredients and you may therefore get an ineffective dose, even if all the vitamin in the patch is 100% absorbed through the skin. </p>
<p>For example, one particular patch that is marketed for immunity states that it contains 3 milligrams of vitamin C, which is likely insufficient if taken to supplement a low vitamin C diet. The health condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK493187/">scurvy</a> is thought to occur when daily vitamin C intake drops lower than <a href="https://www.healthdirect.gov.au/vitamin-c-and-your-health">7 milligrams per day</a>. </p>
<p>In contrast, a typical vitamin C tablet contains 500 milligrams. The recommended daily intake of vitamin C is around <a href="https://www.healthdirect.gov.au/vitamin-c-and-your-health">45 milligrams per day</a> – more if a woman is breastfeeding. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person puts clear patch on skin of upper arm" src="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573947/original/file-20240207-22-3nunzy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nicotine patches work by providing a sustained release of the drug into the skin.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nicotine-patch-on-skin-quitting-smoking-438277147">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-tiktok-right-will-eating-three-carrots-a-day-really-give-me-a-natural-tan-214270">Is TikTok right – will eating three carrots a day really give me a natural tan?</a>
</strong>
</em>
</p>
<hr>
<h2>Why not just take a tablet?</h2>
<p>When other medicines are supplied in a patch formulation it is usually because a constant supply of the drug is needed in the body; think smoking replacement nicotine patches, <a href="https://www.healthdirect.gov.au/hormone-replacement-therapy">menopausal hormone therapy</a> and some types of <a href="https://www.nps.org.au/radar/articles/fentanyl-patches-durogesic-for-chronic-pain">pain relief</a>.</p>
<p>There is no reason why you would need the slow release, continuous supply of vitamins that patches promise – but there may be other reasons to choose them over tablets and gummy products.</p>
<p>One selling point used by the marketers is that patches are a “cleaner” form of vitamins. A vitamin in tablet or gummy form will contain inactive ingredients called <a href="https://australianprescriber.tg.org.au/articles/pharmaceutical-excipients-where-do-we-begin.html">excipients</a>. Excipients do various tasks in medicines from binding ingredients together, making the medicine look and smell nice, to ensuring drugs don’t break down during storage. The presumption is that patches don’t contain and release any, or very few, excipients into your body. </p>
<p>But many patches don’t list all their ingredients – just the active vitamins – so this claim can not be tested. Some patches may still contain a large number of excipients, some of which may irritate the skin.</p>
<p>For example, one type of <a href="https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=203285&agid=%28PrintDetailsPublic%29&actionid=1">nicotine patch</a> contains 12 excipients including acrylic acid and vinyl acetate, which are chemicals used to help stick the patch to the skin.</p>
<p>A patch may be worth investigating for people who have trouble swallowing or chewing. In this instance it could be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7810703/">difficult to take a solid tablet</a> or gummy to get your vitamins. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/paracetamol-versus-ibuprofen-which-works-best-and-when-207921">Paracetamol versus ibuprofen – which works best and when?</a>
</strong>
</em>
</p>
<hr>
<h2>Should you buy them?</h2>
<p>As there are no vitamin patches approved by the TGA in Australia, you should not buy them. </p>
<p>If at some point in the future they become listed medicines, it will be important to remember that they may not have been assessed for efficacy. </p>
<p>If you remain curious about vitamin patches, you should discuss them with your doctor or local pharmacist.</p><img src="https://counter.theconversation.com/content/222280/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Jasmine Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are no vitamin patches listed on the Australian Register of Therapeutic Goods and there’s not enough evidence to show they work better than tablets.Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJasmine Lee, Pharmacist and PhD Candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2152172023-11-20T13:18:45Z2023-11-20T13:18:45ZImmune health is all about balance – an immunologist explains why both too strong and too weak an immune response can lead to illness<figure><img src="https://images.theconversation.com/files/559704/original/file-20231115-15-wutiiv.png?ixlib=rb-1.1.0&rect=0%2C0%2C2044%2C1593&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When immune cells become overactive, your immune system itself can cause disease.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/2oHpNSe">NIAID/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>For immune health, some influencers seem to think the Goldilocks philosophy of “just right” is overrated. Why settle for less immunity when you can have more? Many social media posts push supplements and other life hacks that “boost your immune system” to keep you healthy and fend off illness.</p>
<p>However, these claims are not based on science and what is known about immune function. Healthy immune systems don’t need to be “boosted.” Instead, the immune system works best when it is <a href="https://doi.org/10.1038/ni.2430">perfectly balanced</a>. Scientific experts on the immune system – immunologists – know that too much of an immune reaction could result in allergies, autoimmune disorders or <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">chronic inflammation</a>. On the flip side, <a href="https://theconversation.com/immunocompromised-people-make-up-nearly-half-of-covid-19-breakthrough-hospitalizations-an-extra-vaccine-dose-may-help-166241">too little of an immune reaction</a> could result in illness or infection.</p>
<p>Your immune system requires a delicate balance to operate properly. When it’s out of balance, your immune system itself can cause disease.</p>
<h2>Cellular balance</h2>
<p>The immune system is the mobile defense system of your body. It is a complex network of cells and organs that work together to protect your body from infection and disease. Your immune cells are continually on patrol, traveling throughout your body looking for infectious invaders and damage. </p>
<p>New immune cells are created in your bone marrow. Certain immune cells – called <a href="https://theconversation.com/coronavirus-b-cells-and-t-cells-explained-141888">B and T cells</a> – are the special forces of the immune system, playing an important role in the elimination of infectious invaders. Because of this role, these cells undergo a rigorous boot camp during their development to ensure they will not discharge friendly fire on healthy cells in the body. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/PSRJfaAYkW4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your immune system is an extensive network of cells and many other components that constantly surveil your body.</span></figcaption>
</figure>
<p>Any <a href="https://doi.org/10.1038/nri.2017.19">B cell</a> or <a href="https://doi.org/10.1146/annurev-immunol-101320-022432">T cell</a> exhibiting activity against the self – or autoreactivity – is killed during training. Millions of newly created B and T cells are killed every day because they fail this training process. If these self-reactive cells escape destruction, they could turn against the body and carry out an inappropriate <a href="https://doi.org/10.1038/ni.3731">autoimmune attack</a>. </p>
<p><a href="https://scholar.google.com/citations?view_op=list_works&hl=en&hl=en&user=PGIEO34AAAAJ">My research</a> investigates how B cells are able to slip past the checkpoints the immune system has in place to guard against autoreactivity. These <a href="https://doi.org/10.1172/jci12462">tolerance checkpoints</a> ensure that autoreactive immune cells are either purged from the body or held in permanent lockdown and unable to engage in inappropriate responses that would target healthy tissue.</p>
<h2>More isn’t necessarily better</h2>
<p>You’ve likely seen advertisements for dietary supplements that promise to “boost immune function.” While this may sound appealing, it is important to keep in mind that the immune system functions best when perfectly balanced.</p>
<p>If the immune system is like a thermostat, turning it up too high results in overactivation and uncontrolled inflammation, while turning it down too low results in a failure to respond to infection and disease. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of immune activation scale in the shape of a rainbow wedge, with 'vulnerable to infection' at the smaller end, 'sweet spot' in the middle, and 'autoimmunity' at the larger end" src="https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=326&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=326&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559701/original/file-20231115-23-d6qlle.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=326&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Too much or too little immune activation can lead to illness.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Inflammation_scale.svg">Kevbonham/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Because sustaining <a href="https://www.nature.com/collections/mxwslsscsf">immune balance</a> is critical, tinkering with the immune system through the use of supplements is not a good idea unless you have a clinical deficiency in certain vital nutrients. For people with healthy levels of nutrients, taking supplements could lead to a false sense of security, particularly since the fine print on the back of supplements usually has <a href="https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements">this disclaimer</a> about their listed benefits: “This statement has not been evaluated by the FDA. Not intended to diagnose, treat, cure, or prevent any disease.”</p>
<p>Eating a <a href="https://www.hsph.harvard.edu/nutritionsource/nutrition-and-immunity/">well-balanced diet</a>, exercising regularly, reducing stress and getting decent sleep, on the other hand, can help your body maintain a functioning and healthy immune system. Although these lifestyle behaviors are not foolproof, they contribute to overall good health and ultimately to a more healthy immune system.</p>
<p>In reality, <a href="https://doi.org/10.1080/07853890.2017.1407035">vaccines are the only safe and effective tool</a> beyond healthy lifestyle behaviors to support your immune system. Vaccines contain harmless forms of pathogens that help to train your immune cells to recognize and fight them. When you come into contact with the real and harmful version of the pathogen out in the wild – whether it’s at a grocery store, social event or school – at a later date, these fully trained immune memory cells will immediately begin to fight and destroy the pathogen, sometimes so quickly that you don’t even realize you’ve been infected.</p>
<p>In a world where people are continually bombarded by the marketing mantra that more is better, rest assured that when it comes to the immune system, maintaining perfect balance is just right.</p><img src="https://counter.theconversation.com/content/215217/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Pugh Bernard is affiliated with Immunize Colorado and Colorado Immunization Advocates as an unpaid board member.</span></em></p>Dietary supplements claim to be able to ‘boost your immune system’ to combat disease. But attaining immune balance through a healthy lifestyle and vaccination is a safer bet to keep in good health.Aimee Pugh Bernard, Assistant Professor of Immunology and Microbiology, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2112682023-10-02T01:25:59Z2023-10-02T01:25:59ZShould I be getting my vitamin D levels checked?<figure><img src="https://images.theconversation.com/files/547920/original/file-20230913-23-limj5h.jpg?ixlib=rb-1.1.0&rect=1014%2C476%2C4958%2C3485&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-beautiful-woman-sitting-on-a-wooden-bench-looking-sideways-9032708/">Pexels/Kevin Malik</a></span></figcaption></figure><p>Australia has seen a <a href="https://insightplus.mja.com.au/2023/29/gps-urged-not-to-routinely-test-children-for-vitamin-d/">surge in vitamin D testing</a> of children, with similar trends reported for adults around the <a href="https://pubmed.ncbi.nlm.nih.gov/29659534/">world</a>. GPs are now <a href="https://insightplus.mja.com.au/2023/29/gps-urged-not-to-routinely-test-children-for-vitamin-d/">being urged</a> not to test for vitamin D unnecessarily.</p>
<p>So when is low vitamin D a potential concern? And when might you need to get your levels tested?</p>
<h2>How much vitamin D do we need?</h2>
<p>Vitamin D is not only a nutrient – when metabolised in the body it acts as a <a href="https://pubmed.ncbi.nlm.nih.gov/29080638/">hormone</a>. We have receptors for this hormone all around our body and it helps regulate the metabolism of calcium and phosphorus. </p>
<p>Vitamin D also has many other roles, including helping our immune defences and contributing to <a href="https://pubmed.ncbi.nlm.nih.gov/11295155/">DNA repair</a> and cell differentiation. </p>
<p>We can thank the sun for most of our vitamin D. A chemical in our skin called 7-dehydrocholesterol is converted to vitamin D after contact with UVB radiation from the sun. </p>
<p>While we get some vitamin D also <a href="https://pubmed.ncbi.nlm.nih.gov/35253289/">through our diet</a>, this makes a relatively small contribution. It’s difficult to get much more than one-third of our daily vitamin D requirement from diet without supplementation. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-how-does-the-sun-help-your-body-make-vitamin-d-139670">Curious Kids: how does the Sun help your body make vitamin D?</a>
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<p>Nutritional vitamin D status is <a href="https://en.wikipedia.org/wiki/Calcifediol">typically measured</a> via a blood test. This checks the calcidiol (calcifediol, 25-hydroxyvitamin D) concentrations, which reflect the average intakes from the sun and diet over the past three to four weeks. </p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/22708765/">current recommendation</a> is that we should all aim to have at least 50nmol/L (20ng/mL) at the end of winter.</p>
<p>However, one problem with vitamin D tests is that there is <a href="https://pubmed.ncbi.nlm.nih.gov/37182753/">variation</a> in measured concentrations between the laboratories and between the assays, and whether you’re deemed to have a deficiency can depend on the testing method used. </p>
<figure class="align-center ">
<img alt="Man wearing glasses looks into the distance" src="https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547934/original/file-20230913-29-2kgkhk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We get most of our vitamin D from sunshine.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/man-wearing-black-sunglasses-343717/">Pexels/Asim Alnamat</a></span>
</figcaption>
</figure>
<p>Doctors do not always agree with what is deficiency. While very low concentrations are likely to prompt doctors to recommend a supplement (and, potentially, follow-up testing), some may consider even relatively high concentrations as inadequate. </p>
<p>This is all understandable as research in this space is still evolving, and we know low concentrations do not always cause any symptoms. </p>
<h2>Why avoid vitamin D deficiency?</h2>
<p>Prolonged, severe vitamin D deficiency will lead to softening of bone tissue and cause diseases such as rickets (children) and osteomalacia (adults). </p>
<p>However, avoiding low concentrations is likely to be good for <a href="https://pubmed.ncbi.nlm.nih.gov/37483080/">many aspects of health</a>, with consistent evidence suggesting benefits for <a href="https://www.bmj.com/content/356/bmj.i6583">infectious diseases</a> and autoimmune conditions such as multiple sclerosis. </p>
<p>Randomised trials have also provided evidence for lower <a href="https://pubmed.ncbi.nlm.nih.gov/35676320/">cancer</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24414552/">all cause mortality</a> by daily supplementation, although any benefit is likely to be restricted to those who otherwise have insufficient intakes. </p>
<h2>Who is at risk of deficiency?</h2>
<p>Most of us do not need tests to have a relatively good idea whether we might be at risk of a clinically important deficiency. </p>
<p>If it’s not late winter, we spend regularly at least some time outside with skin exposed to the sun, and we do not belong to a specific high-risk group, it is unlikely that our <a href="https://pubmed.ncbi.nlm.nih.gov/22168576/">levels would be very low</a>. </p>
<p>The two main reasons for vitamin D deficiency typically relate to:</p>
<p><strong>1. not getting (enough) vitamin D through sun exposure.</strong> Deficiency risk <a href="https://www.healthdirect.gov.au/vitamin-d-deficiency">can be high</a> for anyone who is housebound, such as older or disabled people in residential care. The risk of deficiency increases if we always cover our skin carefully by <a href="https://pubmed.ncbi.nlm.nih.gov/19211395/">modest cultural dress,</a> and also <a href="https://pubmed.ncbi.nlm.nih.gov/6119494/">dark skin pigmentation</a> is known to reduce vitamin D synthesis. </p>
<p><strong>2. having a chronic disease that alters your requirement.</strong> Medications such as anticonvulsants used to treat epilepsy, and conditions such as <a href="https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency">liver and kidney diseases</a> can interfere with vitamin D metabolism. Some <a href="https://my.clevelandclinic.org/health/diseases/15050-vitamin-d-vitamin-d-deficiency">digestive diseases</a> can reduce vitamin D absorption from your diet, while <a href="https://pubmed.ncbi.nlm.nih.gov/30020507">obesity</a> will increase your vitamin D requirement and make it more difficult to raise your blood levels.</p>
<h2>Am I getting enough sun exposure?</h2>
<p>In Australia, it is possible to get enough vitamin D from the sun <a href="https://healthybonesaustralia.org.au/your-bone-health/vitamin-d-bone-health">throughout the year</a>. This isn’t so for many people living in the northern hemisphere. </p>
<p>For those who live in the top half of Australia – and for all of us during summer – we <a href="https://healthybonesaustralia.org.au/your-bone-health/vitamin-d-bone-health">only need</a> to have skin exposed to the sun a few minutes on most days. </p>
<p>The body can only produce a certain amount of vitamin D at the time, so staying in the sun any longer than needed is not going to help increase your vitamin D levels, while it will increase your risk of skin cancer. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-you-need-more-vitamin-d-in-the-winter-128898">Why you need more Vitamin D in the winter</a>
</strong>
</em>
</p>
<hr>
<p>During winter, catching enough sun can be difficult, especially if you spend your days confined indoors. Typically, the required exposure increases to two to three hours per week in winter. This is because sunlight exposure can only help produce vitamin D if the UVB rays reach us at the correct angle. So in winter we should regularly spend time outside in the middle of the day to get our dose of vitamin D. </p>
<p>If you are concerned, you have very dark skin, or are otherwise in a high-risk group, you may want to talk to your GP. </p>
<p>In any case, taking a modest daily dose of vitamin D (1,000-2,000 IU) during the darker winter months is unlikely to cause harm and it <a href="https://pubmed.ncbi.nlm.nih.gov/37483080/">may be beneficial</a>.</p>
<h2>Why does excess vitamin D testing matter?</h2>
<p>When not indicated, testing can cause unnecessary worry and promote a cascade of <a href="https://pubmed.ncbi.nlm.nih.gov/32675268/">laboratory, prescription and imaging services</a> that are of low value. </p>
<p>Excessive testing is also a waste of health-care resources, with one <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50619">single test</a> costing about the same as a years’ worth of vitamin D supplementation.</p>
<p>Very often, we can make relatively small changes to our lifestyles to reduce the risks of vitamin D deficiency. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/theres-no-such-thing-as-a-safe-tan-heres-whats-happening-underneath-your-summer-glow-109439">There's no such thing as a safe tan. Here's what's happening underneath your summer glow</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/211268/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elina Hypponen receives funding from the National Health and Medical Research Council, Australian Research Council, Medical Research Future Fund Australia, and Arthritis Australia. She is affiliated with Multicultural Communities Council South Australia. </span></em></p>Here’s when low vitamin D is a potential concern and when you might need to get your levels tested.Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2129052023-09-27T14:07:10Z2023-09-27T14:07:10ZDo liposomes make food supplements more effective? A chemistry expert explains common myths about these products<figure><img src="https://images.theconversation.com/files/548044/original/file-20230913-17-dqkm54.jpg?ixlib=rb-1.1.0&rect=44%2C66%2C7304%2C4836&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medicine-human-holding-drugs-tablets-pills-1278001642">LookerStudio/Shutterstock</a></span></figcaption></figure><p>There has been an explosion in nutritional supplements that promise a
superior product because they contain nanoparticles called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118483/#:%7E:text=Liposomes%20are%20spherical%20lipid%20vesicles,13%5D%20(Figure%201).">liposomes</a>. But there’s a lot of misleading information and outright myths about these being shared online, so it’s important to understand how liposomes work before you spend money on an expensive new food supplement. </p>
<p>Liposomes have been used to enhance the effectiveness of medicines <a href="https://pubmed.ncbi.nlm.nih.gov/22484195/">since 1995</a>. They are <a href="https://www.moleaer.com/nanobubbles#:%7E:text=Nanobubbles%20are%2070%2D120%20nanometers,%2C%20chemical%2C%20and%20biological%20processes.">nano-size</a> bubbles from a group of fatty or oily compounds called <a href="https://www.britannica.com/science/phospholipid">phospholipids</a> – the building blocks of all the cells in your body. Liposomes can fuse together to form a similar structure to human cell membranes while retaining a liquid core. </p>
<p>This structure gives them a unique ability to carry medicines inside their shell. While many medicines would dissolve straight away on contact with your body fluids, liposome shells can protect them until they reach the part of your body the medicine is supposed to treat. </p>
<p>Liposome use in the pharmaceutical industry and clinical research <a href="https://www.mdpi.com/1999-4923/11/11/610,%20and%20regulated%20https://www.fda.gov/regulatory-information/search-fda-guidance-documents/liposome-drug-products-chemistry-manufacturing-and-controls-human-pharmacokinetics-and">is regulated</a>, meaning they are tested by independent organisations to see whether they perform as well as the manufacturers claim. There is also <a href="https://www.mdpi.com/1999-4923/11/11/610">large body of research</a> demonstrating how effective they are as medicine carriers. </p>
<h2>Pharmaceutical vs food supplement liposomes</h2>
<p>People are <a href="https://www.theatlantic.com/health/archive/2013/12/experts-decisive-against-multivitamins-stop-wasting-money/282440/">becoming more aware</a> that your body is better at absorbing vitamins and other nutrients from food rather than supplements. This means food supplement companies are having to work harder to convince people their products can overcome this problem. </p>
<p>It may seem logical that if liposomes work well for medicines, they could help your body absorb vitamins and other supplements too. But it’s not that simple. In the food supplement industry, there are a multitude of products on the market that are of poor quality or downright fake. This is due to the lack of rigorous regulation in the industry, especially for advanced formulations like liposomes. </p>
<p>Since their discovery in 1966, the structure of liposomes has been developed for several applications in the medical field, including prolonged circulation (making the medicine stay in your system longer), targeted delivery, and controlled release. In 1995, Doxil(R) was the <a href="https://www.sciencedirect.com/science/article/pii/S0168365912002301">first liposomal drug</a> licensed for cancer treatment. It is a type of chemotherapy which uses liposomes to give the drug more time to reach tumour tissue, where the drug is slowly released. </p>
<p>But researchers achieved this using complicated processes that <a href="https://www.cell.com/trends/biotechnology/fulltext/0167-7799(85)90014-9">are expensive</a> and demand a high level of skill. For example, some medical liposomes use cholesterol in the outer shell to keep it intact for longer. </p>
<p>In contrast, the liposomes used in food supplements are often the most basic, delicate type. The more delicate the liposome, the faster it breaks down. </p>
<h2>Do liposomes enhance oral absorption?</h2>
<p>There are conflicting reports about whether liposomes enhance gastrointestinal absorption. </p>
<p>Food supplement liposomes may enhance absorption by improving the ability of the nutrients they contain to fuse with other substances in your food. However, there is <a href="https://www.future-science.com/doi/10.4155/tde.15.69#:%7E:text=Although%20the%20underlying%20mechanisms%20of,%20can%20be%20made%20more%20stable">limited evidence</a> that even advanced types of liposome pass through the stomach and small intestine membrane into the bloodstream. </p>
<p>And even if the liposomes can reach the blood intact, <a href="https://pubmed.ncbi.nlm.nih.gov/36084713/">they will then be attacked</a> by your immune system as a foreign substance. Medicinal liposomes are better equipped to withstand this kind of attack.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A diagram comparing the different kinds of liposomes" src="https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547522/original/file-20230911-23-q366sl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not all liposomes are created equal.</span>
<span class="attribution"><span class="source">Mohammad Najlah</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Conventional liposomes are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362257/">easily destroyed</a> in the stomach and small intestine. This means claims that such liposomes protect nutrients from stomach acid are false. The same goes for claims that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9118483/">conventional liposomes</a> are absorbed into your bloodstream and remain intact. Similarly, claims that food supplement liposomes carry nutrients through the gut, into circulation, and then travel to organs <a href="https://www.frontiersin.org/articles/10.3389/fphar.2015.00286/full">are a work of fiction</a>, as a review of 50 years of liposome research showed.</p>
<h2>Can liposomes be used with any type of nutrient?</h2>
<p>The simple answer is no. There are many nutrients that liposomes struggle to encapsulate for different reasons.</p>
<p>Firstly, some nutrients are made from molecules too big to fit inside a liposome. It would be like trying to fit a full trolley of food inside one small plastic bag. Even in pharmaceutical research, where more advanced techniques are used, some drug molecules are <a href="https://pubmed.ncbi.nlm.nih.gov/26621170/">difficult to fit inside</a> liposomes. </p>
<p>Furthermore, liposomes are not an impervious plastic bag, but more akin to a cotton bag through which water can pass. This sometimes leads to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748343">content leakage</a>. Water-soluble materials such as vitamin C or vitamin B are thus <a href="https://www.sciencedirect.com/science/article/pii/S0927776514005001">even trickier</a> to encapsulate than fat-soluble ones such as vitamin D, <a href="https://www.webmd.com/diet/supplement-guide-turmeric#:%7E:text=Curcumin%2C%20a%20substance%20in%20turmeric,turmeric%20might%20also%20be%20medicinal.">curcumin</a> or <a href="https://www.webmd.com/vitamins/ai/ingredientmono-307/resveratrol">resveratrol</a>. </p>
<p>In pharmaceutics, the maximum loading is <a href="https://pubmed.ncbi.nlm.nih.gov/27834116/">10% drug molecules</a> to <a href="https://my.clevelandclinic.org/health/body/24425-lipids#:%7E:text=Lipids%20are%20fatty%20compounds%20that,absorbing%20vitamins%20and%20making%20hormones.">lipid molecules</a> (fatty compounds that perform a variety of functions in your body). This means if you take a dose, only 10% of it will consist of the drug molecules encapsulated in liposomes. In the case of food supplements, the ratio is higher but claims of 100% encapsulation efficiency are simply not possible. </p>
<p>And unfortunately, it is not possible to tell whether a product contains liposomes just by looking at it. Liposomal formulations are watery rather than creamy or gel-like. Manufacturers add thickening agents and other additives to make their products look more appealing – so neither colour nor thickness can tell you whether a product contains high-quality liposomes, as some companies may claim.</p>
<p>If a company says its products contain liposomes, always check its website for evidence such as electron microscope imaging in production. The sizes of liposomes vary, but it is impossible to see them without a microscope. </p>
<p>While it might be possible to see larger liposomes using a quality light microscope, the smaller and more effective liposomes are measured in nanometres. They can only be seen with more sophisticated, electron-scanning microscopy.</p>
<p>Ultimately, until there is better regulation of nutritional supplements, it is difficult to verify these businesses’ claims about how they make their products, and what is and isn’t in them.</p><img src="https://counter.theconversation.com/content/212905/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof Mohammad Najlah receives funding from Innovate UK, European Regional Development Fund (ERDF) and research contracts with industry.
</span></em></p>Liposomes have been used to enhance the effectiveness of medicines for decades – but it doesn’t necessarily mean they will work in food supplements too.Mohammad Najlah, Professor of Pharmaceutics & Nanomedicine, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117482023-09-15T00:56:34Z2023-09-15T00:56:34ZHow can I lower my cholesterol? Do supplements work? How about psyllium or probiotics?<figure><img src="https://images.theconversation.com/files/545897/original/file-20230901-17-zovk4b.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C1908%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/white-ceramic-bowls-with-supplements-7615572/">Nataliya Vaitkevich/Pexels</a></span></figcaption></figure><p>Your GP says you have high cholesterol. You’ve six months to work on your diet to see if that’ll bring down your levels, then you’ll review your options. </p>
<p>Could taking supplements over this time help?</p>
<p>You can’t rely on supplements alone to control your cholesterol. But there’s some good evidence that taking particular supplements, while also eating a healthy diet, can make a difference.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-high-cholesterol-here-are-five-foods-to-eat-and-avoid-63941">Got high cholesterol? Here are five foods to eat and avoid</a>
</strong>
</em>
</p>
<hr>
<h2>Why are we so worried about cholesterol?</h2>
<p>There are two main types of cholesterol, both affecting your risk of heart disease and stroke. Both types are carried in the bloodstream inside molecules called lipoproteins.</p>
<p><strong>Low-density lipoprotein or LDL cholesterol</strong></p>
<p>This is often called “bad” cholesterol. This lipoprotein carries cholesterol from the liver to cells throughout the body. High levels of LDL cholesterol in the blood can lead to the <a href="https://www.ahajournals.org/doi/full/10.1161/JAHA.118.011433">build-up of plaque</a> in arteries, which leads to an <em>increased</em> risk of heart disease and stroke. </p>
<p><strong>High-density lipoprotein or HDL cholesterol</strong></p>
<p>This is often called “good” cholesterol. This lipoprotein helps remove excess cholesterol from the bloodstream and transports it back to the liver for processing and excretion. Higher levels of HDL cholesterol are <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCRESAHA.119.312617">linked to</a> a <em>reduced</em> risk of heart disease and stroke. </p>
<p>Diet can play a key role in reducing blood cholesterol levels, especially LDL (“bad”) cholesterol. Healthy dietary choices are <a href="https://theconversation.com/got-high-cholesterol-here-are-five-foods-to-eat-and-avoid-63941">well recognised</a>. These include a focus on eating more unsaturated (“healthy”) fat (such as from olive oil or avocado), and eating less saturated (“unhealthy”) fat (such as animal fats) and trans fats (found in some shop-bought biscuits, pies and pizza bases).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cut avocado, glass of olive oil, green herbs and cut lemon on timber background" src="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546536/original/file-20230905-26-5plf10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can find unsaturated fat in foods such as olive oil and avocado.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/food-background-fresh-organic-avocado-lime-253287091">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-healthier-butter-or-margarine-19777">Health Check: what's healthier, butter or margarine?</a>
</strong>
</em>
</p>
<hr>
<h2>Fibre is your friend</h2>
<p>An additional way to significantly reduce your total cholesterol and LDL cholesterol levels through diet is by eating more <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">soluble fibre</a>.</p>
<p>This is a type of fibre that dissolves in water to form a gel-like substance in your gut. The gel can bind to cholesterol molecules preventing them from being absorbed into the bloodstream and allows them to be eliminated from the body through your faeces. </p>
<p>You can find soluble fibre in whole foods such as fruits, vegetables, oats, barley, beans and lentils.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">Fiber is your body's natural guide to weight management – rather than cutting carbs out of your diet, eat them in their original fiber packaging instead</a>
</strong>
</em>
</p>
<hr>
<h2>Fibre supplements, such as psyllium</h2>
<p>There are also many fibre supplements and food-based products on the market that may help lower cholesterol. These include:</p>
<ul>
<li><p><strong>natural soluble fibres</strong>, such as inulin (for example, Benefiber) or psyllium (for example, Metamucil) or beta-glucan (for example, in ground oats)</p></li>
<li><p><strong>synthetic soluble fibres</strong>, such as polydextrose (for example, STA-LITE), wheat dextrin (also found in Benefiber) or methylcellulose (such as Citrucel)</p></li>
<li><p><strong>natural insoluble fibres</strong>, which bulk out your faeces, such as flax seeds.</p></li>
</ul>
<p>Most of these supplements come as fibres you add to food or dissolve in water or drinks. </p>
<p>Psyllium is the fibre supplement with the strongest evidence to support its use in improving cholesterol levels. It’s been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5413815/">studied</a> in at least 24 high-quality randomised controlled trials.</p>
<p>These trials show consuming about 10g of psyllium a day (1 tablespoon), as part of a healthy diet, <a href="https://www.sciencedirect.com/science/article/pii/S0002916523070107#:%7E:text=Conclusions%3A,mild%2Dto%2Dmoderate%20hypercholesterolemia.">can significantly lower</a> total cholesterol levels by 4% and LDL cholesterol levels by 7%.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person stirring in psyllium into glass of water, bowl of psyllium next to glass" src="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545910/original/file-20230901-20-orbx53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can mix psyllium fibre into a drink or add it to your food.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-adds-spoon-psyllium-fiber-mix-2031428417">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-are-you-eating-the-right-sorts-of-fibre-20089">Health Check: are you eating the right sorts of fibre?</a>
</strong>
</em>
</p>
<hr>
<h2>Probiotics</h2>
<p>Other cholesterol-lowering supplements, such as probiotics, are not based on fibre. Probiotics are thought to help lower cholesterol levels via a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3352670/">number of mechanisms</a>. These include helping to incorporate cholesterol into cells, and adjusting the microbiome of the gut to favour elimination of cholesterol via the faeces.</p>
<p>Using probiotics to reduce cholesterol is an upcoming area of interest and the <a href="https://www.sciencedirect.com/science/article/abs/pii/S089990071500461X">research</a> is promising. </p>
<p>In a <a href="https://pubmed.ncbi.nlm.nih.gov/29384846/">2018 study</a>, researchers pooled results from 32 studies and analysed them altogether in a type of study known as a meta-analysis. The people who took probiotics reduced their total cholesterol level by 13%.</p>
<p><a href="https://www.tandfonline.com/doi/full/10.3109/07853890.2015.1071872">Other</a> <a href="https://link.springer.com/article/10.1007/s11906-020-01080-y">systematic reviews</a> support these findings.</p>
<p>Most of these studies use probiotics containing <em>Lactobacillus acidophilus</em> and <em>Bifidobacterium lactis</em>, which come in capsules or powders and are consumed daily.</p>
<p>Ultimately, probiotics could be worth a try. However, the effects will likely vary according to the probiotic strains used, whether you take the probiotic each day as indicated, as well as your health status and your diet.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-healthy-people-take-probiotic-supplements-95861">Health Check: should healthy people take probiotic supplements?</a>
</strong>
</em>
</p>
<hr>
<h2>Red yeast rice</h2>
<p><a href="https://www.nccih.nih.gov/health/red-yeast-rice">Red yeast rice</a> is another non-fibre supplement that has gained attention for lowering cholesterol. It is often used in Asia and some European countries as a complementary therapy. It comes in capsule form and is thought to mimic the role of the cholesterol-lowering medications known as statins.</p>
<p>A <a href="https://www.frontiersin.org/articles/10.3389/fphar.2021.819482/full">2022 systematic review</a> analysed data from 15 randomised controlled trials. It found taking red yeast rice supplements (200-4,800mg a day) was more effective for lowering blood fats known as triglycerides but less effective at lowering total cholesterol compared with statins.</p>
<p>However, these trials don’t tell us if red yeast rice works and is safe in the long term. The authors also said only one study in the review was registered in a major <a href="https://www.clinicaltrials.gov">database</a> of clinical trials. So we don’t know if the evidence base was complete or biased to only publish studies with positive results.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Red yeast rice capsules" src="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546589/original/file-20230906-23-a4o8yh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Red yeast rice is often used in Asia and some European countries to lower cholesterol.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-yeast-rice-supplement-capsules-on-1625852824">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Diet and supplements may not be enough</h2>
<p>Always speak to your GP and dietitian about your plan to take supplements to lower your cholesterol.</p>
<p>But remember, dietary changes alone – with or without supplements – might not be enough to lower your cholesterol levels sufficiently. You still need to quit smoking, reduce stress, exercise regularly and get enough sleep. Genetics can also play a role.</p>
<p>Even then, depending on your cholesterol levels and other risk factors, you may still be recommended cholesterol-lowering medications, such as <a href="https://jamanetwork.com/journals/jama/fullarticle/2795522">statins</a>. Your GP will discuss your options at your six-month review.</p><img src="https://counter.theconversation.com/content/211748/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health, Mater Misericordia and the Royal Australian College of General Practitioners. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch works for Southern Cross University.</span></em></p>If you try supplements, you still need to eat a healthy diet, exercise, reduce your stress, quit smoking and get enough sleep. Even then, they may still not be enough.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Dietitian, Researcher & Lecturer, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2099082023-07-24T14:47:09Z2023-07-24T14:47:09ZKetone drinks: why we’re testing the effects of this supplement used by elite athletes on older adults<figure><img src="https://images.theconversation.com/files/538092/original/file-20230718-19-75q9n4.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4291%2C3268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fit-senior-couple-exercising-382763425">Ruslan Huzau/Shutterstock</a></span></figcaption></figure><p>Ketone drinks are used by <a href="https://www.cyclingweekly.com/fitness/nutrition/ketones-controversial-new-energy-drink-next-big-thing-cycling-151877">elite athletes</a> to improve focus and enhance performance. But could they also help people to live healthier for longer? </p>
<p>Considered “super fuels” among some endurance athletes and health enthusiasts, ketone drinks are now being tested in clinical trials for a range of conditions including <a href="https://clinicaltrials.gov/study/NCT04477161">Parkinson’s disease</a>, <a href="https://clinicaltrials.gov/study/NCT04194450">type 2 diabetes</a> and <a href="https://clinicaltrials.gov/study/NCT04442555">heart failure</a>. </p>
<p>Ketones are natural molecules that are produced by the body for energy. Research shows they have profound effects on our physiology, influencing <a href="https://www.annualreviews.org/doi/10.1146/annurev-nutr-111120-111518">metabolism</a>, <a href="https://www.cell.com/med/fulltext/S2666-6340(20)30013-1">immunity</a> and possibly even <a href="https://www.mdpi.com/2072-6643/13/7/2197">ageing</a>.</p>
<p>Ketones are produced by the liver when the body faces a shortage of glucose (sugar). This happens during periods of fasting, prolonged exercise or when eating a very low-carbohydrate “<a href="https://www.webmd.com/diet/ss/slideshow-ketogenic-diet">ketogenic diet</a>”. Under these conditions, the liver converts fats to ketones which are then used to provide a critical fuel for tissues such as the heart and the brain.</p>
<p>Following a ketogenic diet or fasting can be difficult. Keto diets are restrictive, allowing a maximum of 50g of carbs per day – about the amount you’d find in two bananas. </p>
<p>Ketone drinks offer a way to deliver ketones to the body without having to cut carbs. Research has shown that these drinks can enhance <a href="https://physoc.onlinelibrary.wiley.com/doi/epdf/10.1113/JP281988">cognitive function</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993591/">regulate blood sugar</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993591/">improve blood vessel function</a> in adults with obesity and type 2 diabetes. </p>
<figure class="align-center ">
<img alt="An example keto diet" src="https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538286/original/file-20230719-25-946n5c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Keto diets are hard to follow.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/selection-good-fat-sources-healthy-eating-1033763875">Oleksandra Naumenko/Shutterstock</a></span>
</figcaption>
</figure>
<h2>We’ll know in 18 months</h2>
<p>In a new study being launched at the University of Bath, my colleagues and I now want to explore the effects of ketone drinks on health in older adults.</p>
<p>As we age, our immune, metabolic and cognitive systems naturally decline, leading to frailty and increased risk of disease. These changes can lower quality of life and reduce healthspan – the number of years we live in good health. This new study aims to investigate whether consuming a ketone drink three times a day for four weeks can improve physical and cognitive health in older adults.</p>
<p>During the experiment, participants will undergo tests over two weeks (to establish their baseline measurements) before starting the four-week supplementation period. During this time, they will consume either a ketone drink or a placebo three times a day, while their blood sugar control, physical activity and heart rate are monitored. </p>
<p>Before and after the supplementation period, we will collect blood, breath and fat tissue samples to measure markers of metabolic health, inflammation and immune function. Participants will also complete cognitive tests, physical function assessments and quality-of-life questionnaires.</p>
<p>The ketone drink we have chosen for this study uses a ketone monoester, which is widely used in human studies because of its ability to rapidly raise blood ketone levels. But it has some drawbacks. It has an unpleasant taste, which means people might drop out, and it’s expensive.</p>
<p>While two and four weeks of ketone supplementation has shown positive outcomes in adults with obesity and with type 2 diabetes, there is a lack of supplementation studies focused on older adults. Also, the effects of regular ketone supplementation on our fat tissue, a key contributor to low-level chronic inflammation in ageing, remain unexplored. </p>
<p>The results of this study, expected in 18 months, will shed light on these important areas.</p>
<p>With global populations increasingly ageing, finding ways to help people live healthier for longer is becoming ever more pressing. Ketone drinks could be part of the solution, allowing us to tap some of the benefits of fasting and ketogenic diets without enduring dietary restrictions. </p>
<p>As we continue to recruit participants for our study, we are excited to explore the potential for ketone drinks to help people age better. This study aims to offer a “proof of principle”, which we hope will contribute to the research in this exciting field.</p><img src="https://counter.theconversation.com/content/209908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anna Nicholas receives funding from the Biotechnology and Biological Sciences Research Council (BBSRC). </span></em></p>Ketone drinks are all the rage among elite athletes, but can they help older adults age better?Anna Nicholas, PhD Candidate in Nutrition & Metabolism, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048012023-06-05T02:11:04Z2023-06-05T02:11:04ZHot flushes, night sweats, brain fog? Here’s what we know about phytoestrogens for menopausal symptoms<figure><img src="https://images.theconversation.com/files/528787/original/file-20230529-15-uxzrwj.jpg?ixlib=rb-1.1.0&rect=35%2C11%2C7904%2C5273&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-walking-towards-shelf-searching-cold-1847405071">Shutterstock</a></span></figcaption></figure><p>While some women glide through menopause, <a href="https://pubmed.ncbi.nlm.nih.gov/26271251/">more than 85%</a> experience one or more unpleasant symptoms, which can impact their physical and mental health, daily activities and quality of life. </p>
<p>Hot flushes and night sweats are the most common of these, affecting <a href="https://pubmed.ncbi.nlm.nih.gov/29393299/">75% of women</a> and the symptom for which most women seek treatment. Others include changes in weight and body composition, skin changes, poor sleep, headaches, joint pain, vaginal dryness, depression and brain fog. </p>
<p>While menopause hormone therapy is the most effective treatment for menopausal symptoms, it is sometimes not recommended (such as following breast cancer, as there is conflicting evidence about the safety of menopause hormone therapy following breast cancer) or avoided by people, who may seek non-hormonal therapies to manage symptoms. In Australia it is estimated <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">more than one-third</a> of women seek complementary or alternative medicines to manage menopausal symptoms. </p>
<p>But do they work? Or are they a waste of time and considerable amounts of money?</p>
<h2>What’s on the market?</h2>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/30868921/">complementary or alternative interventions</a> for menopausal symptoms are almost as varied as the symptoms themselves. They include everything from mind-body practices (hypnosis, cognitive behavioural therapy and meditation) to alternative medicine approaches (traditional Chinese medicine and acupuncture) and natural products (herbal and dietary supplements). </p>
<p>There is some evidence to support the use of <a href="https://pubmed.ncbi.nlm.nih.gov/23435026/">hypnosis</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/22336748/">cognitive behaviour therapy</a> for the treatment of hot flushes. Indeed these therapies are recommended in <a href="https://www1.racgp.org.au/getattachment/bfaa5918-ddc4-4bcb-93cc-d3d956c1bbfd/Making-choices-at-menopause.aspx">clinical treatment guidelines</a>. But there is less certainty around the benefit of other commonly used complementary and alternative medicines, particularly nutritional supplements. </p>
<p>The most popular <a href="https://pubmed.ncbi.nlm.nih.gov/26224187/">nutritional supplements</a> for hot flushes are phytoestrogens (or plant estrogens). This trend has been driven in part by <a href="https://www.dailymail.co.uk/femail/article-11915645/HRT-not-supplement-created-experts-women-RAVING-effects.html">supplement companies</a> that promote such agents as a safer or more natural alternative to hormone therapy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-long-does-menopause-last-5-tips-for-navigating-uncertain-times-195211">How long does menopause last? 5 tips for navigating uncertain times</a>
</strong>
</em>
</p>
<hr>
<h2>What are phytoestrogens?</h2>
<p>Phytoestrogens are plant-derived substances that can show oestrogen-like activity when ingested. </p>
<p>There are numerous types including isoflavones, coumestans and lignans. These can be consumed in the form of food (from whole soybeans, soy-based foods such as tofu and soy milk, legumes, wholegrains, flaxseeds, fruits and vegetables) and in commercially produced supplements. In the latter category, extracts from soy and red clover yield isoflavones and flaxseed gives us lignans. </p>
<p>Because declining oestrogen levels drive menopausal symptoms, the theory is that consuming a “natural”, plant-based substance that acts like oestrogen will provide relief.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Soy-rich foods on a table: edamame, soy milk, soy sauce" src="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528788/original/file-20230529-17-mh3zlk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Phytoestrogens can be consumed in foods like tofu or soy milk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soy-bean-tofu-other-products-187030769">Shutterstock</a></span>
</figcaption>
</figure>
<h2>What does the evidence say?</h2>
<p>In the case of isoflavones, initial support came from <a href="https://pubmed.ncbi.nlm.nih.gov/23562010/">epidemiological data</a> showing <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">women in Asian countries</a>, consuming a traditional, phytoestrogen-rich diet (that is, one including tofu, miso and fermented or boiled soybeans), experienced fewer menopausal symptoms than women in Western countries.</p>
<p>However, several factors may influence the effect of dietary phytoestrogens on menopausal symptoms. This includes gut microbiota, with research showing only around <a href="https://pubmed.ncbi.nlm.nih.gov/15919681/">30% of women</a> from Western populations possess the gut microbiota needed to convert isoflavones to their active form, known as equol, compared to an estimated 50–60% of menopausal women from Japanese populations. </p>
<p>Circulating oestrogen levels (which drop considerably during menopause) and the <a href="https://academic.oup.com/humupd/article/11/5/495/605995">duration of soy intake</a> (longer-term intake being more favourable) may also influence the effect of dietary phytoestrogens on menopausal symptoms. </p>
<p>Overall, evidence regarding the benefit of phytoestrogens for hot flushes is fairly mixed. A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001395.pub4/full">Cochrane review</a> synthesised study results and failed to find conclusive evidence phytoestrogens, in food or supplement form, reduced the frequency or severity of hot flushes or night sweats in perimenopausal or postmenopausal women. </p>
<p>The review did note genistein extracts (an isoflavone found in soy and fava beans) may reduce the number of hot flushes experienced by symptomatic, postmenopausal women, though to a lesser extent than hormone therapy. </p>
<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/36253903/">recent study</a> showed marked reductions in hot flushes in women following a low fat, vegan diet supplemented with daily soybeans. However, it was questioned whether concurrent weight loss contributed to this benefit. </p>
<p>In Australia, <a href="https://ranzcog.edu.au/wp-content/uploads/2022/05/Managing-menopausal-symptoms.pdf">clinical guidelines</a> do not endorse the routine use of phytoestrogens. <a href="https://www.nice.org.uk/guidance/ng23/chapter/Recommendations#managing-short-term-menopausal-symptoms">Guidelines for the United Kingdom</a> note some support for the benefit of isoflavones, but highlight multiple preparations are available, their safety is uncertain and interactions with other medicines have been reported. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308">Is menopause making me put on weight? No, but it's complicated</a>
</strong>
</em>
</p>
<hr>
<h2>Can phytoestrogens help the psychological symptoms of menopause?</h2>
<p>Less research has explored whether phytoestrogens improve psychological symptoms of menopause, such as depression, anxiety and <a href="https://theconversation.com/brain-fog-during-menopause-is-real-it-can-disrupt-womens-work-and-spark-dementia-fears-173150">brain fog</a>. </p>
<p>A recent systematic review and <a href="https://pubmed.ncbi.nlm.nih.gov/33987926/">meta-analysis</a> found phytoestrogens reduce depression in post- but not perimenopausal women. Whereas a more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9022873/">recent clinical trial</a> failed to find an improvement. </p>
<p>Some research suggests phytoestrogens may reduce the <a href="https://www.sciencedirect.com/science/article/pii/S0960076015301254?via=ihub">risk of dementia</a>, but there are no conclusive findings regarding their effect on menopausal brain fog.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1472645519080149004"}"></div></p>
<h2>The bottom line</h2>
<p>At present there is uncertainty about the benefit of phytoestrogens for menopause symptoms. </p>
<p>If you do wish to see if they might work for you, start by including more phytoestrogen-rich foods in your diet. Examples include tempeh, soybeans, tofu, miso, soy milk (from whole soybeans), oats, barley, quinoa, flaxseeds, sesame seeds, sunflower seeds, almonds, chickpeas, lentils, red kidney beans and alfalfa. </p>
<p>Try including one to two serves per day for around three months and monitor symptoms. These are nutritious and good for overall health, irrespective of the effects on menopausal symptoms. </p>
<p>Before you trial any supplements, discuss them first with your doctor (especially if you have a history of breast cancer), monitor your symptoms for around three months, and if there’s no improvement, stop taking them.</p><img src="https://counter.theconversation.com/content/204801/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Caroline Gurvich has received funding from the NHMRC, the Rebecca Cooper Foundation and Perpetuel Trustees.</span></em></p><p class="fine-print"><em><span>Jane Varney receives funding from the Medical Research Future Fund. </span></em></p><p class="fine-print"><em><span>Jayashri Kulkarni receives funding from NHMRC, and has received honoraria from Servier , Janssen, Lundbeck pharmaceutical industries. She has also received two honoraria from Swisse, H&H companies.</span></em></p>The most popular supplements for hot flushes are phytoestrogens (or plant estrogens). This trend has been partly driven by companies that promote them as a safer alternative to hormone therapy.Caroline Gurvich, Associate Professor and Clinical Neuropsychologist, Monash UniversityJane Varney, Senior Research Dietitian in the Department of Gastroenterology, Monash UniversityJayashri Kulkarni, Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2028292023-04-04T20:20:45Z2023-04-04T20:20:45ZPrime drinks aren’t suitable for children and pregnant women. Here’s why<figure><img src="https://images.theconversation.com/files/519151/original/file-20230403-14-8ognt5.jpg?ixlib=rb-1.1.0&rect=48%2C796%2C8003%2C4357&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/los-angeles-california-united-states-02012023-2275143831">Shutterstock</a></span></figcaption></figure><p>Prime drinks have been heavily promoted in Australia, leading to <a href="https://au.news.yahoo.com/woolworths-shoppers-in-frenzy-to-get-hands-on-cult-drink-prime-062849789.html">frenzied sales</a> in supermarkets, as well <a href="https://www.abc.net.au/news/2023-03-29/prime-logan-paul-ksi-drink-australian-schools-ban/102154550">bans in schools</a>. </p>
<p>Prime offers two products: one is marketed as a “hydration” drink, the other as an “energy” drink. The latter comes with a <a href="https://drinkprime.com/pages/faq">warning</a> it’s not suitable for people under 18 years of age, or pregnant or lactating women and isn’t legally sold in stores in Australia.</p>
<p>But both drinks may pose problems to under-18s and women who are pregnant or lactating. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1637195918595313665"}"></div></p>
<h2>What’s in Prime Energy?</h2>
<p>Prime Energy contains <a href="https://drinkprime.com/pages/faq">200 milligrams</a> of caffeine per can, which is equivalent to about two to three instant coffees. This caffeine content is roughly double what is <a href="https://www.foodstandards.gov.au/consumer/generalissues/pages/caffeine.aspx">legally allowed</a> for products sold in Australia. </p>
<p>Despite its name, Prime Energy drink contains only about 40 kilojoules from carbohydrates, which is one of our body’s key sources of energy. The “energy” in Prime Energy refers to the caffeine, which makes you feel more alert and lessens the perceived effort involved in any work you do. </p>
<p>Caffeine <a href="https://www.ais.gov.au/__data/assets/pdf_file/0003/1001379/Caffeine-Infographic-final.pdf">does provide performance benefits</a> for athletes aged over 18. However, given the high quantities in the drinks, there may be better ways to get caffeine in more appropriate doses. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-coffee-improve-your-workout-the-science-of-caffeine-and-exercise-92366">Can coffee improve your workout? The science of caffeine and exercise</a>
</strong>
</em>
</p>
<hr>
<h2>Caffeine is a concern during pregnancy</h2>
<p>Health guidelines recommend <a href="https://www.foodstandards.gov.au/consumer/generalissues/Pages/Caffeine.aspx">limiting</a> caffeine intake during pregnancy and while breastfeeding to below 200mg a day. </p>
<p>Theoretically, this drink alone, with 200mg of caffeine per can, should be fine. But practically, diets include many other sources of caffeine including coffee, tea, chocolate and cola drinks. Consumption of these alongside the energy drinks would increase the intake for pregnant women above this safety threshold. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=840&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=840&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=840&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1056&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1056&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518988/original/file-20230403-14-14bsg4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1056&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.foodstandards.gov.au/consumer/generalissues/Pages/Caffeine.aspx">FSANZ</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Why is caffeine a problem for fetuses and babies?</h2>
<p>Caffeine can cross the placenta into the growing fetus’s bloodstream. Fetuses can’t break down the caffeine, so it remains in their circulation. </p>
<p>As the pregnancy proceeds, the mother becomes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872737/">slower at clearing caffeine</a> from her metabolism. This potentially exposes the fetus to caffeine for longer. </p>
<p>Studies have shown a high intake of caffeine is associated with <a href="https://link.springer.com/article/10.1007/s10654-014-9944-x">growth restriction</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26026343/">reduced birth weight, preterm birth and stillbirth</a>. Some experts argue there is <a href="https://ebm.bmj.com/content/26/3/114">no safe limit of caffeine intake</a> during pregnancy. </p>
<p>With breastfeeding, <a href="https://adc.bmj.com/content/54/10/787.short">caffeine passes into the breast milk</a>. It remains in the baby’s circulation, as they’re unable to metabolise it. <a href="https://pubmed.ncbi.nlm.nih.gov/9849117/">Evidence shows</a> that caffeine may make babies more colicky, irritable and less likely to sleep.</p>
<h2>What about in kids?</h2>
<p>Children also have a limited ability to break down caffeine. Combined with their lighter body mass, a caffeine-based drink will have a more pronounced effect. </p>
<p>As such, safe caffeine levels are determined on a weight basis: <a href="https://www.foodstandards.gov.au/code/proposals/Documents/P1056%20SD1%201st%20CFS%20Safety%20Assessment.pdf">3mg per kg of body weight per day</a>. For example, children aged 9 to 13 years, who weigh no more than 40kg, should have no more than 120mg of caffeine per day. Those aged between 14 to 17 years who weigh less than 60kg should have no more than 180mg per day.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1640853762519728129"}"></div></p>
<p><a href="https://www.internationaljournalofcardiology.com/article/S0167-5273(15)30918-9/fulltext">Studies have shown</a> higher intakes increase the risk of heart problems, such as heart palpitations, chest pain, shortness of breath and fainting. This may reflect underlying heart rhythm problems, which have in some case ended up with <a href="https://www.internationaljournalofcardiology.com/article/S0167-5273(15)30918-9/fulltext">children and teenagers</a> presenting to hospital emergency departments.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-teens-taking-adhd-anxiety-and-depression-drugs-consume-energy-drinks-and-coffee-166864">Should teens taking ADHD, anxiety and depression drugs consume energy drinks and coffee?</a>
</strong>
</em>
</p>
<hr>
<h2>What about Prime Hydrate, which doesn’t contain caffeine?</h2>
<p>This drink contains branch chain amino acids, or BCAA, which the supplements industry promotes as helping gain muscle bulk. There are three BCAA: valine, leucine and isoleucine.</p>
<p>However, there is no evidence they provide any benefit. As such, the <a href="https://www.ais.gov.au/nutrition/supplements/group_c">Australian Institute of Sport</a> has concluded they are not an effective supplement for athletes. </p>
<p>Supplements in general are not recommended in <a href="https://www.nccih.nih.gov/health/dietary-and-herbal-supplements">children or pregnant women</a> as they have not been tested in these groups. </p>
<p>There is also concern about the impact of BCAA and how they may impact the growth of the fetus. A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178017/">scientific animal study</a> has shown altered patterns of growth with fetal mice. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551332/">No human studies</a> have examined BCAA and fetal growth, so that research needs to be done before recommendations can be given to pregnant women. They should avoid these ingredients in the absence of evidence.</p>
<p>Similarly, there has been no testing of these supplements in children under 18 years, so there is no guarantee of their safety. </p>
<p>Performance-enhancing sport supplements are <a href="https://journals.humankinetics.com/view/journals/ijsnem/24/5/article-p570.xml">not recommended</a> for children and adolescents, as they are still developing physically as well as refining and improving their sporting skills. </p>
<figure class="align-center ">
<img alt="Children running" src="https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519150/original/file-20230403-28-nwlh6e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Children shouldn’t use performance-enhacing supplements.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What does the science say about BCAA?</h2>
<p>Scientists have been investigating how BCAA affect adults. Circulating BCAA can affect carbohydrate metabolism in the muscle and therefore can <a href="https://www.mdpi.com/2072-6643/14/7/1454">change insulin sensitivity</a>. BCAA are elevated in adults with diet-induced obesity and are associated with <a href="https://www.mdpi.com/2072-6643/14/7/1454">increased future risk of type 2 diabetes</a>, even when scientists account for other baseline risk factors.</p>
<p>Adults with obesity and insulin resistance have been found to have higher levels of BCAA. <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.2047-6310.2012.00087.x">Emerging evidence suggests</a> children and adolescents with obesity also have higher levels of BCAA, which may predict future insulin resistance, a risk factor for diabetes. </p>
<p>However we don’t yet know if these elevated levels of BCAA in the blood are because people are overweight or obese, or if it plays a role in them becoming overweight or obese.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-athletes-really-need-protein-supplements-92773">Do athletes really need protein supplements?</a>
</strong>
</em>
</p>
<hr>
<p>The bottom line is we have clear evidence that caffeine is problematic for children and women who are pregnant and lactating. And there is emerging evidence BCAA may be also problematic.</p><img src="https://counter.theconversation.com/content/202829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Prime has two offerings: one is marketed as a ‘hydration’ drink, the other as an ‘energy’ drink. But what’s actually in them?Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983452023-02-02T12:23:35Z2023-02-02T12:23:35ZVitamins and supplements: what you need to know before taking them<figure><img src="https://images.theconversation.com/files/507046/original/file-20230130-20-x1ljxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Supitcha McAdam/Shutterstock </span></span></figcaption></figure><p>If you were to open your medicine cabinet right now, there’s a fair chance that you’d find at least one bottle of vitamins alongside the painkillers, plasters and cough syrup.</p>
<p>After all, people are definitely buying vitamins: in 2020, the global market for complementary and alternative medicines, which includes multivitamin supplements, had an estimated value of <a href="https://www.grandviewresearch.com/industry-analysis/complementary-alternative-medicine-market">US$82.27 billion</a>. The use of natural health products such as minerals and amino acids has <a href="https://journals.lww.com/nutritiontodayonline/Abstract/2007/03000/Why_People_Use_Vitamin_and_Mineral_Supplements.4.aspx">increased</a> – and continues to rise, partly driven by consumers’ buying habits during the COVID-19 pandemic.</p>
<p>People <a href="https://www.businesslive.co.za/bd/companies/healthcare/2021-02-08-native-sales-of-sas-vitamins-and-nutritional-supplements-boom/">sought out</a> vitamins C and D, as well as zinc supplements, as potential preventive measures against the virus – even though the <a href="https://www.health.harvard.edu/blog/do-vitamin-d-zinc-and-other-supplements-help-prevent-covid-19-or-hasten-healing-2021040522310">evidence</a> for their efficacy was, and <a href="https://pubmed.ncbi.nlm.nih.gov/35888660/#:%7E:text=Concluding%2C%20available%20data%20on%20the,trials%20(RCTs)%20are%20inconsistent">remains</a>, inconclusive. </p>
<p>Multivitamins and mineral supplements are easily accessible to consumers. They are often marketed for their health claims and benefits – sometimes unsubstantiated. But their potential adverse effects are not always stated on the packaging.</p>
<p>Collectively, vitamins and minerals are known as micronutrients. They are essential elements needed for our bodies to function properly. Our bodies can only produce micronutrients in small amounts or not at all. We get the bulk of these nutrients <a href="https://www.iprjb.org/journals/index.php/IJF/article/view/1024">from our diets</a>. </p>
<p>People usually buy micronutrients to protect against disease or as dietary “insurance”, in case they are not getting sufficient quantities from their diets. </p>
<p>There’s a common perception that these supplements are harmless. But they can be dangerous at incorrect dosages. They provide a false sense of hope, pose a risk of drug interactions – and can delay more effective treatment. </p>
<h2>Benefits</h2>
<p>Vitamins are beneficial if taken for the correct reasons and as prescribed by your doctor. For example, folic acid supplementation in pregnant women has been shown to prevent neural tube defects. And individuals who reduce their intake of red meat without increasing legume consumption require a vitamin B6 supplement. </p>
<p>But a worrying trend is increasing among consumers: intravenous vitamin therapy, which is often punted by celebrities and social media marketing. Intravenous vitamins, nutrients and fluids are administered at pharmacies as well as beauty spas, and more recently “<a href="https://www.health.harvard.edu/blog/drip-bar-should-you-get-an-iv-on-demand-2018092814899">IV bars</a>”. Users believe these treatments can quell a cold, slow the effects of ageing, brighten skin, fix a hangover or just make them feel well. </p>
<p>Intravenous vitamin therapy was previously only used in medical settings to help patients who could not swallow, needed fluid replacements or had an electrolyte imbalance. </p>
<p>However, the evidence to support other benefits of intravenous vitamin therapy is limited. No matter how you choose to get additional vitamins, there are risks. </p>
<h2>Warning bells</h2>
<p>Most consumers use multivitamins. But others take large doses of single nutrients, especially vitamin C, iron and calcium. </p>
<p>As lecturers in pharmacy practice, we think it’s important to highlight the potential adverse effects of commonly used vitamins and minerals: </p>
<ul>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-a/">Vitamin A/retinol</a> is beneficial in maintaining good eye health. But it can cause toxicity if more than 300,000IU (units) is ingested. Chronic toxicity (hypervitaminosis) has been <a href="https://www.ncbi.nlm.nih.gov/books/NBK532916/">associated</a> with doses higher than 10,000IU a day. Symptoms include liver impairment, loss of vision and intracranial hypertension. It can cause birth defects in pregnant women.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/niacin-vitamin-b3/">Vitamin B3</a> is beneficial for nervous and digestive system health. At moderate to high doses it can cause peripheral vasodilation (widening or dilating of the blood vessels at the extremities, such as the legs and arms), resulting in skin flushing, burning sensation, pruritis (itchiness of the skin) and hypotension (low blood pressure). </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-b6/">Vitamin B6</a> is essential for brain development and in ensuring that the immune system remains healthy. But it can result in damage to the peripheral nerves, such as those in the hands and feet (causing a sensation of numbness and often referred to as pins and needles) at doses over 200mg/daily.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-c/">Vitamin C</a> is an antioxidant and assists in the repair of body tissue. Taken in high doses it can cause kidney stones and interactions with drugs, such as the oncology drugs doxorubicin, methotrexate, cisplatin and vincristine. </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-d/">Vitamin D</a> is essential for bone and teeth development. At high doses it can cause hypercalcaemia (calcium level in the blood is above normal) that results in thirst, excessive urination, seizures, coma and death.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/calcium/#:%7E:text=Calcium%20is%20a%20mineral%20most,heart%20rhythms%20and%20nerve%20functions">Calcium</a> is essential for bone health, but can cause constipation and gastric reflux. High doses can cause hypercalciuria (increased calcium in the urine), kidney stones and secondary hypoparathyroidism (underactive parathyroid gland). It can have drug interactions with zinc, magnesium and iron. </p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/magnesium/">Magnesium</a> is important for muscle and nerve functioning. At high doses it can cause diarrhoea, nausea and abdominal cramping, and can interact with tetracyclines (antibiotics).</p></li>
<li><p>Zinc <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781367/">can impair</a> taste and smell, and doses over 80mg daily have been <a href="https://link.springer.com/article/10.1007/s10654-022-00922-0#:%7E:text=Zinc%20supplementation%20of%20more%20than,zinc%20supplements%20among%20adult%20men.">shown</a> to have adverse prostate effects.</p></li>
<li><p><a href="https://www.hsph.harvard.edu/nutritionsource/selenium/">Selenium</a> can cause hair and nail loss or brittleness, lesions of the skin and nervous system, skin rashes, fatigue and mood irritability at high doses.</p></li>
<li><p><a href="https://www.sciencedirect.com/science/article/pii/S0098299720300364#:%7E:text=Expert%20guidelines%20for%20oral%20iron%20supplementation&text=Traditionally%2C%20the%20recommended%20daily%20dose,iron%20(Brittenham%2C%202018).">Iron</a> at 100-200mg/day can cause constipation, black faeces, black discoloration of teeth and abdominal pain.</p></li>
</ul>
<h2>Recommendations</h2>
<p>People need to make <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8377299/">informed decisions</a> based on evidence before consuming health products. </p>
<p>Regular exercise and a well-balanced diet are more likely to do us good, as well as being lighter on the pocket.</p>
<p>Seeking advice from a healthcare professional before consuming supplements can reduce the risk of adverse effects.</p>
<p>Be aware of the potential adverse effects of vitamins and seek a healthcare professional’s guidance if you have symptoms.</p><img src="https://counter.theconversation.com/content/198345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s a common perception that supplements are harmless. But they can be dangerous at incorrect dosages.Neelaveni Padayachee, Senior Lecturer, Department of Pharmacy and Pharmacology, University of the WitwatersrandVarsha Bangalee, Associate Professor, Pharmaceutical Sciences, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1946892022-12-07T13:53:51Z2022-12-07T13:53:51ZMosquitoes are not repelled by vitamins and other oral supplements you might take<figure><img src="https://images.theconversation.com/files/499541/original/file-20221207-11795-5gitd3.jpg?ixlib=rb-1.1.0&rect=1077%2C565%2C4913%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's only wishful thinking that you can ward off mosquitoes from within.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/aedes-aegypti-mosquito-close-up-a-mosquito-sucking-royalty-free-image/831023822">frank600/iStock via Getty Images Plus</a></span></figcaption></figure><p>A longstanding medical myth suggests that taking vitamin B1, also known as thiamine, can make your body repel mosquitoes.</p>
<p>A “<a href="http://doi.org/10.1001/jama.1966.03100160106030">systemic repellent</a>” that makes your whole body unappealing to biting insects certainly sounds good. Even if you correctly reject the <a href="https://doi.org/10.1186/s12936-020-03217-5">misinformation</a> questioning <a href="https://doi.org/10.4269/ajtmh.1998.59.323">safe</a> and <a href="https://doi.org/10.1056/nejm200207043470102">effective</a> <a href="https://www.epa.gov/insect-repellents/deet">repellents</a> like <a href="https://doi.org/10.1186/1756-3305-7-173">DEET</a>, oral repellents would still have the benefit that you wouldn’t need to worry about covering every inch of exposed skin or carrying containers of bug spray whenever you venture into the great outdoors.</p>
<hr>
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<hr>
<p>Along with thiamine, other alleged oral mosquito repellents include <a href="https://doi.org/10.1055/s-0039-3399744">brewer’s yeast</a>, which contains thiamine, and <a href="https://doi.org/10.1001/jama.285.1.39">garlic</a>, the legendary <a href="https://europepmc.org/article/med/7825135">vampire repellent</a>.
If oral repellents sound too good to be true, it’s because they are. </p>
<p><a href="https://scholar.google.com/citations?user=TSIGUnYAAAAJ&hl=en&oi=ao">As a professor of entomology</a> in Taiwan, where the mosquito-transmitted Dengue virus is endemic, I was curious what science really says about food-based repellents. After a very deep dive into the literature and reading practically every paper ever written on the subject, I compiled this knowledge into the first <a href="https://doi.org/10.1017/S0007485321001176">systematic review</a> of the subject.</p>
<p>The scientific consensus is, unequivocally, that oral repellents don’t exist. Despite <a href="https://doi.org/10.5281/zenodo.7403167">extensive searches</a>, no <a href="http://doi.org/10.1371/journal.pntd.0006247">food, supplement</a>, <a href="https://doi.org/10.4269/ajtmh.1968.17.461">medication, or condition</a> has ever been proven to make people repellent. People with vitamin B1 deficiency don’t attract more mosquitoes, either. </p>
<p>So where did the myth that mosquitoes hate vitamins come from, and why is it so hard to exterminate?</p>
<h2>Making of a myth</h2>
<p>In 1943, Minnesota pediatrician <a href="https://doi.org/10.5281/zenodo.7313319">W. Ray Shannon</a> gave 10 patients varying doses of thiamine, which had only <a href="https://doi.org/10.1159/000343109">first been synthesized</a> seven years prior. They reported back that it relieved itching and prevented further mosquito bites. In 1945, California pediatrician <a href="https://doi.org/10.5281/zenodo.7403108">Howard Eder</a> claimed 10 milligram doses could protect people from fleas. In Europe in the 1950s, physician <a href="https://doi.org/10.5281/zenodo.7403124">Dieter Müting</a> claimed that daily 200 milligram doses kept him bite-free while vacationing in Finland, and hypothesized a breakdown product of thiamine was expelled through the skin.</p>
<p>These findings drew rapid attention, and almost immediate repudiation. The U.S. Naval Medical Research Institute <a href="https://doi.org/10.1126/science.100.2590.147.a">tried to replicate Shannon’s findings, but failed</a>. By 1949, Californians using thiamine to repel fleas from dogs were reporting it as “<a href="https://doi.org/10.1001/archderm.1949.01530070124012">completely worthless</a>.” Controlled studies from <a href="https://pubmed.ncbi.nlm.nih.gov/13568728/">Switzerland</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/4733214/">Liberia</a> repeatedly failed to find any effects at any dose. The first <a href="https://doi.org/10.5281/zenodo.7403142">clinical trial</a> in 1969 concluded definitively that “vitamin B1 is not a systemic mosquito repellent in man,” and <a href="https://doi.org/10.2987/8756-971X(2005)21%5B213:TVBAAH%5D2.0.CO;2">all controlled studies since</a> suggest the same for thiamine, <a href="https://pubmed.ncbi.nlm.nih.gov/6885593/">brewer’s yeast</a>, <a href="https://doi.org/10.1111/j.0269-283X.2005.00544.x">garlic</a>, and <a href="https://doi.org/10.1024/0040-5930.62.11.713">other</a> <a href="https://doi.org/10.1093/pch/19.6.326">alternatives</a>. </p>
<p>The evidence was so overwhelming that, in 1985, the <a href="https://doi.org/10.1016/B978-0-323-54696-6.00006-9">U.S. Food and Drug Administration declared</a> all oral insect repellents are “<a href="https://tile.loc.gov/storage-services/service/ll/fedreg/fr050/fr050116/fr050116.pdf#page=140">not generally recognized as safe and effective and are misbranded</a>,” making labeling supplements as repellents technically fraud.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="foods including egg, lentils, nuts and a " src="https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499542/original/file-20221207-27-o3hgzd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Along with being in poultry and pork, B1 is found in many whole grains and legumes.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/products-and-ingredients-containing-vitamin-b1-and-royalty-free-image/668509672">ratmaner/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Medical mechanisms aren’t there</h2>
<p>Scientists know much more about both mosquitoes and vitamins today than ever before.</p>
<p>Vitamin B1 <a href="https://www.ncbi.nlm.nih.gov/books/NBK482360/">does not break down in the body</a> and has <a href="https://doi.org/10.1021/bi401618y">no known effect on skin</a>. The body strongly regulates it, absorbing little ingested thiamine after the first 5 milligrams and <a href="https://doi.org/10.1177/0884533611426149">quickly excreting any excess</a> via urine, so it <a href="https://doi.org/10.1177/0885066616659429">does not build up</a>. Overdose is almost impossible.</p>
<p>As in humans, thiamine is an <a href="https://doi.org/10.1093/aesa/70.4.541">essential nutrient</a> <a href="https://doi.org/10.1093/aesa/52.1.26">for mosquitoes</a>. There is no reason they would fear it or try to avoid it. Nor is there evidence that they can smell it.</p>
<p>The best sources of thiamine are <a href="https://doi.org/10.3390/nu12092810">whole grains, beans, pork, poultry and eggs</a>. If eating a carnitas burrito won’t make you repel mosquitoes, then neither should a pill.</p>
<p>What explains the early reports, then? Along with shoddy experimental design, many used anecdotal patient reports of fewer bite symptoms as a proxy for reduced biting, which is not a good way to get an accurate picture of what’s going on.</p>
<p>Mosquito bites are followed by <a href="https://doi.org/10.1111/j.1346-8138.1989.tb01251.x">two reactions</a>: an immediate reaction that starts fast and lasts hours and a delayed reaction lasting days. The presence and intensity of these reactions depends not on the mosquito, but on your own immune system’s familiarity with that particular species’ saliva. With age and continued exposure, the body goes from no reaction, to delayed reaction only, to both, to immediate reaction only, and eventually no reaction.</p>
<p>What Shannon and others thought was repellency could have been <a href="https://doi.org/10.3109/07853899409147906">desensitization</a>: The patients were still getting bitten, they just stopped showing symptoms.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman with backpack in woods sprays her arm" src="https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499543/original/file-20221207-27-w8izk8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Applying a safe and effective insect repellent to your skin is a proven way to ward off mosquitoes and their bites.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-applies-mosquito-spray-to-her-hands-during-royalty-free-image/1404334863">SimpleImages/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>So, what’s the problem?</h2>
<p>Despite the scientific consensus, a 2020 survey of pharmacists in <a href="https://doi.org/10.3390/pharmacy8020094">Australia</a> found that 27% were still recommending thiamine as a repellent to patients traveling abroad: an unacceptable recommendation. Besides wasting money, people relying on vitamins as protection against mosquitoes can still get bitten, potentially putting them at risk of <a href="https://doi.org/10.1001/jama.296.18.2234">diseases</a> like <a href="https://doi.org/10.1155/2003/158926">West Nile</a> and <a href="https://doi.org/10.2310/7060.2000.00074">malaria</a>.</p>
<p>To get around the American ban and widely agreed-upon scientific consensus on oral repellents, some unscrupulous dealers are making thiamine patches or even injections. Unfortunately, while thiamine is safe if swallowed, it <a href="https://doi.org/10.1016/j.alit.2022.01.004">can</a> <a href="https://doi.org/10.1016/S0196-0644(89)80215-X">cause</a> <a href="https://doi.org/10.1016/S0091-6749(95)70111-7">severe</a> <a href="https://doi.org/10.1001/jama.1941.72820340003008a">allergic</a> <a href="https://doi.org/10.1001/archderm.1950.01530120149018">reactions</a> when taken by other routes. <a href="https://doi.org/10.1016/j.actatropica.2012.10.009">These products</a> are thus not only <a href="https://doi.org/10.1093/jisesa/iev125">worthless</a>, but also potentially dangerous.</p>
<p>Not every problem can be solved with food. Long sleeves and <a href="https://doi.org/10.7326/0003-4819-128-11-199806010-00013">bug spray</a> <a href="http://doi.org/10.1056/NEJMoa011699">containing DEET</a>, <a href="http://npic.orst.edu/ingred/picaridin.html">picaridin</a> or <a href="https://www.epa.gov/insect-repellents/skin-applied-repellent-ingredients">other proven repellents</a> are still your best defense against biting pests.</p><img src="https://counter.theconversation.com/content/194689/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matan Shelomi does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A medical myth persists that the B vitamin thiamine is a systemic insect repellent that wards off mosquitoes when taken orally. But scientists have disproven this mistaken belief again and again.Matan Shelomi, Associate Professor of Entomology, National Taiwan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1841512022-08-29T05:13:46Z2022-08-29T05:13:46ZCan supplements or diet reduce symptoms of arthritis? Here’s what the evidence says<figure><img src="https://images.theconversation.com/files/480522/original/file-20220823-14-oll0pn.jpg?ixlib=rb-1.1.0&rect=48%2C19%2C6420%2C3302&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-cooking-kitchen-preparation-dinner-concept-335469521">Shutterstock</a></span></figcaption></figure><p><a href="https://www.healthdirect.gov.au/arthritis">Arthritis is a disease</a> that affects body joints. There are more than <a href="https://arthritisaustralia.com.au/what-is-arthritis/">100 types</a> of arthritis, with more than <a href="https://globalranetwork.org/project/disease-info/">350 million people</a> affected around the globe, including about <a href="https://arthritisaustralia.com.au/what-is-arthritis/fastfacts/">four million Australians</a>.</p>
<p>Arthritis causes pain and disability and commonly reduces quality of life. In Australia in 2015, about <a href="https://pubmed.ncbi.nlm.nih.gov/29793478/">54,000 people aged 45–64</a> couldn’t work due to severe arthritis. Their median income was only a quarter of the income of full-time workers who did not have arthritis.</p>
<p>So it is not surprising some people want to try different diets, supplements or therapies to see if they alleviate symptoms or help them gain a <a href="https://pubmed.ncbi.nlm.nih.gov/30024952/">sense of control</a> over their condition. </p>
<p>However, a <a href="https://pubmed.ncbi.nlm.nih.gov/35654458/">major review</a> found specific supplements or food components were unlikely to lead to <em>significant</em> improvements in arthritis outcomes such as stiffness, pain and function.</p>
<p>The main nutrition recommendation was to adopt healthy eating patterns.</p>
<h2>Remind me, what causes arthritis? And what are the symptoms?</h2>
<p><a href="https://www.cdc.gov/arthritis/basics/risk-factors.htm">Risk factors</a> for developing arthritis include ones you can’t control – such as genetics, sex, and age – and some you may be able to, such as smoking, repetitive injuries, body weight, occupation and some infections. </p>
<p>Types of arthritis include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, juvenile arthritis, gout, systemic lupus erythematosus (lupus) and scleroderma. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/arthritis-isnt-just-a-condition-affecting-older-people-it-likely-starts-much-earlier-67698">Arthritis isn't just a condition affecting older people, it likely starts much earlier</a>
</strong>
</em>
</p>
<hr>
<p>Common <a href="https://arthritisaustralia.com.au/what-is-arthritis/understanding-arthritis/">symptoms include</a>:</p>
<ul>
<li>pain</li>
<li>stiffness or reduced joint movement</li>
<li>swelling, redness and warmth in the joints.</li>
</ul>
<p>Less specific symptoms include tiredness, weight loss or feeling unwell. </p>
<h2>So what does the evidence say about supplements?</h2>
<p>The <a href="https://www.eular.org/index.cfm">European Alliance of Associations for Rheumatology</a>, the expert European group on arthritis, recently published a detailed critique on <a href="https://pubmed.ncbi.nlm.nih.gov/35654458/">diet and supplement use in arthritis</a>. It synthesised findings from 24 systematic reviews of existing research as well as an additional 150 extra studies, covering more than 80 different dietary components and supplements. </p>
<p>The alliance identified there were limited studies on each individual product with the majority of studies being of low quality. This means that for most supplements they couldn’t make recommendations about whether or not to use them. </p>
<figure class="align-center ">
<img alt="Woman drinks water" src="https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481007/original/file-20220825-15-gs7h42.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most research on supplements is of low quality.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/PcU17evKnew">Engin Akyurt/Unsplash</a></span>
</figcaption>
</figure>
<p>However, for osteoarthritis and rheumatoid arthritis, although most studies were of low or moderate quality, a few supplements had positive effects. </p>
<p><strong>Vitamin D, chondroitin and glucosamine</strong></p>
<p>For osteoarthritis, there was moderate-quality evidence supporting a small positive effect on pain and function for taking vitamin D, chondroitin and glucosamine (both compounds found in cartilage) supplements. </p>
<p>Here, moderate quality means although the studies had some limitations and their results should be interpreted with caution, they can be used to guide recommendations. </p>
<p>This suggests people could choose to try these common supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement in their symptoms. </p>
<p><strong>Fish oil</strong></p>
<p>For rheumatoid arthritis, there was moderate quality evidence for a small positive effect on pain for omega-3 (fish) oils.</p>
<p>Again, people could try these supplements for a few months and see whether they get any benefit, but stop taking them if there is no improvement. </p>
<p><strong>Other supplements</strong></p>
<p>For all other arthritis categories, and other specific dietary components or supplements, the evidence was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9096533/">rated</a> as low to very low (<a href="https://rmdopen.bmj.com/content/8/2/e002167.long">see tables 1–5 in this link</a>). </p>
<p>This means any improvements in arthritis outcomes could be due to chance or bias, with positive results more likely to be published, or potential bias occurring when a trial was sponsored by a supplement manufacturer. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-taking-glucosamine-for-my-arthritis-so-whats-behind-the-new-advice-to-stop-131648">I'm taking glucosamine for my arthritis. So what's behind the new advice to stop?</a>
</strong>
</em>
</p>
<hr>
<h2>What does it all mean?</h2>
<p>Current research indicates it’s unlikely specific foods, supplements or dietary components affect arthritis outcomes to a large degree. </p>
<p>However, given the <a href="https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(22)01349-6.pdf">higher risk for heart disease</a> associated with arthritis, the <a href="https://pubmed.ncbi.nlm.nih.gov/35260387/">recommendation</a> is to have a healthy diet and <a href="https://pubmed.ncbi.nlm.nih.gov/35260387/">lifestyle</a> in order to improve your overall health and wellbeing. </p>
<p>So how do you improve your health and wellbeing? Here are four key things to consider: </p>
<h2>1. Eat a healthy, varied diet</h2>
<figure class="align-center ">
<img alt="Bowl of vegetables and eggs" src="https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481005/original/file-20220825-17-pqwx4b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prioritise eating healthy food, rather than taking supplements.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/jUPOXXRNdcA">Brooke Lark/Unsplash</a></span>
</figcaption>
</figure>
<p>Eating food – rather than taking supplements – means you get the other nutrients that foods contain, including healthy sources of fat, protein, dietary fibre and a range of vitamin and minerals essential to maintain a healthy body. </p>
<p>This is why the recommendation for people with arthritis is to eat a healthy diet, because vegetables, fruit, legumes and wholegrains contain a range of <a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">phytonutrients</a> needed to help dampen down oxidative stress triggered by inflammatory processes associated with arthritis.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
</strong>
</em>
</p>
<hr>
<p>A healthy diet includes foods rich in omega-3 fats such as fatty fish (salmon, tuna, sardines), chia seeds, flaxseed oil, walnuts, canola oil, and vitamin D (eggs, fish, and milk or margarine fortified with vitamin D). And don’t forget <a href="https://www.cancer.org.au/cancer-information/causes-and-prevention/sun-safety/vitamin-d">sun exposure</a>, which allows the body to produce vitamin D. </p>
<h2>2. Avoid alcohol</h2>
<p>Alcohol intake should be discussed with your doctor as it can interact with other treatments. </p>
<p>Small amounts of alcohol are unlikely to have negative impacts on arthritis, <a href="https://pubmed.ncbi.nlm.nih.gov/35260387/">unless you have other health issues</a> like liver disease or you take certain medications such as <a href="https://www.nps.org.au/medicine-finder/dbl-methotrexate-tablets">methotrexate</a> or <a href="https://www.nps.org.au/medicine-finder/leflunomide-apotex-tablets">leflunomide</a>. </p>
<p>For rheumatoid arthritis, moderate alcohol consumption could <a href="https://pubmed.ncbi.nlm.nih.gov/35260387/">increase the risk of arthritis flare ups</a>. </p>
<p>Alcohol can also increase the risk of gout flare ups.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-gout-heres-what-to-eat-and-avoid-50239">Got gout? Here's what to eat and avoid</a>
</strong>
</em>
</p>
<hr>
<h2>3. Aim for a healthy weight</h2>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/35260387/">Aiming for a healthy weight</a> can help arthritis by reducing the load on affected joints such as hips and knees, and by boosting your intake of healthy foods rich in phytonutrients. </p>
<p>Ask your doctor for support to achieve well managed, intentional weight loss if you’re carrying excess weight. You may need referral to an accredited practising dietitian for personalised medical nutrition therapy or to a physiotherapist or exercise physiologist for specific help to improve mobility and physical activity.</p>
<figure class="align-center ">
<img alt="Older person walks in the bush" src="https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481006/original/file-20220825-239-dw2s7a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Achieving a healthy weight reduces the load on joints.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/u7xln_gMQyY">Olia Gozha/Unsplash</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">Health Check: what's the best diet for weight loss?</a>
</strong>
</em>
</p>
<hr>
<h2>4. Be cautious with supplements</h2>
<p>If you decide to try specific complimentary therapies or dietary supplements, discuss potential side-effects or interactions with your regular medicines with your doctor and pharmacist. </p>
<p>Try the products for a few months (or as long as one container lasts) so you can monitor any side-effects versus your sense of wellbeing, reduction in use of pain medications and the cost. If you’re not getting any benefit then spend that money on more healthy foods instead.</p>
<p><em>Find out how healthy your diet is by taking our free <a href="https://nomoneynotime.com.au/">Healthy Eating Quiz</a>.</em></p><img src="https://counter.theconversation.com/content/184151/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is a Laureate Professor in Nutrition and Dietetics at the University of Newcastle, NSW and a Hunter Medical Research Institute (HMRI) affiliated researcher. She is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from NHMRC, ARC, MRFF, HMRI, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>A major review found specific supplements or food components were unlikely to lead to significant improvements in stiffness, pain and function.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1863572022-07-05T09:56:20Z2022-07-05T09:56:20ZMyrkl: new anti-hangover pill said to break down up to 70% of alcohol in an hour – what you need to know<figure><img src="https://images.theconversation.com/files/472460/original/file-20220705-13-sc4t9w.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drunk-people-party-777424762">Rawpixel/Shutterstock</a></span></figcaption></figure><p>A new anti-hangover supplement has just <a href="https://www.telegraph.co.uk/news/2022/07/04/hangover-prevention-pill-breaks-alcohol-body-goes-sale/">gone on sale</a> in the UK. It is marketed by Swedish firm Myrkl as “the pre-drinking pill that works”.</p>
<p>The pill is said to break down up to 70% of alcohol after 60 minutes. This means that if someone drinks 50ml of 40% spirits, which contains 20ml of pure alcohol, as little as 6ml of the alcohol will enter the bloodstream. This is the same as the person only drinking 15ml of spirits. </p>
<p>This reduction in the amount of alcohol absorbed by the body is mirrored by a reduction in the short-term effects of alcohol, such as euphoria and reduced anxiety. </p>
<p>The company that makes this supplement recommends that two pills are taken one to 12 hours before drinking alcohol.</p>
<p>The probiotic supplement contains two gut-friendly bacteria – <em>Bacillus subtilis</em> and <em>Bacillus coagulans</em> – produced from fermented rice bran. These bacteria naturally break down alcohol into water and carbon dioxide. An acid-resistant capsule protects the bacteria from the stomach’s natural acids so they can reach the intestine where most alcohol is absorbed into the bloodstream.</p>
<h2>What the science says</h2>
<p>The pill is aimed at those who do not want a hangover after drinking the day before. But can these pills really prevent a hangover? </p>
<p>A hangover is mainly due to the <a href="https://www.mayoclinic.org/diseases-conditions/hangovers/symptoms-causes/syc-20373012">dehydrating effects of alcohol</a>, which can give a headache. The direct effect of alcohol on the stomach can also cause a sore stomach and nausea. If less alcohol is taken into the body, the risks of being dehydrated are less. But since the pills only work after alcohol has passed through the stomach to the intestine, they will not stop alcohol’s effect on the stomach.</p>
<figure class="align-center ">
<img alt="A man holds his stomach in pain." src="https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/472493/original/file-20220705-20-bhtg7f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pills won’t stop alcohols effect on the stomach.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abdominal-pain-headache-unhappy-black-man-1619920417">Prostock-studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>The evidence for Myrkl is based on a <a href="https://journals.sagepub.com/doi/pdf/10.1177/11786388221108919">single published research study</a>. Twenty-four healthy young white adults were asked to take either two Myrkl pills or dummy pills (placebo) each day for seven days. They were then given a small amount of alcohol (between 50 and 90ml of spirits) based on their weight. Their blood alcohol level was tested for the next two hours. </p>
<p>The researchers found that within the first 60 minutes, the amount of alcohol in the blood was 70% lower in those who received Myrkl compared with the dummy pill.</p>
<p>Although this study was well designed, including randomly allocating people to the Myrkl or dummy pill groups, several problems make the results weaker. First, the researchers only reported results from 14 of the 24 people because ten had lower blood alcohol levels at the start. </p>
<p>Second, results varied between different people, which reduces the accuracy of the study. And third, the researchers tested seven days of treatment before a single drink of alcohol, but the company recommend only two pills one to 12 hours before drinking any amount.</p>
<p>The study also leaves many unanswered questions. Does the pill work in people who are not young, healthy and white? Does it work in people with gut or liver disease? Are there differences in the effect of the pill between men and women? What happens when food and alcohol are taken together? Do medications change the action of the pills?</p>
<p>It is already known that friendly gut bacteria are changed by <a href="https://www.nature.com/articles/s41467-020-18871-1">long-term illnesses and lifestyle</a> (smoking, regular alcohol consumption and diet). It is also known that alcohol is absorbed differently according to <a href="https://pubmed.ncbi.nlm.nih.gov/1930365/">weight, sex, physical activity and food consumption</a>. These factors may reduce or increase the effect of the friendly bacteria in the Myrkl pills.</p>
<p>Probiotics are safe and widely available. They can be bought as yoghurts, drinks or pills from many supermarkets and health food shops. The two bacteria in the Myrkl pills are also likely to be safe for most people. Yet probiotics given to people with illnesses can upset the natural balance of healthy gut bacteria causing <a href="https://pubmed.ncbi.nlm.nih.gov/25922398/">infection or gut symptoms</a>.</p>
<p>A pre-drinking pill to prevent the hangover the next day would be of benefit to some people. However, with all the unanswered questions around Myrkl, the best cure for a hangover remains drinking less alcohol the day before.</p><img src="https://counter.theconversation.com/content/186357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashwin Dhanda does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Could a new probiotic supplement really cure your hangover?Ashwin Dhanda, Honorary Associate Professor, Hepatology, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1790532022-03-17T11:07:28Z2022-03-17T11:07:28ZMelatonin: should I take it to help me sleep?<figure><img src="https://images.theconversation.com/files/452419/original/file-20220316-17-1995law.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5991%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/belgrade-serbia-april-2018-5mg-melatonin-1079372021">TB photo/Shutterstock</a></span></figcaption></figure><p>I have been a doctor for over 20 years, 12 of which were dedicated exclusively to the practice of sleep medicine. Over the years, I have seen an enormous increase in the use of melatonin by my patients and their families. Although melatonin has helped many of my patients, there are some concerns that I have that are worth sharing. </p>
<p>First, I am not sure most of my patients that took melatonin before my clinical evaluation knew exactly what melatonin was. <a href="https://theconversation.com/uk/topics/melatonin-15404">Melatonin</a> is a hormone produced by a gland in the brain called the pineal gland. The main function of melatonin is sleep regulation. </p>
<p>Melatonin levels increase in response to darkness, telling the brain that night has arrived and it is time to sleep. When there is bright light, as in the morning, melatonin production shuts down and the brain knows that it is daytime. </p>
<p>The day-night regulation properties of melatonin and light make them the two key factors in the establishment of the internal sleep-wake clock, or what is called the “circadian cycle”. </p>
<figure class="align-center ">
<img alt="The pineal gland" src="https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=504&fit=crop&dpr=1 600w, https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=504&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=504&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/452442/original/file-20220316-17-1ft40ke.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pea-sized pineal gland regulates the sleep-wake cycle.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/pineal-gland-labeled-diagram-166170098">Alila Medical Media/Shutterstock</a></span>
</figcaption>
</figure>
<p>A circadian disorder occurs when there is a mismatch between the internal clock and the socially accepted time to go to sleep or to wake up, as is seen when someone travels across time zones and has jet lag. But jet lag sometimes can occur in the absence of travel. For example, when you remain in an environment of bright lights until late hours of the night, you fool your brain into thinking that it is still daytime. In this case, melatonin production does not occur and you don’t feel sleepy until the late hours of the night, or sometimes early hours in the morning. </p>
<p>I have seen many teenagers come to my clinic because they can’t sleep until 2am or 3am, but they’re up watching videos on their electronic devices until late at night.</p>
<p>I usually recommend my patients turn the lights off at a reasonable time and expect sleepiness to start occurring within one hour. But it takes time for the natural clock to adjust to a new schedule, and often my patients prefer to use a melatonin supplement to quicken the circadian time adjustment.</p>
<p>With the increase in use of electronic devices, sleep disorders have <a href="https://pubmed.ncbi.nlm.nih.gov/30577441/">become quite common</a> and melatonin use has increased. Because of its sleep-promoting properties, melatonin is also an incredibly attractive option for people who suffer from insomnia or sleep disruption. </p>
<h2>Over-the-counter melatonin</h2>
<p>In some countries, such as the US, melatonin can be bought without a prescription. This situation concerns me because a lack of regulation can mean an increased risk of taking a different dose or ingredients than those reported. In fact, a study of melatonin supplements found that the <a href="https://pubmed.ncbi.nlm.nih.gov/27855744/">content of the hormone</a> ranged from -83% to +478% of the labelled content. The researchers also found other substances that were not reported to be in the preparation, including serotonin and valerian. </p>
<p>In the EU, the UK and Australia, melatonin is obtained <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5263069/#:%7E:text=OTC%20melatonin%20has%20been%20banned,medicine%2C%20available%20only%20by%20prescription.">only by prescription</a> for the short-term treatment of insomnia. This approach allows for better regulation, understanding and explanation of risks, benefits and alternatives to the use of melatonin. </p>
<p>Even though melatonin is a naturally occurring hormone, it does not come without side-effects, the most common being <a href="https://www.nhs.uk/medicines/melatonin/">headaches and dizziness</a>. It can <a href="https://pubmed.ncbi.nlm.nih.gov/12076414/">also interact</a> with other medicines, such as anticoagulants (drugs that help prevent blood clots). </p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/30148726/">best evidence of safety</a> for the use of melatonin is for short-term use only (one to three months) and in low doses (0.5-1mg). The long-term effects of melatonin remain unknown. </p>
<p>Have I used melatonin or recommended it to my patients? Absolutely. But only when I know exactly what I am recommending it for. Insomnia can be a symptom of a sleep disorder like restless legs syndrome or obstructive sleep apnoea, or it can be a symptom of another condition, such as depression, asthma or pain. </p>
<p>When a sleep specialist identifies the correct diagnosis, then the treatment options can be explored. When I need to prescribe melatonin, I usually recommend starting with the lowest dose possible (0.5mg) one to two hours before their current bedtime, and I recommend that the patient turns their lights off, or dims them, before taking melatonin. I also recommend avoiding other contributors to poor sleep, such as caffeinated products after 3pm, heavy exercise in the evening, or the use of electronic devices before bedtime. </p>
<p><em>Correction: An earlier version of this article stated that melatonin supplements are only available on prescription in Canada. This is incorrect.</em></p><img src="https://counter.theconversation.com/content/179053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lourdes M. DelRosso does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Melatonin can be useful as a sleep aid, but should be prescribed by a physician after a careful analysis of the causes of sleep loss.Lourdes M. DelRosso, PhD Candidate, Sleep Disorders, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1738102022-03-15T12:11:43Z2022-03-15T12:11:43ZFor dogs with arthritis, daily activities don’t have to be painful<figure><img src="https://images.theconversation.com/files/446054/original/file-20220212-13-1brruqq.jpg?ixlib=rb-1.1.0&rect=28%2C0%2C6369%2C4268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physical therapy – which can include small jumps, stretches, massage, heat therapy and even water exercises – can help manage arthritis in dogs.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/veterinary-woman-training-a-dog-inside-a-rehab-room-royalty-free-image/1301665432?adppopup=true">Manu Vega/Monument via Getty Images</a></span></figcaption></figure><p>Otis was our bighearted bloodhound, whom we loved dearly. He had an active life playing with our three other dogs and going for long walks every morning and evening with us. But when he was 8 years old, his lifestyle completely changed. He experienced a knee injury that required surgery, and he later developed osteoarthritis from that injury.</p>
<p>As <a href="https://www.vetmed.msstate.edu/directory/mhj95">faculty</a> <a href="https://www.vetmed.msstate.edu/directory/tj1232">members</a> at the Mississippi State University College of Veterinary Medicine, we see approximately 100 dogs and cats in our hospital daily. Our job is to diagnose and treat medical conditions these animals are experiencing, and when necessary, perform surgery on patients whose condition is severe.</p>
<p>Like Otis, many of our patients suffer from <a href="https://www.acvs.org/small-animal/osteoarthritis-in-dogs">canine osteoarthritis</a> – the most common orthopedic disorder that we see in our clinic. <a href="https://doi.org/10.3389/fvets.2020.00220">More than 20% of dogs</a> over the age of 1 in North America are thought to be affected by osteoarthritis. Common activities like going for long walks, running and playing often become more difficult for dogs with this condition.</p>
<h2>How can you tell if your dog has arthritis?</h2>
<p><a href="https://doi.org/10.1016/j.prevetmed.2020.105198">Common signs of canine osteoarthritis</a> include stiffness after rest, difficulty getting up, limping or avoiding the use of one leg. Arthritic dogs may also be less active, or reluctant to use stairs or <a href="https://doi.org/10.1016/j.prevetmed.2020.105198">get in or out of a vehicle</a>. For pets with arthritis, just going for a walk or playing in the yard can result in joint pain and muscle soreness.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="bloodhound lying on bright green grass" src="https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443229/original/file-20220128-25-awmrin.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Otis was able to get back to his normal lifestyle of walking and playing – even with arthritis.</span>
<span class="attribution"><span class="source">Michael Jaffe</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>As in people, arthritis is a degenerative process <a href="https://doi.org/10.2460/javma.229.5.690">defined as inflammation of a joint</a>. It can occur in both young and old dogs, though it is <a href="https://doi.org/10.1111/j.1365-2885.2005.00668.x">more common as dogs age</a>. Sometimes, as in Otis’ case, arthritis develops following an injury. It can impact all components of the joint, but the cartilage – the connective tissue covering the bones where a joint is formed – <a href="https://doi.org/10.1016/s0195-5616(97)50076-3">is the most affected</a>.</p>
<p>Unfortunately, <a href="https://doi.org/10.1053/j.tcam.2009.10.005">canine arthritis cannot be cured</a>. Instead, the goal of treatment of arthritis in dogs is to reduce inflammation and increase comfort to improve a dog’s quality of life regardless of age.</p>
<h2>What causes arthritis in pets?</h2>
<p>Arthritis develops in pets because of age-related changes in the joint similar to that which occurs in people. Pets that are very active may be prone to mild injuries that can <a href="https://doi.org/10.1016/s0195-5616(97)50076-3">later develop into arthritic joints</a> as they get older.</p>
<p>Other pets may be born with a hereditary problem that <a href="https://doi.org/10.1111/j.1532-950X.2011.00928.x">develops into arthritis as they age</a>. Some breeds, including German shepherds, golden retrievers and Rottweilers, may be <a href="https://doi.org/10.1371/journal.pone.0172918">more prone to developing arthritis</a> as a result of a condition like <a href="https://www.akc.org/expert-advice/health/hip-dysplasia-in-dogs/">hip dysplasia</a>, which causes loose hip joints.</p>
<p>When arthritis is suspected, a veterinarian can confirm it, often through X-rays of the affected joint. Once the condition is diagnosed, a veterinarian will then come up with a treatment plan for each patient.</p>
<p>Veterinarians generally prefer nonsurgical treatment. Although surgical options exist, including joint replacement, most dogs can be successfully managed through <a href="https://www.routledge.com/Multimodal-Management-of-Canine-Osteoarthritis/Fox/p/book/9780367112493">a combination of approaches</a> including weight management, exercise, joint supplements, prescription anti-inflammatory medications – or NSAIDs – and physical therapy.</p>
<p>Here’s how each of these works to help arthritic dogs stay healthy and active.</p>
<h2>Weight management</h2>
<p>Weight management is an <a href="https://doi.org/10.2460/javma.229.5.690">essential aspect of managing arthritis</a> in pets. When a pet is less physically active, it may lose some muscle mass and gain weight in the form of body fat. Coupled with arthritis, this reduction in muscle tone and added weight places additional pressure on already achy joints. </p>
<p>Cutting back on a few treats and carefully monitoring calorie intake will go a long way in helping your dog shed a few pounds and reduce its discomfort. As in people, weight loss doesn’t happen overnight. Ask for guidance from your veterinarian. </p>
<h2>Exercise</h2>
<p>Exercise is another important aspect of <a href="https://www.routledge.com/Multimodal-Management-of-Canine-Osteoarthritis/Fox/p/book/9780367112493">maintaining healthy joints</a> and keeping weight controlled. Low-impact exercises such as leash walks, swimming and light running are valuable as long as your dog does not overdo it. </p>
<p>How will you know how much movement is too much? In general, walks and jogs should be of a distance, time or intensity such that your dog comes home from that activity still feeling comfortable. That means that if your four-legged companion leads you at the beginning of your walk, it should still be able to stay ahead of you at the walk’s end. </p>
<p>If your pet trudges behind you as you are nearing home, it may be because it is starting to feel tired and its joints are hurting. The signals dogs send their humans are important to monitor so that owners know when to cut back on the length or intensity of a walk or run.</p>
<figure class="align-center ">
<img alt="woman walking small dog that is lagging behind" src="https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446307/original/file-20220214-17-fih4h3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If your dog is dragging behind you during a walk, it may be a sign that its joints are achy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/person-walking-a-dog-down-the-city-street-of-royalty-free-image/1360645950?adppopup=true">Thales Antonio/EyeEm via Getty Images</a></span>
</figcaption>
</figure>
<p>It is possible to overdo the activity of an arthritic pet and cause discomfort. Just as we might not want to go right back to the gym the day after a hard workout, a pet may not be ready to exercise right away either. Rest is the best remedy for sore muscles. A good day or two of rest, sometimes even longer for an arthritic pet, may be necessary between intense periods of exercise. The key to knowing if your pet is ready to go again is if it can rise from a resting position easily and doesn’t appear slow or sore. </p>
<h2>Joint supplements</h2>
<p>Just as in people, joint supplements are available for pets with arthritis. These products, such as glucosamine and chondroitin sulfate, <a href="https://www.routledge.com/Multimodal-Management-of-Canine-Osteoarthritis/Fox/p/book/9780367112493">provide nutrients and building blocks</a> for healthy joint function. Essential fatty acids, like those found in fish oils for dogs, can also <a href="https://www.routledge.com/Multimodal-Management-of-Canine-Osteoarthritis/Fox/p/book/9780367112493">help prevent some inflammation</a> in arthritic pets. Some owners give up on joint supplements because they do not see dramatic improvement in their pets right away. However, these products work internally, just like the multivitamins people take, and their benefits may be gradual and subtle. </p>
<p>Other treatments such as polysulfated glycosaminoglycan injections, also known as Adequan, may be used to <a href="https://doi.org/10.1016/j.cvsm.2005.01.001">prevent further worsening of osteoarthritis</a> early in the course of the disease.</p>
<h2>NSAIDs</h2>
<p>Anti-inflammatory drugs may be prescribed by a veterinarian when a dog has significant joint pain from chronic inflammation. <a href="https://www.routledge.com/Multimodal-Management-of-Canine-Osteoarthritis/Fox/p/book/9780367112493">These medications effectively reduce discomfort</a> but may have negative side effects, such as kidney or liver damage, that may limit long-term use. However, they can effectively keep a patient comfortable as long as a veterinarian carefully monitors their use.</p>
<figure class="align-center ">
<img alt="shepherd dog balancing front legs on yellow exercise balls while physical therapist gives dog a treat" src="https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446056/original/file-20220212-25032-xr0w7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Physical therapy for dogs with joint issues can include balancing on exercise balls and other strength-building activities.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/male-physiotherapist-training-malinois-belgian-royalty-free-image/1283961458?adppopup=true">Westend61 via Getty Images</a></span>
</figcaption>
</figure>
<h2>Rehab or physical therapy</h2>
<p>Canine rehabilitation and physical therapy specialists work with dogs that are arthritic or out of condition to improve limb function, rebuild muscle and assist in weight management. Specific exercises for arthritic pets, such as <a href="https://www.youtube.com/watch?v=pNQTkUtfoHc">little jumps known as “cavalettis,”</a> may be tailored to enhance limb movement while providing comfort. Helping an arthritic dog’s ability to move around better will allow it to exercise more and improve its muscle tone while assisting in weight loss.</p>
<h2>Healthy joints, happy pets</h2>
<p>Helping older or arthritic pets keep their joints healthy and their bodies in good condition can let them enjoy walks and playtime throughout the duration of their lives. Even pets with advanced arthritis can maintain a good quality of life and stay active with the help of a veterinarian and good treatment plan.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>Sadly, we lost Otis a few years ago at the age of 11. But for the three years following his surgery, we were able to manage his arthritis and maintain his comfort with a combination of weight management, exercise, NSAIDs, essential fatty acids and joint supplements. He was able to get back to the activities he loved and play with our other three dogs. It warmed our hearts to see his quality of life return to a happy, healthy one for his remaining years.</p><img src="https://counter.theconversation.com/content/173810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Jaffe is a paid speaker for Nutramax Labs, Inc.</span></em></p><p class="fine-print"><em><span>Tracy Jaffe does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Since canine arthritis can’t be cured, the goal of treatment in dogs is to reduce inflammation to increase comfort and improve a dog’s quality of life.Michael Jaffe, Associate Professor of Small Animal Surgery, Mississippi State UniversityTracy Jaffe, Clinical Instructor of Veterinary Medicine, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1782102022-03-07T11:30:41Z2022-03-07T11:30:41ZVitamin D2 and D3: what’s the difference and which should you take?<figure><img src="https://images.theconversation.com/files/450062/original/file-20220304-13-1qxevmm.jpg?ixlib=rb-1.1.0&rect=508%2C316%2C4078%2C2262&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vitamin D3 is found in fish, cheese, and eggs.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-table-ingredients-food-rich-vitamin-721103494">Cegli/Shutterstock</a></span></figcaption></figure><p>Vitamin D is important for maintaining health, as it has many roles in the human body. But there is more than one form of vitamin D, and recent research suggests that these forms may have <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2022.790444/full">different effects</a>. So what are the different types of vitamin D, and is one really more beneficial than the other?</p>
<p>Although medical conditions later associated with vitamin D deficiency, such as the bone disease rickets, have been known about since the 17th century, vitamin D itself wasn’t identified until the early 20th century. This discovery led to <a href="https://academic.oup.com/jn/article/134/6/1299/4688802">Adolf Windaus</a> winning the Nobel prize for chemistry in 1928. </p>
<p>The vitamin D family actually includes five molecules, with the two most important being vitamin D2 and D3. These molecules are also known as ergocalciferol and cholecalciferol, respectively. While both of these types of vitamin D contribute to our health, they differ in how we get them. </p>
<p>Dietary vitamin D2 generally comes from plants, <a href="https://www.sciencedirect.com/science/article/pii/S1074552114000246">particularly mushrooms and yeast</a>, whereas we get vitamin D3 from animal sources, such as <a href="https://www.hsph.harvard.edu/nutritionsource/vitamin-d/">oily fish, liver and eggs</a>. Both forms of vitamin D are also available in dietary supplements. </p>
<p>What most people probably don’t know is that most of our vitamin D comes from <a href="https://www.bda.uk.com/resource/vitamin-d.html">exposing our skin to sunlight</a>. When our skin is exposed to the sun, ultraviolet rays convert a precursor molecule called 7-dehydrocholesterol into vitamin D3. This important effect of exposure to the sun explains why people living at more extreme latitudes, or people who have darker skin, are more prone to <a href="https://pubmed.ncbi.nlm.nih.gov/28662556/#:%7E:text=Conclusion%3A%20Latitude%20was%20found%20to,risk%20for%20vitamin%20D%20deficiency.">vitamin D deficiency</a>. Melanin, a pigment in the skin, blocks ultraviolet rays from activating 7-dehydrocholesterol, thus limiting D3 production. Wearing clothing or sunscreen has a similar effect. </p>
<figure class="align-center ">
<img alt="Man getting some sun rays." src="https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450077/original/file-20220304-17-61rrpd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most of our vitamin D comes from exposing our skin to sunlight.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-asian-senior-male-wear-glasses-642155260">Eggeegg/Shutterstock</a></span>
</figcaption>
</figure>
<p>Both vitamins D2 and D3 are essentially inactive until they go through two processes in the body. First, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968073/">liver changes their chemical structure</a> to form a molecule known as calcidiol. This is the form in which vitamin D is stored in the body. Calcidiol is then further altered in the kidneys <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303849/">to form calcitriol</a>, the active form of the hormone. It is calcitriol that is responsible for the biological actions of vitamin D, including helping bones to form, metabolising calcium and supporting how our <a href="https://www.ncbi.nlm.nih.gov/books/NBK526025/">immune system works</a>. </p>
<p>Technically, vitamin D isn’t a vitamin at all, but a pro-hormone. This means the body converts it into an active hormone. All hormones have receptors (on bone cells, muscle cells, white blood cells) that they <a href="https://www.sciencedirect.com/science/article/pii/B9780128096338900876">bind to and activate</a>, like a key unlocking a lock. Vitamin D2 has the same <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968073/">affinity for the vitamin D receptor as vitamin D3</a>, meaning neither form is better at binding to its receptor.</p>
<h2>Different effects on the immune system</h2>
<p>A <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2022.790444/full">recent study</a> found that vitamin D2 and D3 supplementation had different effects on genes important for immune function. These findings are significant, as most previous research has failed to find much difference in the effect of supplementation with either vitamin D2 or D3. </p>
<p>Most of the research published to date has suggested that the main difference between vitamin D2 and D3 supplementation is the effect on circulating vitamin D levels in the bloodstream. Studies have repeatedly shown that vitamin D3 is <a href="https://www.nutritionadvance.com/vitamin-d2-vs-d3/#:%7E:text=Vitamin%20D2%20and%20D3%20both%20significantly%20raise%20serum%20vitamin%20D,for%20longer%20periods%20of%20time">superior</a> at raising levels of vitamin D in the body. These findings were supported by a recent review of the evidence which found that vitamin D3 supplementation increased vitamin D levels in the body <a href="https://www.mdpi.com/2072-6643/13/10/3328">better than vitamin D2</a>. But not all studies <a href="https://academic.oup.com/jcem/article/93/3/677/2598025?login=true">agree</a>.</p>
<p>Very few studies support vitamin D2 supplementation being superior to vitamin D3. One trial showed that vitamin D2 was better at treating immune issues in patients who were on <a href="https://www.hindawi.com/journals/jos/2015/729451/">steroid therapy</a>. However, other than increasing vitamin D levels in the body, there is not much evidence that vitamin D3 supplements are better than vitamin D2 supplements. One study found that vitamin D3 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4971338/">improved calcium levels</a> more than vitamin D2. But we need more research to provide definitive answers.</p>
<h2>So which should I take?</h2>
<p>Vitamin D deficiency is now <a href="https://www.ncbi.nlm.nih.gov/books/NBK532266/">more prevalent than ever</a>, with around <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/">a billion people</a> worldwide being vitamin D deficient. It is important that people at risk of vitamin D deficiency – older adults, people living in less sunny climates and people with darker skin – take vitamin D supplements. </p>
<p>Health professionals recommend that most people take <a href="https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/">10 micrograms of vitamin D a day</a>, especially <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/longterm-vitamin-d3-supplementation-is-more-effective-than-vitamin-d2-in-maintaining-serum-25hydroxyvitamin-d-status-over-the-winter-months/A6CD4FE5C649E0FAC9BCBAFB23538707">in winter</a>. It would appear that vitamin D3 supplements are the superior option for maintaining vitamin D levels, but short exposure of the skin to the sun, even on a cloudy day, will also help you keep healthy vitamin D levels.</p><img src="https://counter.theconversation.com/content/178210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Brown has previously received funding from the EU Horizon 2020 scheme to study personalised approaches to food choices.</span></em></p>Very few studies support vitamin D2 supplementation being superior to vitamin D3.James Brown, Associate Professor in Biology and Biomedical Science, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1650462021-08-13T12:42:51Z2021-08-13T12:42:51ZHow religious fervor and anti-regulation zealotry laid the groundwork for America’s $36 billion supplement industry<figure><img src="https://images.theconversation.com/files/415895/original/file-20210812-21-1ylnp27.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C1917%2C1261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than half of Americans regularly take supplements.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-woman-lifting-loaded-spoon-to-her-mouth-fr-bowl-full-news-photo/50469593?adppopup=true">James Keyser/Getty Images</a></span></figcaption></figure><p>Spend any time watching television or scrolling through social media, and you’ll inevitably <a href="https://eu.usatoday.com/story/money/2020/06/09/39-most-outrageous-false-product-claims-of-all-time/111913486/">see advertisements</a> for pills, powders and potions that promise to grow muscle, shed body fat, improve your focus and resurrect your youth. </p>
<p>Most of us have used them. At last count, the National Center for Health Statistics found that <a href="https://www.cdc.gov/nchs/products/databriefs/db399.htm#Key_findings">over 50% of all adults in America have used a supplement in the past 30 days</a>. The center used data from 2017 and 2018, but more recent polls suggest this figure to be closer to <a href="https://apnews.com/press-release/business-wire/virus-outbreak-consumer-products-and-services-business-customer-statistics-public-opinion-fad4390334494d859b17888723e4c7f5">over 70%</a>. </p>
<p>Globally, the nutritional supplement industry was said to be worth over <a href="https://www.grandviewresearch.com/industry-analysis/dietary-supplements-market">US$140 billion</a> in 2020. Within the United States alone, this figure is estimated to be around <a href="https://www.ibisworld.com/industry-statistics/market-size/vitamin-supplement-manufacturing-united-states/">$36 billion</a> – despite evidence that the majority of these supplements <a href="https://www.washingtonpost.com/lifestyle/food/most-dietary-supplements-dont-do-anything-why-do-we-spend-35-billion-a-year-on-them/2020/01/24/947d2970-3d62-11ea-baca-eb7ace0a3455_story.html">do not work</a>.</p>
<p>How did products with questionable benefits and expensive prices become so mainstream? Nutritional supplements are not a new phenomenon. Their history dates back at least 150 years, and they’ve been able to thrive in the United States thanks to false promises, fanatical adherents and weak regulation.</p>
<h2>Stoking an appetite for alternatives</h2>
<p>Given the outlandish claims that can adorn supplement labels, it is perhaps unsurprising that some of the earliest supplement enthusiasts were religious figures. Their supplements weren’t pills, but rather food alternatives. </p>
<p><a href="https://www.newenglandhistoricalsociety.com/sylvester-graham-health-food-nut-makes-butchers-bakers-crackers/">Sylvester Graham</a>, born in 1794, was an American Presbyterian minister who preached salvation through a vegetarian diet.</p>
<p>Part of Graham’s teaching centered on temperance and <a href="https://www.theatlantic.com/health/archive/2014/01/looking-to-quell-sexual-urges-consider-the-graham-cracker/282769/">whole grain foods</a>. Graham’s followers made and marketed Graham bread, <a href="https://daily.jstor.org/origins-of-graham-crackers/">crackers</a> and flour with the promise that these products would promote righteous living and eternal salvation. </p>
<figure class="align-right ">
<img alt="An ad for graham crackers featuring two kids." src="https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=880&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=880&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=880&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1105&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1105&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415891/original/file-20210812-17-mth0lc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1105&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Graham crackers, which are made using course wheat flour, were pitched as a healthy alternative to traditional bread.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/advertisement-for-the-national-biscuit-company-features-an-news-photo/1332017605?adppopup=true">Transcendental Graphics/Getty Images</a></span>
</figcaption>
</figure>
<p>While Graham didn’t officially endorse these products, his spiritual successor, Dr. John Harvey Kellogg, was an eager proponent of his family’s line of new foods. A doctor, inventor and businessman rolled into one, Kellogg ran his own health spa in Michigan – <a href="https://www.pbs.org/newshour/health/dr-kelloggs-world-renowned-health-spa-made-wellness-titan">the Battle Creek Sanitarium</a> – during the late-19th and early-20th century. Although he did not create cornflakes – that was his brother, Will – Kellogg was responsible for marketing flours, protein replacements, granolas and peanut butters. Like the Graham products, Kellogg’s foods were linked to improved health and virtue. </p>
<p>Graham crackers and granola may seem relatively benign compared to some health and wellness products sold today, such as detox teas and vitamin-enriched waters. But they were nevertheless important in promoting the still-powerful message underpinning most of the supplements we see today: This product will improve your health and your life.</p>
<h2>Fitness supplements become all the rage</h2>
<p><a href="https://scholar.google.com/citations?user=iEwrgR4AAAAJ&hl=en">When teaching this topic to students</a>, I recount a discovery made by historians John Fair and Daniel Hall <a href="https://starkcenter.org/igh/igh-v8/igh-v8-n3/igh0803d.pdf">when they were researching the history of protein powders</a>.</p>
<p>Sometime in the 1940s, the American nutritionist Paul Bragg reached out to barbell manufacturer Bob Hoffman.</p>
<p>At the time, Hoffman was making a small fortune selling his York Barbell workout equipment throughout the United States. Bragg, meanwhile, had firmly established himself as a leading expert on alternative nutrition. Sensing a potentially lucrative partnership, Bragg wrote to Hoffman with an idea.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man uses a fitness contraption." src="https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=829&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=829&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=829&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1042&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1042&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415869/original/file-20210812-21-7d7g5x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1042&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dr. Paul Bragg saw supplements as a financial windfall because they would always need to be replenished.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/dr-paul-c-bragg-90-year-old-dietician-and-consultant-to-news-photo/1079510328?adppopup=true">Stuart William Macgladrie/Fairfax Media via Getty Images</a></span>
</figcaption>
</figure>
<p>In the letter, Bragg told Hoffman the fundamental flaw in his York business: his products were durable. If someone bought a barbell set in the 1930s, it was likely they could still use it in the 1950s. Bragg recommended selling nutritional supplements, which would need to be replaced on a biweekly or monthly basis. </p>
<p>Hoffman decided to pass on partnering up with Bragg, but he soon recognized the idea’s potential. In the 1950s, nutritionist and bodybuilding coach Irving Johnson began selling protein supplements in Hoffman’s Strength & Health magazine. Made from soy, Johnson’s “Hi Protein” powder <a href="https://starkcenter.org/igh/igh-v8/igh-v8-n3/igh0803d.pdf">was a huge success</a>.</p>
<p>Within a year, Hoffman banned Johnson from his magazine and began selling his own “<a href="https://physicalculturestudy.com/2016/06/15/soy-science-and-selling-bob-hoffmans-hi-proteen-powder/">Hi-Proteen</a>” powder. Protein supplements, as an industry, grew in size and scope. Soy protein products were eventually replaced by milk protein powders in the 1960s. By the late 1990s several other derivatives, ranging from pea protein to collagen powders, existed. </p>
<p>The size and scope of other offerings grew with time. Vitamin and mineral supplements became popular <a href="https://www.sciencehistory.org/distillations/vitamins-come-to-dinner">in the 1950s</a>. Energy drinks and energy boosters like creatine started flying off the shelves <a href="https://insidebodybuilding.com/is-creatine-healthy/">in the late 1980s and early 1990s</a>. Prohormones – which purported to build muscle and were eventually banned – <a href="https://www.intechopen.com/chapters/22047">were introduced in the early 2000s</a>. Each decade, profits ballooned, as did the creativity in the branding of the products. </p>
<p>Outlandish promises were commonplace. Vitamin producers promised <a href="https://www.jstor.org/stable/284966?seq=6#metadata_info_tab_contents">cancer-curing products</a>, protein powders advertised <a href="https://www.nutraingredients-asia.com/Article/2017/09/27/Undeclared-anabolic-steroids-discovered-in-sports-supplements-sold-in-NZ-and-Australia">steroid-like effects</a>, while pre-workout supplements – often laced with methamphetamines – <a href="https://eu.usatoday.com/story/news/nation/2013/10/14/tests-of-supplements-craze-and-detonate-find-methamphetamine-like-compound/2968041/">offered boundless energy</a>. </p>
<p>Government authorities did little to stop them.</p>
<h2>The flailing FDA</h2>
<p>It wasn’t for lack of trying. The supplements industry and federal authorities have long been playing a game of cat and mouse.</p>
<p>When Hoffman and others began selling supplements, they were technically subject to the policies of the Food and Drug Administration. But during the 1950s, the FDA was ill-equipped to regulate nutritional supplements. However, some of the manufacturers’ outlandish claims and unhygienic practices started to attract the attention of the regulatory body, which soon sought to gain more control.</p>
<p>By the 1960s, Hoffman – who routinely claimed his products added pounds of muscles in rapid time – became a target of the FDA. The secret to his Hi-Proteen powder? A <a href="https://physicalculturestudy.com/2016/06/15/soy-science-and-selling-bob-hoffmans-hi-proteen-powder/">large mixing vat</a> in which he stirred Hershey’s chocolate powder together with soy protein powder using a rowing oar.</p>
<p>Hoffman was regularly censored but never stopped. During the 1960s and 1970s, the FDA regularly locked horns with manufacturers for their lax production methods and incredulous claims. </p>
<p>The problem was that the FDA was never able to fully regulate the industry. </p>
<p>From <a href="https://analyticalsciencejournals.onlinelibrary.wiley.com/doi/full/10.1002/dta.1919">1968 to 1970</a>, Congress held several public hearings on the FDA’s plans to regulate supplements. Legislators, supplement trade associations, manufacturers and citizens discussed restrictions and bans on certain products, such as making it illegal to sell supplements with nutrients in excess of 150% of daily intake recommendations.</p>
<p>Public and private outcry stopped such plans in their tracks. The FDA was forced to engage in light-touch regulation. In 1975, a court ruling allowed supplements to advertise themselves as natural. One year later, <a href="https://doi.org/10.1002/dta.1919">the Rogers Proxmire Act</a> prohibited the FDA from imposing limits on vitamin and mineral amounts in supplements. </p>
<p>The FDA retained the right to pursue baseless or misleading claims, but this did little to slow down the industry. The number of products continued to grow. </p>
<p>Put simply, it became impossible to oversee what went into products. This also explains why so many supplements include a note to say they are not FDA approved or endorsed. </p>
<p>In the early-1990s the FDA resumed its efforts to regulate the supplement industry. In particular, the agency wanted to increase its own enforcement powers while simultaneously making it illegal to advertise therapeutic claims on supplement labels. Once more, private lobbying and public outcry watered down the agency’s powers. </p>
<p>In 1994, Congress passed the Dietary Supplement Health Education Act, which completely changed the nutritional landscape. <a href="https://quackwatch.org/consumer-protection/dshea/">Supplements were now classified as foods, not medicines or food additives</a>. By classifying supplements as foods, and not drugs, the act lowered the <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/dietary-supplement-health-and-education-act-of-1994">burden of proof</a> for manufacturer’s claims. </p>
<figure class="align-center ">
<img alt="A collage of pills in the shape of a hamburger." src="https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415872/original/file-20210812-19-n857r1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Classifying supplements as a food allowed manufacturers to sidestep stringent FDA regulations applied to drugs.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/capsules-and-pills-in-shape-of-hamburger-royalty-free-image/89127926?adppopup=true">JW LTD/Getty Images</a></span>
</figcaption>
</figure>
<p>The legislation also expanded which products could be classified as a supplement – and, therefore, not be subjected to the FDA’s purview.</p>
<p>Today, responsibility is placed on producers to self-regulate their potentially harmful products. This does expose producers to lawsuits, but it can be <a href="https://www.raps.org/news-and-articles/news-articles/2020/6/dietary-supplement-class-actions-in-focus-recent-o">a long and lengthy process</a> for consumers. In effect, supplements are brought to market before being thoroughly tested. Thus, many products are sold despite containing <a href="https://dx.doi.org/10.2105%2FAJPH.2014.302348">banned substances</a>.</p>
<h2>A single promise wrapped in a pill</h2>
<p>Since the mid-20th century, nutritional supplements have been promoted in a variety of ways within the United States. But acknowledging the differences in product, taste and price, they’ve generally been marketed based upon a single promise: This product will, in some way, improve your life.</p>
<p>Whether this is true or not for the individual product – some supplements do, in fact, work, with <a href="https://examine.com/supplements/creatine/">creatine</a> being one example – it has become problematic at a broader level. Federal agencies in the U.S. have continually been impeded from correctly overseeing the market. Private lobbying and public outcry about the government wanting to “<a href="https://quackwatch.org/consumer-protection/dshea/">take away your vitamins</a>” have encouraged malpractice and dangerous messaging.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_F_ZZvdHqPM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Mel Gibson urges people to ‘Call the U.S. Senate and tell them that you want to take your vitamins in peace.’</span></figcaption>
</figure>
<p>A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2706496">study from 2018</a> found 776 instances of unapproved pharmaceutical ingredients being added to supplements in the United States from 2007 to 2016. Many of these additions were relatively harmless. But several ingredients – from steroid compounds to banned weight loss drugs – were not. </p>
<p>Supplements might promise a great deal. But in reality, most of them are articles of faith.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p><img src="https://counter.theconversation.com/content/165046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Conor Heffernan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The FDA has largely lost its ability to regulate the myriad pills, powders and potions that promise to grow muscle, shed body fat and improve your focus.Conor Heffernan, Assistant Professor of Physical Culture and Sport Studies, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1522402021-03-05T01:51:32Z2021-03-05T01:51:32ZThinking about trying collagen supplements for your skin? A healthy diet is better value for money<p>Celebrity <a href="https://www.youtube.com/watch?v=gW653Tgrrwg&feature=emb_logo">testimonials</a> abound for pills, potions and creams that purport to make you look younger.</p>
<p>This time collagen supplements are in the spotlight, after Jennifer Aniston became the face of one wellness brand’s <a href="https://www.instyle.com/beauty/health-fitness/jennifer-aniston-vital-proteins-collagen">collagen campaign in late 2020</a>.</p>
<p>While some research has found benefits of collagen supplementation for some aspects of skin health, it’s a case of buyer beware. The evidence is generally weak, with many of the studies claiming to find positive effects from collagen supplementation funded mostly by industries that manufacture these products. Therefore, the results need to be interpreted with caution.</p>
<p>When you’re reading articles promoting these products, be especially wary of phrases such as “<a href="https://www.usmagazine.com/shop-with-us/news/jennifer-aniston-vital-proteins-collagen-supplements-beauty-routine/">we may receive compensation for some links to products and services</a>”. These statements often mean the publication has negotiated some kind of payment for featuring products in its editorial coverage. Therefore, what you’re reading isn’t necessarily an independent evaluation of the product’s effectiveness. </p>
<p>Rather than spending a lot of money on collagen supplements that promise to defy signs of ageing, smooth wrinkles and renew your skin, spend it on healthy food. You will get better value in terms of your health and well-being in the long-term.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
</strong>
</em>
</p>
<hr>
<h2>What does the science say?</h2>
<p>Normal ageing is associated with <a href="https://pubmed.ncbi.nlm.nih.gov/31036793/">loss of connective tissues within the skin, leading to a reduction in elasticity</a> and development of wrinkles and creases.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/31411379/">2019 review of collagen supplements</a>, conducted by US university researchers, found four of the five studies included had reported some degree of improvement in some skin variables.</p>
<p>This included improvements in: <a href="https://pubmed.ncbi.nlm.nih.gov/26362110/">skin moisture and collagen density</a>; <a href="https://pubmed.ncbi.nlm.nih.gov/29949889/">skin hydration, wrinkling and elasticity</a>; <a href="https://pubmed.ncbi.nlm.nih.gov/23949208/">skin elasticity but not moisture content</a>; and <a href="https://pubmed.ncbi.nlm.nih.gov/26840887/">skin moisture, elasticity, wrinkles and roughness</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/wrinkles-liver-spots-crows-feet-what-happens-to-our-skin-as-we-age-91516">Wrinkles, liver spots, crows' feet: what happens to our skin as we age?</a>
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</em>
</p>
<hr>
<p>Across the studies, closer scrutiny of the methods by the reviewers found many were rated as being of low methodological quality. The reviewers flagged a number of limitations of the studies. These included that the supplements differed across the trials, as did the types of people included in the studies, meaning you can’t compare results between trials.</p>
<p>It also wasn’t clear how the results translated to actual changes in skin appearance and whether this was noticeable to other people.</p>
<p>Amino acids needed to make collagen can be found in other foods containing protein. There’s <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/nbu.12304">no reliable evidence</a> amino acids in collagen supplements speed up the process by which the body makes collagen. </p>
<p>What’s more, most of the studies were either fully or partly funded by cosmetic or supplement companies. This means the results of the research should be interpreted with caution, especially when the affiliation statement shows the study authors were also employed by the supplement manufacturer. Further high quality, independent research studies are needed.</p>
<h2>What is collagen and where does it come from?</h2>
<p><a href="https://en.wikipedia.org/wiki/Collagen">Collagen</a> is the major structural protein in skin and other connective tissues such as cartilage, bone, tendons and ligaments.</p>
<p>It has a triple helix structure. Imagine three <a href="https://en.wikipedia.org/wiki/Slinky">slinkies</a> coiled around each other, and that’s roughly what collagen looks like.</p>
<figure class="align-center ">
<img alt="Artistic depiction of collagen triple helix structure" src="https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386319/original/file-20210225-19-euu64m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An artistic depiction of the collagen triple helix structure. Collagen is the human body’s main structural protein.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The triple helix shape makes it very strong and flexible.</p>
<p>Vitamin C is essential for the chemical pathway that makes collagen in the body. Without adequate vitamin C, the collagen would be unstable, meaning the coils would unfurl, and you would develop <a href="https://en.wikipedia.org/wiki/Scurvy">scurvy</a>. </p>
<p>Before you grab a bottle of collagen supplements, you may want to consider where it came from. Rich sources of collagen include pig skin, cattle hide, pork and cattle bones, tendons and cartilage, chicken cartilage and fish scales.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
</strong>
</em>
</p>
<hr>
<h2>A complete diet is better value for money</h2>
<p>A 2019 survey reported <a href="https://www.statista.com/statistics/985724/australia-average-monthly-spend-cosmetics-personal-care/">37% of Australians spent up to A$20 a month on cosmetics</a> and personal care, with 26% spending between $21-50 and 15% spending $51-200 a month.</p>
<p>A bottle of collagen supplements costs anywhere between roughly A$15-20 to over $100. Each capsule, or per serve, contains roughly between half a gram up to five grams of collagen.</p>
<p>By comparison, you can get better value for money by eating foods rich in protein like meat, chicken, fish, eggs, milk, cheese, nuts, tofu, dried beans and legumes. This will provide the amino acids your body needs to make collagen.</p>
<p>Because collagen would be unstable without vitamin C, it’s also important to regularly eat foods rich in it. Good sources include broccoli, Brussels sprouts, capsicum, tomatoes, spinach, kiwifruit, lemons and oranges.</p>
<p>Also aim to regularly eat foods rich in other nutrients needed to help keep skin healthy. This includes:</p>
<ul>
<li><p>zinc, which is found in seafood, meat, chicken, dried beans and nuts. Inadequate zinc intake can lead to <a href="https://en.wikipedia.org/wiki/Zinc_deficiency">skin conditions including acne and some types of dermatitis</a>. </p></li>
<li><p>vitamin A, from oily fish, egg yolks, cheese, tofu, nuts, seeds, whole grains and legumes. <a href="https://en.wikipedia.org/wiki/Vitamin_A#Dermatology">Vitamin A helps immature skin cells develop</a> into a mature skin layer which forms the body’s first layer of protection. “<a href="https://nomoneynotime.com.au/hacks-myths-faqs/what-are-carotenoids">Beta-carotene</a>” found in vegetables can be converted into vitamin A in the body. Good sources include pumpkin, carrots and leafy green vegetables. </p></li>
<li><p>and foods rich in <a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">polyphenols</a>. These are small chemicals found in vegetables, fruit, herbs and spices that help plants grow well or protect them from pathogens. Studies suggest higher intakes are <a href="https://pubmed.ncbi.nlm.nih.gov/22254062/">associated with slowing some of the skin damage caused by exposure to the sun</a>. </p></li>
</ul>
<p>If you’re interested in recipes that are fast, inexpensive and <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/motivations--better-skin">designed to help promote healthier skin</a>, check our <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/motivations--better-skin">No Money No Time website</a>, which we developed at The University of Newcastle. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mondays-medical-myth-chocolate-causes-acne-6934">Monday's medical myth: chocolate causes acne</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/152240/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She has received research grants from NHMRC, ARC, MRFF, Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>Some studies reported skin improvements from collagen supplements. But many of these studies were sponsored, fully or in part, by cosmetic or supplement companies.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1450672020-09-13T07:37:52Z2020-09-13T07:37:52ZHow false advertising misleads consumers in South Africa<figure><img src="https://images.theconversation.com/files/356050/original/file-20200902-14-1gehyru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advertisers use images of muscular men and slender women to convince consumers to buy their products. </span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>The promise of health, losing weight, or increasing strength greets visitors to many health and supplement shops. Advertisers use images of muscular men and slender women, combined with carefully crafted text, to convince consumers to buy their products. </p>
<p>Words and shapes in bold and bright colours decorate the packaging of products that promise an increase in bulk and strength. Among the myriad of miracle promising products, you may find “testosterone boosting” supplements. A consumer can now buy a “legitimate” testosterone booster in South African retail stores. </p>
<p>In South Africa, <a href="https://www.gov.za/sites/default/files/gcis_document/201409/32975146.pdf">regulations</a> about labelling don’t allow advertisers to use pictures that are likely to create a false impression of the product. The <a href="https://www.gov.za/sites/default/files/gcis_document/201409/321864670.pdf">Consumer Protection Act</a> clearly states suppliers may not mislead consumers. The Act also bars suppliers from making false claims about a product. </p>
<p>But this has not stopped advertisers from making dubious claims. In a recent <a href="https://journals.assaf.org.za/index.php/sajsm/article/view/7426">article</a> I unpacked claims made in an advertisement for a testosterone boosting product. </p>
<p>The alleged active ingredient in some of these testosterone boosting products is <a href="https://www.rxlist.com/aspartates/supplements.htm">D-aspartic acid</a>. The main advertising claim is that a consumer’s testosterone level will increase after consuming a product containing this amino acid. The implied promise is that an increase in testosterone will provide a gain in muscle and strength. Stronger muscles, in turn, hold the promise of improving in sport. One such testosterone boosting product even claims to be based on science and that research was involved. </p>
<h2>Regulating advertising</h2>
<p>Claims that something is clinically proven, and that science and research are involved, require proof. The <a href="http://arb.org.za/">Advertising Regulatory Board</a> of South Africa, for example, requires that advertisers must hold the evidence for their advertising claims. Advertisements must be truthful and may not mislead consumers. Advertisers are not allowed to misuse and misrepresent research results. They are not allowed to make <a href="http://arb.org.za/assets/section02-(2020).pdf">science claims</a> for a product if it does not have such a basis. </p>
<p>My recent <a href="https://journals.assaf.org.za/index.php/sajsm/article/view/7426">article</a> shows how advertising claims about a testosterone boosting product mislead consumers.</p>
<p>The advertiser claimed that the supplement would boost a consumer’s testosterone levels. The advertiser referred to a <a href="https://rbej.biomedcentral.com/articles/10.1186/1477-7827-7-120">scientific paper</a> as the evidence for the product’s testosterone boosting ability. </p>
<p>A closer look at this research showed that a small group of 23 men received a daily dose for 12 days of a product containing D-aspartic acid. The control group of 20 men received a placebo. The group that received the D-aspartic acid showed an increase in total testosterone after 12 days. Their testosterone decreased three days after their last dose on day 12. </p>
<p>The group’s average level of total testosterone increased from 4.5 nanograms per millilitre at the start, to 6.4 nanograms per millilitre on day 12. The advertisers used the ratio of this increase on day 12 to claim that a 42% increase in testosterone is possible. </p>
<p>What they didn’t say is that the study took place at an infertility clinic. The participants had low testosterone levels at the start. The average increase of 1.9 nanograms per millilitre of testosterone appears remarkable if one looks at the percentage difference. This increase was, however, still within the normal testosterone range of men of that age. </p>
<p>Advertisers who use this scientific paper as the basis for their advertising claims misuse and misrepresent science. </p>
<p>There isn’t enough knowledge about D-aspartic acid and its effect on the increase in testosterone levels. The evidence from a <a href="http://journals.ssu.ac.ir/ijrmnew/article-1-794-en.html">few</a> small and short duration studies is not enough to conclude that D-aspartic acid can produce a clinically significant increase in testosterone levels. </p>
<p>Some advertisers also make misleading claims about supplements or weight-loss products. </p>
<p>In one <a href="http://arb.org.za/assets/biostrath---siebert-kruger---louis-fourie.pdf">case</a>, the Advertising Regulatory Board ruled that an advertisement was misleading when it promised improved academic performance. The advertiser was not able to provide adequate proof that the supplement would improve a child’s marks at school. In another <a href="http://arb.org.za/assets/usn---dr-harris-steinman.pdf">case</a>, the Advertising Regulator Board ruled that a well-known supplier of supplements misled consumers. The advertising claims were that the product was “thermogenic” (fat-burning) and that it would aid weight loss. The Advertising Regulatory Board ruled that the claims were without substance. </p>
<h2>Protecting consumers</h2>
<p>Science-based claims that a product is the result of research does not necessarily mean that it works or that it is safe. It also does not mean that the manufacturer tested their own product in a clinical trial. </p>
<p><a href="https://www.healthline.com/health/clinical-trial-phases#phase-iii">Clinical trials</a> are very expensive, go through several stages, and can take several years. The last stage of a clinical trial requires a manufacturer to include a large group of participants to see if the product works as planned.</p>
<p>An advertiser that makes direct or indirect claims that a supplement can boost testosterone, help with weight-loss, or improve school performance must have proof for these claims. Consumers are within their rights to ask advertisers to supply the evidence for their claims. </p>
<p>Scientific articles about ingredients in their products are not sufficient. The scientific evidence must be about the specific product that an advertiser promotes. The evidence must be objective and open for independent scrutiny.</p>
<p>Consumers can lodge a <a href="http://arb.org.za/complaints.html">complaint</a> with the Advertising Regulatory Board about advertisements that they regard as misleading. Alternatively, one can also approach the Consumer Goods and Services Ombud to <a href="http://www.cgso.org.za/what-we-can-deal-with/">complain</a> about misleading labelling.</p><img src="https://counter.theconversation.com/content/145067/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rudi de Lange does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Claims that a product can boost testosterone levels imply that this will lead to a gain in muscle and strength.Rudi de Lange, Associate Professor in Visual Communication, Tshwane University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1400642020-06-11T01:54:26Z2020-06-11T01:54:26ZOM85: could bacteria in a capsule protect us from coronavirus and other respiratory infections?<figure><img src="https://images.theconversation.com/files/340789/original/file-20200610-82640-1w7intu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4587%2C3261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Scientists around the world are continuing to test countless vaccines and drugs in the hope of finding effective ways to prevent and treat COVID-19.</p>
<p>Among the trials happening in Australia is one my team is about to begin, looking at something called OM85. </p>
<p>OM85 is not a conventional drug, but a combination of molecules extracted from the walls of bacteria that commonly cause respiratory infections.</p>
<p>It’s not available in Australia, but has been used widely in Europe and South America for 40-50 years, commonly under the brand name <a href="https://www.ompharma.com/products">Broncho-Vaxom</a>.</p>
<p>We’re now looking at its potential to prevent respiratory infections, including COVID-19. But how does it work?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/where-are-we-at-with-developing-a-vaccine-for-coronavirus-134784">Where are we at with developing a vaccine for coronavirus?</a>
</strong>
</em>
</p>
<hr>
<h2>First, a bit of background</h2>
<p>Some of our organs, including the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0966842X13001996">skin</a>, airways and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894335/">lungs</a>, and gastrointestinal tract, are effectively “open” to the outside world. The cells that line these organs, called mucosal linings, host trillions of bacteria. </p>
<p>These bacteria, known as our “microbiota”, play essential roles in keeping us healthy. This is especially important in the <a href="https://www.bmj.com/content/361/bmj.k2179">gastrointestinal tract</a>, where the microbiota “train” the immune system. </p>
<p>One of the ways they do this is by providing a continuous stream of <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/mucosal-immune-system">signals</a> that move through mucosal linings into the tissues below, where immune cells are found. Specialised immune cells responsible for detecting the invasion of infectious pathogens <a href="https://pubmed.ncbi.nlm.nih.gov/30366757/">recognise and respond</a> to these signals.</p>
<p>We now recognise these signals from the microbiota operate as “immune training” agents, helping to keep the front-line defences of the immune system in a state of high alert.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=350&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=350&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=350&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=440&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=440&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340802/original/file-20200610-82612-uvn5ao.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=440&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">OM85 is made from molecules extracted from the walls of bacteria.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>OM85 is an immune stimulant</h2>
<p>OM85 appears to enhance some important aspects of this natural “immune training” process. One way it does this is by stimulating the maturation of <a href="https://www.touchrespiratory.com/immunomodulation-therapy-clinical-relevance-of-bacterial-lysates-om-85/">regulatory T-cells</a> (called T<sub>regs</sub>) in the lymph glands in the upper intestine.</p>
<p>Once they have fully matured, these T<sub>regs</sub> can migrate to other mucosal surfaces in the body to bolster local anti-inflammatory defences. This process is especially important <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5338315/">in the lungs and airways</a> to prevent respiratory infections.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-the-gut-microbiota-and-how-does-it-affect-mind-and-body-40536">Explainer: what is the gut microbiota and how does it affect mind and body?</a>
</strong>
</em>
</p>
<hr>
<p>OM85 signals also leak into our circulation. There they are recognised by cells in the bone marrow, which control the production of other immune cell types.</p>
<p>This results in increased immune cells – both in number and function – that travel to front-line mucosal surfaces, including the airways, to further bolster our immune defences.</p>
<p>We strongly suspect OM85 also influences the makeup of the gastrointestinal microbiome itself, although we know very little about how this happens. This in turn helps to promote the survival of bacterial strains that stimulate the immune system.</p>
<h2>What the evidence tells us</h2>
<p>OM85 is a preventative, given to those at risk of more severe consequences from respiratory infections, rather than as a treatment of current infections.</p>
<p>Studies have shown OM85 reduces the risk of wheeze linked to infection <a href="https://pubmed.ncbi.nlm.nih.gov/31185221/?from_term=Sly+PD%5BAuthor+-+First%5D&from_sort=&from_pos=2">in infants</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/20920766/?from_term=Razi+CH%5BAuthor+-+First%5D&from_sort=&from_pos=7">schoolchildren</a>. </p>
<p>It also reduces the incidence of
severe flare-ups of <a href="https://pubmed.ncbi.nlm.nih.gov/9412546/?from_term=Collet+J%5BAuthor+-+First%5D+and+COPD&from_pos=2">chronic obstructive pulmonary disease</a> in <a href="https://pubmed.ncbi.nlm.nih.gov/16772707/">adults</a>.</p>
<p>A <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004974.pub2/full">review</a> of 35 placebo-controlled studies involving 4,060 children concluded that immune stimulants, including OM85, reduced respiratory infections by an average of 40% in susceptible children.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-strong-immune-system-helps-ward-off-colds-and-flus-but-its-not-the-only-factor-99512">A strong immune system helps ward off colds and flus, but it's not the only factor</a>
</strong>
</em>
</p>
<hr>
<p>OM85 has a good safety profile. A small proportion of people may experience some gastro-intestinal upset, but in clinical trials, such as <a href="https://pubmed.ncbi.nlm.nih.gov/31185221/?from_term=Sly+PD%5BAuthor+-+First%5D&from_sort=&from_pos=2">one we conducted in infants</a>, side effects are rarely seen.</p>
<h2>So why don’t we use it more widely?</h2>
<p>No application has been made to bring OM85 to Australia. We are a small market not necessarily attractive to drug manufacturers.</p>
<p>In countries where OM85 is available, doctors can prescribe it but people can also buy it over the counter, in the same way they might a complementary medicine or health food supplement.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/340803/original/file-20200610-82661-xg51jn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows OM85 can reduce the risk of severe respiratory infections in children.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>OM85 has attracted plenty of scepticism in its time, with some people regarding it as “<a href="https://www.smh.com.au/national/from-snake-oil-to-covid-19-killer-supplement-tested-in-bid-to-fight-virus-20200603-p54z6f.html">snake oil</a>”. </p>
<p>Scientists are sceptical when we don’t understand why something works, or at least where we don’t have a plausible explanation for how it works. The idea something swallowed but not absorbed could protect the lungs sounds fanciful, especially without solid explanations.</p>
<p>But as we start to understand more about the mechanisms that may explain how OM85 works in the body, and with the accumulating clinical evidence, we have good reason to be open to and further explore its potential.</p>
<h2>What we’ll do in the trial</h2>
<p>Health-care workers are susceptible to severe respiratory respiratory infections associated with other viruses, including influenza, that can cause them to miss work. </p>
<p>We plan to give 1,000 health-care workers OM85, half immediately and half delayed by three months. </p>
<p>To understand how OM85 works we will collect blood samples and test immune responses. </p>
<p>We will determine which virus caused the respiratory illnesses if illness occurs (COVID-19 or other), whether the immune response is different depending on the virus, and whether OM85 is equally effective against all respiratory viruses encountered. </p>
<p>The trial is due to start this month and first results should be available by November.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-fascinating-history-of-clinical-trials-139666">The fascinating history of clinical trials</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/140064/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Sly receives funding from The NHMRC and Medical Research Future Fund for research including with OM85. </span></em></p>OM85 harnesses molecules extracted from bacteria, and has shown promise in preventing severe respiratory infections. It seems to work by training the immune system.Peter Sly, Director, Children’s Health and Environment Program and World Health Organization Collaborating Centre for Children’s Health and Environment, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1380012020-05-21T02:26:01Z2020-05-21T02:26:01ZDoes vitamin D protect against coronavirus?<figure><img src="https://images.theconversation.com/files/335583/original/file-20200518-138665-p61xx5.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C6716%2C4477&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Recent headlines have suggested vitamin D deficiency could increase the <a href="https://www.news.com.au/world/coronavirus/health/experts-claim-those-with-low-vitamin-d-levels/news-story/8207fd86200fd4902b25d47990464f6a">risk of dying</a> from COVID-19, and in turn, that we should consider taking <a href="https://www.bbc.com/news/health-52371688">vitamin D supplements</a> to protect ourselves. </p>
<p>Is this all just hype, or could vitamin D really help in the fight against COVID-19? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-nutrition-could-help-your-immune-system-fight-off-the-coronavirus-133356">5 ways nutrition could help your immune system fight off the coronavirus</a>
</strong>
</em>
</p>
<hr>
<h2>Vitamin D and the immune system</h2>
<p>At least in theory, there may be something to these claims. </p>
<p>Nearly all immune cells have <a href="https://www.ncbi.nlm.nih.gov/pubmed/22503810">vitamin D receptors</a>, showing vitamin D interacts with the immune system.</p>
<p>The active vitamin D hormone, calcitriol, helps regulate both the <a href="https://www.ncbi.nlm.nih.gov/books/NBK279396/">innate and adaptive immune systems</a>, our first and second lines of defence against pathogens.</p>
<p>And vitamin D deficiency is associated with <a href="https://www.mdpi.com/2072-6643/12/5/1248/htm">immune dysregulation</a>, a breakdown or change in the control of immune system processes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/six-things-you-need-to-know-about-your-vitamin-d-levels-15814">Six things you need to know about your vitamin D levels</a>
</strong>
</em>
</p>
<hr>
<p>Many of the ways calcitriol affects the immune system are directly relevant to our ability to defend against viruses. </p>
<p>For example, calcitriol triggers the production of cathelicidin and other defensins – natural antivirals capable of <a href="https://www.ncbi.nlm.nih.gov/pubmed/30614127">preventing the virus</a> from replicating and entering a cell.</p>
<p>Calcitriol can also increase the number of a particular type of immune cell (CD8+ T cells), which play a critical role in <a href="https://www.ncbi.nlm.nih.gov/pubmed/30614127">clearing acute viral infections</a> (such as influenza) in the lungs.</p>
<p>Calcitriol also suppresses pro-inflammatory cytokines, molecules secreted from immune cells which, as their name suggests, promote inflammation. Some scientists have suggested vitamin D might help to alleviate the “<a href="https://www.ncbi.nlm.nih.gov/pubmed/32353742">cytokine storm</a>” described in the most severe COVID-19 cases.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335585/original/file-20200518-138639-q0v5e0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Is there a link between vitamin D and coronavirus? We’re not sure yet.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Evidence from randomised controlled trials suggests regular vitamin D supplementation may help protect against acute respiratory infections.</p>
<p>A recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/30675873">meta-analysis</a> brought together results from 25 trials with more than 10,000 participants who were randomised to receive vitamin D or a placebo.</p>
<p>It found vitamin D supplementation reduced the risk of acute respiratory infections, but only when it was given daily or weekly, rather than in a large single dose. </p>
<p>The benefits of regular supplementation were greatest among participants who were severely vitamin D deficient to begin with, for whom the risk of respiratory infection went down by 70%. In others the risk decreased by 25%. </p>
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Read more:
<a href="https://theconversation.com/my-vitamin-d-levels-are-low-should-i-take-a-supplement-21738">My vitamin D levels are low, should I take a supplement?</a>
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<p>Large one-off (or “bolus”) doses are often used as a quick way to achieve vitamin D repletion. But in the context of respiratory infections, there were no benefits if participants received high single doses. </p>
<p>In fact, <a href="https://pubmed.ncbi.nlm.nih.gov/26747333/">monthly</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/20460620">annual</a> vitamin D supplementation has sometimes had unexpected side effects, such as increased risk of falls and fractures, where vitamin D was administered to <em>protect</em> against these outcomes. </p>
<p>It’s possible intermittent administration of large doses may <a href="https://www.ncbi.nlm.nih.gov/pubmed/19667164">interfere</a> with the synthesis and breakdown of the enzymes regulating vitamin D activity within the body.</p>
<h2>Vitamin D and COVID-19</h2>
<p>We still have relatively little direct evidence about the role of vitamin D in COVID-19. And while early research is interesting, much of it may be circumstantial.</p>
<p>For example, <a href="https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1">one small study</a> from the United States and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484">another study</a> from Asia found a strong correlation between low vitamin D status and severe infection with COVID-19.</p>
<p>But neither study considered any confounders. </p>
<p>In addition to the elderly, COVID-19 generally has the greatest consequences for people with <a href="https://www.medrxiv.org/content/10.1101/2020.05.06.20092999v1">pre-existing conditions</a>. </p>
<p>Importantly, people with existing medical conditions are also often vitamin D deficient. Studies assessing <a href="https://www.ncbi.nlm.nih.gov/pubmed/30682545">ICU patients</a> have reported high rates of deficiency even before COVID-19. </p>
<p>So we would expect to see relatively high rates of vitamin D deficiency in seriously ill COVID-19 patients – whether vitamin D has a role or not. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/335586/original/file-20200518-138639-1akqdzu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vitamin D affects our immune function.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Some researchers have noted high rates of COVID-19 infections in <a href="https://www.bmj.com/content/369/bmj.m1548/rr-6">ethnic minority groups</a> in the UK and US to suggest a role for vitamin D, as ethnic minority groups tend to have lower levels of vitamin D.</p>
<p>However, analyses from the <a href="https://www.ncbi.nlm.nih.gov/pubmed/32413819">UK Biobank</a> did not support a link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration might explain ethnic differences in getting a COVID-19 infection.</p>
<p>Although this research adjusted for confounders, vitamin D levels were measured ten years earlier, which is a drawback.</p>
<p>Researchers have also suggested vitamin D <a href="https://www.researchsquare.com/article/rs-21211/v1">plays a role</a> by looking at the average vitamin D levels of different countries alongside their COVID-19 infections. But in the hierarchy of <a href="https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/descriptive-studies-ecological-studies">scientific evidence</a> these types of studies are weak.</p>
<h2>Should we be trying to get more vitamin D?</h2>
<p>There are several registered <a href="https://clinicaltrials.gov/ct2/results?cond=Covid-19&term=vitamin+D&cntry=&state=&city=&dist=">trials</a> on vitamin D and COVID-19 in their early stages. So hopefully in time we’ll get some more clarity about the potential effects of vitamin D on COVID-19 infection, particularly from studies using stronger designs.</p>
<p>In the meantime, even if we don’t know whether vitamin D can help mitigate the risk of or outcomes from COVID-19, we do know being vitamin D deficient won’t help.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-get-the-covid-19-coronavirus-twice-137309">Can you get the COVID-19 coronavirus twice?</a>
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<p>It’s difficult to get enough vitamin D from food alone. A generous portion of oily fish can cover much of our need, but it’s neither healthy nor palatable to eat this every day.</p>
<p>In Australia we get most of our vitamin D from the sun, but about 70% of us have <a href="https://pubmed.ncbi.nlm.nih.gov/30674358/?from_term=vitamin+D+status+australia+winter&from_sort=date&from_pos=5">insufficient levels</a> during winter. The <a href="https://www.osteoporosis.org.au/vitamin-d">amount of exposure</a> we need to get enough vitamin D is generally low, only a few minutes during summer, while during the winter it might take a couple of hours of exposure in the middle of the day. </p>
<p>If you don’t think you’re getting enough vitamin D, speak to your GP. They may recommend incorporating <a href="https://www.healthline.com/nutrition/how-much-vitamin-d-to-take">daily supplements</a> into your routine this winter.</p><img src="https://counter.theconversation.com/content/138001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elina Hypponen has received funding for scientific research on vitamin D from the National Health and Medical Research Council (Australia), Medical Research Council (UK), Department of Health (UK), British Heart Foundation, Biotechnology and Biological Sciences Research Council (UK), Academy of Finland, The Judith Jane Mason & Harold Stannett Williams Memorial Foundation, and the BUPA Foundation.
</span></em></p>Early research has pointed to a link between severe illness with COVID-19 and vitamin D deficiency. But there’s more to the story.Elina Hypponen, Professor of Nutritional and Genetic Epidemiology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1333562020-03-16T19:01:05Z2020-03-16T19:01:05Z5 ways nutrition could help your immune system fight off the coronavirus<figure><img src="https://images.theconversation.com/files/320678/original/file-20200316-18043-1rg6ra8.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4500%2C2977&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The coronavirus presents many uncertainties, and none of us can completely eliminate our risk of getting COVID-19. But one thing we can do is eat as healthily as possible.</p>
<p>If we do catch COVID-19, our immune system is responsible for fighting it. Research shows improving nutrition helps <a href="https://www.ncbi.nlm.nih.gov/pubmed/15337163">support optimal immune function</a>. </p>
<p>Micronutrients essential to fight infection include vitamins A, B, C, D, and E, and the minerals iron, selenium, and zinc. </p>
<p>Here’s what we know about <a href="https://www.ncbi.nlm.nih.gov/pubmed/30336639">how these nutrients support our immune system</a> and the foods we can eat to get them. </p>
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Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
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<h2>1. Vitamin A</h2>
<p><a href="https://www.healthdirect.gov.au/vitamin-a">Vitamin A</a> maintains the structure of the cells in the skin, respiratory tract and gut. This forms a barrier and is your body’s first line of defence. If fighting infection was like a football game, vitamin A would be your forward line. </p>
<p>We also need vitamin A to help make <a href="https://en.wikipedia.org/wiki/Antibody">antibodies</a> which neutralise the pathogens that cause infection. This is like assigning more of your team to target an opposition player who has the ball, to prevent them scoring. </p>
<p>Vitamin A is found in oily fish, egg yolks, cheese, tofu, nuts, seeds, whole grains and legumes. </p>
<p>Further, vegetables contain <a href="https://en.wikipedia.org/wiki/Beta-Carotene">beta-carotene</a>, which your body can convert into vitamin A. Beta-carotene is found in leafy green vegetables and yellow and orange vegetables like pumpkin and carrots.</p>
<h2>2. B vitamins</h2>
<p><a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-b">B vitamins</a>, particularly B6, B9 and B12, contribute to your body’s first response once it has recognised a pathogen. </p>
<p>They do this by influencing the production and activity of “<a href="https://en.wikipedia.org/wiki/Natural_killer_cell">natural killer</a>” cells. Natural killer cells work by causing infected cells to “implode”, a process called <a href="https://en.wikipedia.org/wiki/Apoptosis">apoptosis</a>. </p>
<p>At a football match, this role would be like security guards intercepting wayward spectators trying to run onto the field and disrupt play.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320685/original/file-20200316-18086-1i9edys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fish is a good source of vitamin B6.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>B6 is found in cereals, legumes, green leafy vegetables, fruit, nuts, fish, chicken and meat. </p>
<p>B9 (<a href="https://en.wikipedia.org/wiki/Folate">folate</a>) is abundant in green leafy vegetables, legumes, nuts and seeds and is added to commercial bread-making flour.</p>
<p><a href="https://theconversation.com/have-you-gone-vegan-keep-an-eye-on-these-4-nutrients-107708">B12</a> (cyanocobalamin) is found in animal products, including eggs, meat and dairy, and also in fortified soy milk (check the nutrition information panel). </p>
<h2>3. Vitamins C and E</h2>
<p>When your body is fighting an infection, it experiences what’s called oxidative stress. Oxidative stress leads to the production of <a href="https://en.wikipedia.org/wiki/Reactive_oxygen_species">free radicals</a> which can pierce cell walls, causing the contents to leak into tissues and exacerbating inflammation.</p>
<p><a href="https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/">Vitamin C</a> and <a href="https://www.healthdirect.gov.au/vitamin-e">vitamin E</a> help protect cells from oxidative stress. </p>
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<strong>
Read more:
<a href="https://theconversation.com/coronavirus-its-time-to-debunk-claims-that-vitamin-c-could-cure-it-132803">Coronavirus: it's time to debunk claims that vitamin C could cure it</a>
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<p>Vitamin C also helps clean up this cellular mess by producing specialised cells to mount an immune response, including <a href="https://en.wikipedia.org/wiki/Neutrophil">neutrophils</a>, lymphocytes and <a href="https://en.wikipedia.org/wiki/Phagocyte">phagocytes</a>. </p>
<p>So the role of vitamin C here is a bit like cleaning up the football ground after the game.</p>
<p>Good sources of vitamin C include oranges, lemons, limes, berries, kiwifruit, broccoli, tomatoes and capsicum. </p>
<p>Vitamin E is found in nuts, green leafy vegetables and vegetables oils.</p>
<h2>4. Vitamin D</h2>
<p>Some immune cells need <a href="https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-d">vitamin D</a> to help destroy pathogens that cause infection. </p>
<p>Although sun exposure allows the body to produce vitamin D, food sources including eggs, fish and some milks and margarine brands may be fortified with Vitamin D (meaning extra has been added).</p>
<p>Most people need just <a href="https://www.cancer.org.au/preventing-cancer/sun-protection/vitamin-d/">a few minutes outdoors</a> most days.</p>
<p>People with vitamin D deficiency may need supplements. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/30675873">review of 25 studies</a> found vitamin D supplements can help protect against <a href="https://www.healthline.com/health/acute-respiratory-disease">acute respiratory infections</a>, particularly among people who are deficient.</p>
<h2>5. Iron, zinc, selenium</h2>
<p>We need iron, zinc and selenium for immune cell growth, among other functions.</p>
<p><a href="https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/iron">Iron</a> helps kill pathogens by <a href="https://www.ncbi.nlm.nih.gov/pubmed/30336639">increasing the number of free radicals</a> that can destroy them. It also regulates enzyme reactions essential for immune cells to recognise and target pathogens. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320686/original/file-20200316-18079-my91st.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Whole grain foods contain a variety of important nutrients.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://www.healthdirect.gov.au/zinc">Zinc</a> helps maintain the integrity of the skin and mucous membranes. Zinc and <a href="https://en.wikipedia.org/wiki/Selenium">selenium</a> also act as an antioxidant, helping mop up some of the damage caused by oxidative stress. </p>
<p>Iron is found in meat, chicken and fish. Vegetarian sources include legumes, whole grains and iron-fortified breakfast cereals. </p>
<p>Zinc is found in oysters and other seafood, meat, chicken, dried beans and nuts. </p>
<p>Nuts (especially Brazil nuts), meat, cereals and mushrooms are good food sources of selenium.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-should-i-take-vitamin-c-or-other-supplements-for-my-cold-98309">Health Check: should I take vitamin C or other supplements for my cold?</a>
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<h2>Putting it all together</h2>
<p>It’s true some supermarkets are out of certain products at the moment. But as much as possible, focus on eating a variety of foods <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">within each of the basic food groups</a> to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25625814">boost your intake</a> of vitamins and minerals.</p>
<p>While vitamin and mineral supplements are <a href="https://theconversation.com/mondays-medical-myth-take-a-vitamin-a-day-for-better-health-8482">not recommended for the general population</a>, there are some exceptions. </p>
<p>Pregnant women, some people with chronic health conditions, and people with conditions that mean they can’t eat properly or are on very restrictive diets, may need specific supplements. Talk to your doctor, Accredited Practising Dietitian or pharmacist.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/social-distancing-what-it-is-and-why-its-the-best-tool-we-have-to-fight-the-coronavirus-133581">Social distancing: What it is and why it's the best tool we have to fight the coronavirus</a>
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<p>And beyond diet, there are other measures you can take to stay as healthy as possible in the face of coronavirus.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30789425">Stop smoking</a> to improve your lung’s ability to fight infection, perform <a href="https://www.ncbi.nlm.nih.gov/pubmed/32139352">moderate intensity exercise</a> like brisk walking, <a href="https://www.ncbi.nlm.nih.gov/pubmed/31941836">get enough sleep</a>, practise social distancing and wash your hands with soap regularly.</p><img src="https://counter.theconversation.com/content/133356/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research and Gladys M Brawn Research Fellow. She has received research grants from NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>The food we eat influences our bodies’ immune responses to infection. So focusing on nutrition is one thing we can do to help protect ourselves in the face of the coronavirus threat.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1316482020-02-13T04:53:21Z2020-02-13T04:53:21ZI’m taking glucosamine for my arthritis. So what’s behind the new advice to stop?<figure><img src="https://images.theconversation.com/files/315132/original/file-20200213-41665-1c7dsys.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/arthritis-old-person-elderly-woman-female-757210732">Shutterstock</a></span></figcaption></figure><p>The Australian Rheumatology Association <a href="https://www.smh.com.au/national/hundreds-harmed-by-glucosamine-as-doctors-warn-stop-taking-it-20200129-p53vq1.html">this week warned</a> people not to take the supplement glucosamine for their osteoarthritis due to possible allergic side-effects.</p>
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<figcaption>The Australian Rheumatology Association warns against taking glucosamine to ease arthritis symptoms. Credit: 7 News Sydney</figcaption>
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<p>What’s the evidence behind this latest advice? And do you really need to stop taking it?</p>
<h2>How did we get here?</h2>
<p>For years, glucosamine has been marketed as a treatment for <a href="https://arthritisaustralia.com.au/types-of-arthritis/osteoarthritis/">osteoarthritis</a>, which can occur when the protective cartilage in the joints wears down over time.</p>
<p>This is despite <a href="https://theconversation.com/science-or-snake-oil-is-glucosamine-good-for-joints-98470">conflicting evidence</a> on whether the supplement works. Yet many patients may buy glucosamine, presuming that even if it doesn’t help, at least it’s “natural” and so won’t do any harm.</p>
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<p>But an <a href="https://pmj.bmj.com/content/early/2019/10/09/postgradmedj-2019-136957.long">Australian study</a>, which has been online since last year and was cited in one of this <a href="https://www.smh.com.au/national/hundreds-harmed-by-glucosamine-as-doctors-warn-stop-taking-it-20200129-p53vq1.html">week’s media reports</a>, has given us more information about glucosamine’s safety.</p>
<p>The study found hundreds of allergic reactions to glucosamine have been reported to Australia’s medicines watchdog, the Therapeutic Goods Administration (TGA).</p>
<p>So is it safe for you to take glucosamine? In short, if it works for you and you haven’t had any side-effects, and your doctor and pharmacist know you are taking it, it is likely to be safe based on the multiple trials conducted to date.</p>
<h2>What is glucosamine?</h2>
<p>Glucosamine is a naturally occurring substance the body uses to help build joint tissue, such as cartilage and tendons. In a supplement, the glucosamine can be made from the shells of prawns and other crustaceans, or it can be made synthetically in a factory.</p>
<p>Whether it works to manage osteoarthritis seems open to debate. The <a href="https://bjsm.bmj.com/content/52/3/167.abstract?casa_token=PYOOQN-X5ZQAAAAA:8bJwh7qncNLBS-QzvwIvX65KZpx55Rm-wXQ8xEeAtxLOls-zVHE-7XIdobVUjAcCkDA_m9nZ-y2a">most recent evidence</a> suggests little to no clinical benefit.</p>
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Read more:
<a href="https://theconversation.com/science-or-snake-oil-is-glucosamine-good-for-joints-98470">Science or Snake Oil: is glucosamine good for joints?</a>
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<p>But advice to GPs <a href="https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/hip-and-knee-osteoarthritis">about how to treat</a> osteoarthritis says the issue isn’t just confined to glucosamine.</p>
<p>When the Royal Australian College of General Practitioners looked at about 62 other medicines and possible treatments for osteoarthritis of the knee and hip (which include registered drugs and complementary medicines), none were backed by high-quality evidence to say they worked. Most of the evidence was based on low- or very low-quality studies.</p>
<h2>Is glucosamine really as dangerous as people say?</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pubmed/31597786">Australia study</a> found 336 cases of side-effects to glucosamine (and to another supplement used for osteoarthritis called chondroitin) were reported to the TGA over 11 years. Of these, 263 cases were allergies, which ranged from mild to severe.</p>
<p>We don’t know if these reactions included those from people with a known allergy to seafood or sulfur, as these would increase their risk of a reaction to glucosamine (glucosamine can come in different formulations, including glucosamine sulfate).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/315133/original/file-20200213-41695-v0jo31.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The glucosamine in supplements can come from the shells of prawns and other crustaceans, which is thought to trigger allergic reactions in some people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/steaming-prawns-419117911">Shutterstock</a></span>
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<p>But a <a href="https://link.springer.com/article/10.1007/s12603-016-0721-2">large percentage</a> of people take glucosamine daily in Australia, with no ill effects. The cases reported to the TGA amount to just 30 people a year, with 16% of allergic reactions considered severe.</p>
<p>Beyond allergic reactions, there are other safety concerns about glucosamine. </p>
<p>For instance, if you are taking glucosamine and a medicine that thins your blood (such as warfarin after a stroke), this can <a href="https://arthritisaustralia.com.au/glucosamine-and-warfarin-alert/">increase your risk</a> of bleeding.</p>
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Read more:
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<p>Glucosamine supplements have also been implicated in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3752575/">chronic liver disease</a> and in worsening underlying <a href="https://www.jabfm.org/content/15/6/481.short">asthma</a>. Some patients may also experience digestive symptoms such as heartburn. </p>
<p>The risks of other side-effects seem unclear, including whether it <a href="https://ard.bmj.com/content/66/2/260.short?casa_token=BBfCGMbeLwkAAAAA:k66n8x8Hc4z1gyc0gSKG6lIEES2lxHPwEWZqER1Ctwd6Iw2R3H7VV3UPgu0Wl3ftwXeUhRSNjFuM">raises</a> <a href="https://www.sciencedirect.com/science/article/abs/pii/S0002934316312530">blood glucose</a> levels in people <a href="https://doi.org/10.1016/j.amjmed.2016.11.038">with</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190977/">without</a> diabetes.</p>
<h2>Conflicting advice</h2>
<p>While the Australian Rheumatology Association has warned people to stop taking glucosamine, other advice is not so clear-cut.</p>
<p>Arthritis Australia <a href="https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/complementary-treatments-and-therapies/glucosamine-and-chondroitin/">reports</a> glucosamine is a relatively safe treatment option for people with osteoarthritis and has relatively few side-effects compared with traditional medicines. </p>
<p>And the <a href="https://www.racgp.org.au/download/Documents/Guidelines/Musculoskeletal/guideline-for-the-management-of-knee-and-hip-oa-2nd-edition.pdf">guidelines for GPs</a> on how to manage osteoarthritis of the knee and hip makes a “conditional” recommendation not to use it, based on uncertainty over the balance of harms with potential benefit.</p>
<h2>So, what should I do?</h2>
<p>What should you do if you’re taking glucosamine? If it works for you and you want to keep using it, then do so only on the advice of your doctor. That’s especially the case if you have any underlying medical conditions including diabetes, allergies or asthma. </p>
<p>Next, let your pharmacist know so they can check for any possible interactions with your other medicines, which can increase your risk of side-effects. You are most at risk if you are also taking warfarin, or any other type of blood thinning medicine. </p>
<p>Finally, if you do have unwanted side-effects from glucosamine, stop using it immediately and report it to your doctor. </p>
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<img src="https://counter.theconversation.com/content/131648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is also a director of the medicinal cannabis company Canngea Pty Ltd and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Joanna Harnett has received funding in the past from, Sigma Pty Ltd (operating as Orphan Australia) and Bioceuticals Pty Ltd in the past to conduct probiotic research. She is a board member of the Australasian Integrative Medicine Association. </span></em></p>Many people are taking glucosamine for their osteoarthritis. But do they really need to stop in light of new safety warnings?Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of SydneyJoanna Harnett, Lecturer (Complementary Medicines) Sydney Pharmacy School, Faculty of Medicine and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.