CHURCHILL LIVINGSTONE an Elsevier Science Company Notice Complementary and alternative medicine is an ever-changing field. Standard safety precautions must be fol- lowed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product infor- mation provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the licensed pre- scriber, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the publisher nor the editors assume any liability for any injury and/or dam- age to persons or property arising from this publication. Publishing Director: Linda Duncan Publishing Manager: Inta Ozols Associate Developmental Editor: Melissa Kuster Deutsch Project Manager: Peggy Fagen Designer: Mark Bernard Copyright © 2003 by Churchill Livingstone All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Library of Congress Cataloging-in-Publication Data Jamison, Jennifer R. Clinical guide to nutrition and dietary supplements in disease management / Jennifer R. Jamison. p. cm. Includes bibliographical references and index. ISBN 0-443-07193-4 (alk. paper) 1. Dietary supplements. 2. Diet therapy. 3. Nutrition. I. Title RM258.5.J35 2003 615.8’54–dc21 2003048515 Table of Contents Pt. 1 Principles of Nutritional Medicine 1 1 The Science of Nutritional Medicine 3 2 The Art of Nutritional Medicine: Patient-Centered Care 21 Self-Regulation: Pathophysiological Mechanisms Influencing 3 41 Health and Disease 4 Towards Nutritional Health: Choosing Food or Supplements 73 5 Supplements: Principles and Practice 103 6 Assessment of Nutritional Status 137 7 Laboratory Diagnosis and Nutritional Medicine 169 Pt. 2 Disease Management 203 8 Acne 205 9 Allergic Rhinitis 211 10 Alzheimer's Disease 215 11 Anxiety 225 12 Asthma 235 13 Benign Prostatic Hypertrophy 241 14 Breast Disease 245 15 Candidiasis 253 16 Cataract 259 17 Carpal Tunnel Syndrome 265 18 Cervical Cancer 267 19 Chronic Fatigue Syndrome 271 20 Colon Cancer 275 21 Coryza 281 22 Depression 285 23 Diabetes Mellitus 293 24 Eczema / Atopic Dermatitis 301 25 Fibromyalgia 305 26 Food Intolerance 311 27 Gout 315 28 Herpes Infection 319 29 Hypertension 323 30 Irritable Bowel Syndrome 329 31 Inflammatory Bowel Disease 333 32 Insomnia 339 33 Ischemic Heart Disease 345 34 Menopause 353 35 Migraine 359 36 Osteoarthritis 363 37 Osteoporosis 373 38 Peptic Ulcer Syndrome 383 39 Peripheral Arterial Disease 389 40 Premenstrual Syndrome 397 41 Prostate Cancer 403 42 Psoriasis 411 43 Rheumatoid Arthritis 417 44 Stones - Cholelithiasis and Urolithiasis 427 45 Recurrent Urinary Tract Infections 433 46 Venous Disorders 437 Pt. 3 Dietary Supplements 443 47 Astragalus Membranaceus 445 48 Bilberry Fruit (Vaccinium myrtillus) 449 49 Biotin 453 50 Black Cohosh (Cimicifuga racemosa) 455 51 Boron 459 52 Bromelain (Ananas comosus) 463 53 Calcium 467 54 Carotenoids 475 55 Chamomile (Matricaria reculita) 481 56 Chaste Tree (Vitex angus-castus) 483 57 Choline 487 58 Chromium 489 59 Coenzyme Q10 (ubiquinone) 493 60 Copper 497 61 Echinacea 501 62 Evening Primrose Oil 507 63 Feverfew (Tanacetum parthenium) 513 64 Fish Oils 517 65 Flavonoids 525 66 Fluoride 531 67 Folate 535 68 Garlic (Allium Sativum) 541 69 Ginger (Zingiber officinale) 547 70 Ginkgo biloba (ginkgo) 551 71 Ginseng (Eleutherococcus senticosus and Panax ginseng) 557 72 Goldenseal (Hydrastis canadensis) 563 73 New Zealand Green-Lipped Mussel (Perna canaticulus) 567 74 Hawthorn (Crataegus oxyacantha) 569 75 Iodine 573 76 Iron 577 77 Kava Kava (Piper methysticum) 583 78 Licorice (Glyrrhiza glabra) 587 79 Magnesium (Mg) 591 80 Manganese (Mn) 597 81 Meadowsweet (Filipendula ulmaria L) 601 82 Mistletoe (Viscum album) 603 83 Pau D'Arco (Tabebuia species) 607 84 Peppermint (Mentha Piperita) 611 85 Phytochemicals (Phytonutrients) 615 86 Phytoestrogens 619 87 Phytosterols 625 88 Potassium (K) 629 89 Quercetin 633 90 Saw Palmetto (Serenoa repens) 637 91 Selenium (Se) 641 92 Sodium (Na) 647 93 Soy Products 651 94 St. John's Wort (Hypericum Perforatum) 659 95 Stinging Nettle (Urtica dioica) 665 96 Turmeric (Curcuma longa) 669 97 Valerian (Valeriana officinalis) 673 98 Vitamin A 677 99 Vitamin B[subscript 1] (Thiamin) 685 100 Vitamin B[subscript 2] (Riboflavin) 689 101 Vitamin B[subscript 3] (Niacin) 693 102 Vitamin B[subscript 5] (Pantothenic Acid) 699 103 Vitamin B[subscript 6] 703 104 Vitamin B[subcript 12] (Cobalamin) 709 105 Vitamin C (Ascorbate) 715 106 Vitamin D 725 107 Vitamin E 733 108 Vitamin K 743 109 Witch Hazel (Hamamelis Virginiana L) 749 110 Zinc (Zn) 753 Appendices 761 App. A: Definitions and Sources of Dose Information 763 App. B: Abbreviations 765 Preface utritional medicine is gaining popularity as health professionals become more aware of scientifically proven links between diet and disease and Nlaypersons find it increasingly agreeable to self-medicate using natural remedies. The mushrooming interest in herbs and supplements has recently resulted in the publication of a plethora of texts in this area. The texts tend to fall into two dis- tinct categories: either they are well referenced, detailed, and tending to the esoteric, offering little practical advice to the generalist, or they are full of handy hints but lack any evidence of being based on scientifically validated information. It is hoped that this text will provide scientifically sound information while providing useful clinical guidance to those embarking on a pathway that boldly traverses conventional and alternative health care. Part One focuses on a number of important principles in the use of diet, nutri- ent, and herbal supplements. Part Two discusses certain disorders that are prevalent and/or particularly amenable to nutrient or herbal intervention. No attempt has been made to provide a comprehensive list of anecdotally useful interventions. Instead, the attempt has been to identify at least one probable mechanism involved in the pathogenesis of each listed condition and to demonstrate how selection of par- ticular foods, nutrients, and/or herbs can offer biologically plausible intervention. Part Three provides additional details on popular nutrients, herbs, and functional foods. Rather than attempting to list all the active constituents in herbs, only major physiologically active constituents are noted. When exploring the potential clinical usefulness of dietary supplements, I have made an attempt to provide an overview of current scientific thinking. In clinically effective doses, herbs and nutrient supple- ments constitute drug therapy; accordingly safe clinical care in nutritional medicine requires careful attention to dose, side effects, and interactions. Pregnant and breast- feeding women should be particularly cautious. Nutritional medicine is a rapidly advancing area that holds enormous promise. It is hoped that this text will be a useful aid in an exciting but often confusing area of health care. Jennifer R. Jamison Contributors Colm Benson, ND, BHSc Health Services Manager Analytical Reference Laboratories Victoria, Australia Ian Brighthope, MBBS, Dip Agr Sc, MATA, FACNEM President Australasian College of Nutritional and Environmental Medicine Victoria, Australia Paul Holman, MA, MB, Bchir, MRCPsych Consultant Psychiatrist Victoria, Australia Toni Jordan, BSc, Grad Cert BA, AACNEM National Sales & Marketing Manager Nutrition Care Pharmaceuticals Victoria, Australia Foreword he question of what to eat has been around since the dawn of humanity. Eating is fundamental to survival. The content of foods not only influences our short- Tterm feelings of well being and satiety but also a profoundly affects our long- term health, longevity, and risk of developing both acute and chronic diseases. Although it is becoming increasingly acknowledged that diet is one of the most important factors in determining our health, there are many factors that can be con- sidered when determining our food choices. These include social factors such as tra- dition, culture, religion, social status, fashion, branding, societal norms, media exposure, education, mass-marketing, peer pressures, and commercial interests; pragmatic factors such as availability, location, production methods, distribution and storage, time of day, affordability, and cooking methods; and individual factors such as time pressures, impulses, instant versus delayed gratification, physical activity, boredom, hunger, personal taste, education, past exposure, weight considerations, ethical beliefs, environmental concerns, desired health status, and specific medical conditions. It is important not only that we consider all of these factors but also that we understanding how these factors interact. In addition to making choices about what to eat, we must also contend with an expanding range of options for supplementing our diets. A visit to any health store or pharmacy will attest to the vast number of products available, including products containing vitamins, trace elements, and minerals; fish and plant oils; probiotics; amino acid and protein combinations; herbal and plant products, including teas, tinc- tures, extracts, powders, tablets, and whole plant extracts; and a vast array of combi- nation products that include many of these ingredients in various formulations and potencies. The scientific study of nutrition aims to determine how different nutritional substances interact with life processes and contribute to healthy functioning and to determine how they may be manipulated to help prevent and treat disease. Nutritional medicine is based on evidence accumulated from a variety of different sources, including basic biochemical investigations and in vitro studies looking at fundamental biologicalprocesses; animal studies looking at dietary manipulations in specific diseases and deficiency states; and human trials that range from randomized, double-blind, placebo-controlled studies of specific interventions for specific dis- eases, to case-control studies, cohort studies, and individual case series, to epidemi- ological studies looking at patterns of nutrition and disease in large populations. Evaluating the available evidence can be very confusing, because it is often dif- ficult to understand how in vitro or biochemical studies are relevant to clinical use. In addition, research results are not always clear-cut, as evidenced by the often- conflicting results and ongoing controversies among experts. Furthermore, it may be difficult to determine the independence of the information because many powerful forces behind the scenes control what studies are done and how information is presented. Given the vast array of food choices, the many possibilities for supplementa- tion, and the numerous studies on different nutrients and diseases, it is easy to Foreword xi become overwhelmed by the complexity of it all. This complexity is further increased when we consider the possible interactions that nutritional factors may have with pharmaceutical interventions and the highly individual physiological, psychological, and social factors that contribute to our overall health status. Despite the difficulties involved, the use of any therapy should be based on the best available evidence and informed decision making on behalf of both practition- ers and patients. Such decision making is both a subtle art and an inexact science, and it is up to individual practitioners and patients to seek the necessary information upon which to base their decisions. This book attempts to help guide us through this maze of information. The author has a long history of teaching and performing research in nutritional medicine and provides a well-referenced, evidence-based account of the clinical use of nutri- tional interventions in the treatment of specific diseases. This book should make the task of finding relevant information easier and therefore go along way toward help- ing us make informed decisions that contribute to the prevention and alleviation of human disease. Marc Cohen, MBBS (Hons) PhD, BMed Sc (Hons), FAMAS President, Australasian Integrative Medicine Association (AIMA) Head of Department, Department of Complementary Medicine, Faculty of Life Sciences RMIT University ■ C H A P T E R 1 ■ THE SCIENCE OF NUTRITIONAL MEDICINE The science of nutritional medicine identifies dietary choices and supplements likely to benefit most people: it uses evidence-based medicine to cate to the norm. Nutritional medicine holds enormous promise for health care in the new millennium. New insights are anticipated to emerge from the often dis- agreeable discourse between conventional and alternative health profes- sionals. Instead of a conceptual gulf caused by adherence to discrepant practice paradigms, practitioners of conventional and alternative medicine are likely to join forces in delivering a humanized yet scientific form of health care. Increasing acceptance of natural medicine and enhanced criti- cism of the mechanistic nature of conventional practice have fostered a transformation in health care. Conventional health care is undergoing an overhaul. The reductionist approach characteristic of the biomedical model is increasingly being modified to embrace the more holistic interactive approach captured by the infomedical model. Table 1-1 compares the bio- medical and infomedical models. The system proposed within the infomed- ical model is one of continual interaction between and within mind and body.1 The clinical repercussions of this changed perception include recog- nition of a consciously active role for the patient, acceptance of clinical uncertainty as an inevitable component of care, and a renewed appreciation of the complexity of those processes that influence the balance between health and disease. The paradigm shift in contemporary health care is characterized by a pro- found change in how the relationships between physician and patient, mind and body, and cause and effect are viewed. Instead of conforming to a dominant-submissive relationship, patients are emerging as partners in health care. Instead of viewing mind and body as separate, patients and physicians are recognizing psyche and soma as inseparable. Health and dis- ease triggers are no longer viewed as being limited to physical, chemical, or microbial factors; psychosocial stimuli are also perceived to advance wellness or disease. In contrast to the belief that individual disease triggers have a unilinear cause-effect relationship, multiple causes are perceived to 3