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This manuscript proposes a new extraction method for analyzing natural compounds in herbal supplements for weight loss and determining adulterants by a comprehensive two-dimensional gas chromatography system coupled to a quadrupole time-of-flight mass spectrometer (GCxGC/Q-TOFMS). In this new approach, a hydrophilic microporous cartridge (HMCart) was developed to enclose the samples, protecting the SPME (solid-phase microextraction) fibers. The cartridge is loaded with herbal supplement samples during direct immersion of SPME fiber in the aqueous phase to allow the analytes to be trapped. The new sample preparation method using chromatographic analyses enabled the detection of 650 compounds, including natural compounds, such as terpenes, aldehydes, ketones, and fatty acids. Adulterants found in other studies in the literature, such as sibutramine and ephedrine. The fluoxetine and caffeine were detected and quantified. The new method has achieved the goal of simple, effective, solvent-free, and versatile sample preparation that can be applied in future studies, including determining other compound classes in various matrix samples. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The use of natural interventions as uncomplicated treatment solutions has attracted the attention of many doctors and patients today. This review analyzes the effects of different strategies of exercise training and curcumin consumption on the level of adipokines and adipocytes. Results: One of the important spices whose medicinal properties have been proven is turmeric, which is medically confirmed due to the presence of important polyphenols such as curcumin, which have anti-inflammatory and antioxidant properties. Due to its anti-inflammatory properties, curcumin can help to improve the inflammation and muscle pain caused by exercise, thus leading to the improvement of health status in all populations. Due to their different characteristics, adipokines, and adipocytes released from fat tissue can play different roles in the body and lead to different physiological responses in the body, some of which can lead to disturbances in the normal function of the body. An increase in fat tissue leads to an increase in the level of pro-inflammatory adipokines and, as a result, a decrease in anti-inflammatory adipokines. Conclusion: Emphasizing the importance of lifestyle modifications, the review underscores the potential of curcumin and exercise as effective and accessible interventions for individuals grappling with metabolic syndrome, obesity, and diabetes. By addressing inflammation and promoting metabolic balance, these natural approaches offer promising avenues for therapeutic intervention.

AbstractThe growing co-consumption of botanical natural products with conventional medications has intensified the need to understand potential effects on drug safety and efficacy. This review delves into the intricacies of intestinal pharmacokinetic interactions between botanical natural products and drugs, such as alterations in drug solubility, permeability, transporter activity, and enzyme-mediated metabolism. It emphasizes the importance of understanding how drug solubility, dissolution, and osmolality interplay with botanical constituents in the gastrointestinal tract, potentially altering drug absorption and systemic exposure. Unlike reviews that focus primarily on enzyme and transporter mechanisms, this article highlights the lesser known but equally important mechanisms of interaction. Applying the Biopharmaceutics Drug Disposition Classification System (BDDCS) can serve as a framework for predicting and understanding these interactions. Through a comprehensive examination of specific botanical natural products such as byakkokaninjinto, green tea catechins, goldenseal, spinach extract, and quercetin, we illustrate the diversity of these interactions and their dependence on the physicochemical properties of the drug and the botanical constituents involved. This understanding is vital for healthcare professionals to effectively anticipate and manage potential natural product-drug interactions, ensuring optimal patient therapeutic outcomes. By exploring these emerging mechanisms, we aim to broaden the scope of natural product-drug interaction research and encourage comprehensive studies to better elucidate complex mechanisms. [ABSTRACT FROM AUTHOR]

We aimed to evaluate herbal medicine and supplement use patterns among adolescent and young adult women at a clinic focused on family planning. We conducted a cross-sectional survey of patients (age 14-25) at an adolescent Title X clinic. Participants completed an electronic survey that assessed herbal medicine and supplement use, baseline demographic characteristics, and current contraceptive method. We evaluated supplement-drug interactions using the Natural Medicines database Interaction Checker. Quantitative analyses were performed using χ2 and independent medians tests. We enrolled 99 participants with a median age of 20 (15-24) years. Overall, 42.4% of patients reported ever having used supplements or herbal medicines, with 29.9% of patients reporting current supplement or herbal medicine use. Patients with higher education and private insurance were more likely to report a history of and current supplement use (P <.05). The most common herbal supplements reported were green tea (n = 26), cannabidiol (n = 17), and cranberry (n = 16), with 29.6% of participants reporting use to their general health care provider. The most common reasons for use were general health and wellness (29.1%), immune support (23.2%), stress (16.8%), and menstrual irregularities (6.0%). We found 62 moderate risk supplement-drug interactions, with 50 interactions attributed to hormonal contraceptive therapies. The most common interactions were via cytochrome P450 enzyme (CYP3A4 or CYP1A2) inhibition, decreased caffeine clearance, and potential hepatotoxicity. Adolescent and young adult women frequently reported past and current herbal medicine and supplement use, with high rates of moderate-risk supplement-drug interactions. Further research is needed to better elucidate these clinically relevant supplement-contraception interactions. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic was associated with an increased global use of traditional medicines, including Ayurvedic herbal preparations. Due to their growing demand, their processed nature, and the complexity of the global supply chain, there is an increased risk of adulteration in these products. Objectives: The objective of this study was to assess the use of DNA barcoding for species identification in herbal supplements on the US market associated with the Ayurvedic treatment of respiratory symptoms. Methods: A total of 54 commercial products containing Ayurvedic herbs were tested with four DNA barcoding regions (i.e., rbcL, matK, ITS2, and mini‐ITS2) using two composite samples per product. Nine categories of herbs were targeted: amla, ashwagandha, cinnamon, ginger, guduchi, tribulus, tulsi, turmeric, and vacha. Results: At least one species was identified in 64.8% of products and the expected species was detected in 38.9% of products. Undeclared plant species, including other Ayurvedic herbs, rice, and pepper, were detected in 19 products, and fungal species were identified in 12 products. The presence of undeclared plant species may be a result of intentional substitution or contamination during harvest or processing, while fungal DNA was likely associated with the plant material or the growing environment. The greatest sequencing success (42.6–46.3%) was obtained with the matK and rbcL primers. Conclusion: The results of this study indicate that a combination of genetic loci should be used for DNA barcoding of herbal supplements. Due to the limitations of DNA barcoding in identification of these products, future research should incorporate chemical characterization techniques. This study assessed the use of DNA barcoding for species identification in herbal supplements associated with the Ayurvedic treatment of respiratory symptoms. A total of 54 commercial herbal products were tested with four DNA barcoding regions. The expected species was detected in 21 of the 54 products; undeclared plant species were detected in 19 products; and fungal species were identified in 12 products. The results reveal that a combination of genetic loci allows for increased sequencing success in herbal products. [ABSTRACT FROM AUTHOR]

Serotonin toxicity is a well-described phenomenon that is commonly attributed to a variety of drug–drug combinations. Some unregulated herbal supplements have been implicated in the onset of serotonin toxicity, however, there is currently minimal literature available on the potential for black cohosh to contribute to rhabdomyolysis and serotonin toxicity, in spite of its known serotonergic properties. A middle-aged woman presented to the emergency department with serotonin toxicity and rhabdomyolysis shortly after taking black cohosh supplements in the setting of long-term dual antidepressant use. The serotonin toxicity and rhabdomyolysis resolved with IV fluids, benzodiazepines, and discontinuation of the offending drugs. Patients are sometimes not aware of how over-the-counter supplements might interact with their prescription medications. Female patients taking black cohosh to manage hot flashes and menopausal symptoms could be at risk for developing rhabdomyolysis and serotonin toxicity if they are also taking other serotonergic agents. [ABSTRACT FROM AUTHOR]

Acute respiratory infection is a health problematic in Islamic boarding school. Lack of student awareness in maintaining health causes an increase in acute respiratory infections. This community service aims to increase the knowledge, skills and awareness of students in improving immunity and preventing acute respiratory infection. The method used is participatory action research (PAR), which is divided into four stages, namely focus group discussions, education, making herbal supplements, and evaluation. Focus group discussion was participated by some element, including coordinator of santri husada, santri husada, basic health service and students. Education was presented as lectures, discussion and consultation about immunity elevation. Education was conducted in several days for student in A1, A2, B, and M’hadul Quran dormitory to encourage more students. The next step was training to make herbal supplement, which attended by 42 students. The Forty-two student were divided into six groups to make herbal drink and instant supplement drink. Based on training evaluation, the education and training increased the knowledge and skill of participants. In summary, this activity increase health immune knowledge and supplement making of students.

Background/objectiveExogenous Cushing syndrome is usually diagnosed in the setting of known glucocorticoid exposure; however, occult glucocorticoid use is possible. We present 2 cases of patients who developed Cushing syndrome while taking Artri King (AK), an over-the-counter "herbal" supplement for joint pains reported to contain glucocorticoids.Case reportPatient 1, a 49-year-old woman, reported rapid weight gain, large stretch marks, poor wound healing, and recent diagnoses of type 2 diabetes mellitus and hypertension over a course of 1 year. Her serum am cortisol level was

This review assessed the efficacy and safety of pharmacologic agents (prostaglandins, oxytocin, mifepristone, hyaluronidase, and nitric oxide donors) and mechanical methods (single- and double-balloon catheters, laminaria, membrane stripping, and amniotomy) and those generally considered under the rubric of complementary medicine (castor oil, nipple stimulation, sexual intercourse, herbal medicine, and acupuncture). A substantial body of published reports, including 2 large network meta-analyses, support the safety and efficacy of misoprostol (PGE1) when used for cervical ripening and labor induction. Misoprostol administered vaginally at doses of 50 μg has the highest probability of achieving vaginal delivery within 24 hours. Regardless of dosing, route, and schedule of administration, when used for cervical ripening and labor induction, prostaglandin E2 seems to have similar efficacy in decreasing cesarean delivery rates. Globally, although oxytocin represents the most widely used pharmacologic agent for labor induction, its effectiveness is highly dependent on parity and cervical status. Oxytocin is more effective than expectant management in inducing labor, and the efficacy of oxytocin is enhanced when combined with amniotomy. However, prostaglandins administered vaginally or intracervically are more effective in inducing labor than oxytocin. A single 200-mg oral tablet of mifepristone seems to represent the lowest effective dose for cervical ripening. The bulk of the literature assessing relaxin suggests this agent has limited benefit when used for this indication. Although intracervical injection of hyaluronidase may cause cervical ripening, the need for intracervical administration has limited the use of this agent. Concerning the vaginal administration of nitric oxide donors, including isosorbide mononitrate, isosorbide, nitroglycerin, and sodium nitroprusside, the higher incidence of side effects with these agents has limited their use. A synthetic hygroscopic cervical dilator has been found to be effective for preinduction cervical ripening. Although a pharmacologic agent may be administered after the use of the synthetic hygroscopic dilator, in an attempt to reduce the interval to vaginal delivery, concomitant use of mechanical and pharmacologic methods is being explored. Combining the use of a single-balloon catheter with dinoprostone, misoprostol, or oxytocin enhances the efficacy of these pharmacologic agents in cervical ripening and labor induction. The efficacy of single- and double-balloon catheters in cervical ripening and labor induction seems similar. To date, the combination of misoprostol with an intracervical catheter seems to be the best approach when balancing delivery times with safety. Although complementary methods are occasionally used by patients, given the lack of data documenting their efficacy and safety, these methods are rarely used in hospital settings. [ABSTRACT FROM AUTHOR]

Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an "Integrative Oncology" (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations. [ABSTRACT FROM AUTHOR]

Background: The overstoring of surplus calories in mature adipocytes causes obesity and abnormal metabolic activity. The anti-obesity effect of a Celosia cristata (CC) total flower extract was assessed in vitro, using 3T3-L1 pre-adipocytes and mouse adipose-derived stem cells (ADSCs), and in vivo, using high-fat diet (HFD)-treated C57BL/6 male mice. Methods: CC extract was co-incubated during adipogenesis in both 3T3-L1 cells and ADSCs. After differentiation, lipid droplets were assessed by oil red O staining, adipogenesis and lipolytic factors were evaluated, and intracellular triglyceride and glycerol concentrations were analyzed. For in vivo experiments, histomorphological analysis, mRNA expression levels of adipogenic and lipolytic factors in adipose tissue, blood plasma analysis, metabolic profiles were investigated. Results: CC treatment significantly prevented adipocyte differentiation and lipid droplet accumulation, reducing adipogenesis-related factors and increasing lipolysis-related factors. Consequently, the intracellular triacylglycerol content was diminished, whereas the glycerol concentration in the cell supernatant increased. Mice fed an HFD supplemented with the CC extract exhibited decreased HFD-induced weight gain with metabolic abnormalities such as intrahepatic lipid accumulation and adipocyte hypertrophy. Improved glucose utilization and insulin sensitivity were observed, accompanied by the amelioration of metabolic disturbances, including alterations in liver enzymes and lipid profiles, in CC-treated mice. Moreover, the CC extract helped restore the disrupted energy metabolism induced by the HFD, based on a metabolic animal monitoring system. Conclusion: This study suggests that CC total flower extract is a potential natural herbal supplement for the prevention and management of obesity.

Phyto additives and their bioactive ingredients prove to be effective in enhancing the nutritional content of fish feed. This study aimed to elucidate the impact of incorporating powdered herbal seeds (fennel, fenugreek, and anise) as feed supplements at 5 g / kg of feed on zootechnical performance, entire body chemical composition, hemogram, hepato-renal biomarkers, immune response, and the diversity of the intestinal microbiota of European sea bass (Dicentrarchus labrax). During a 90-day feeding trial, a cohort of 240 fish with an average body weight of 9.52 ± 0.17 g were mono-cultured in concrete tanks within the hapa net enclosures (1 m3) at a stocking density of 20 fish/hapa. The results revealed significant enhancements in weight gain (P ≤ 0.001), feed conversion ratio (P < 0.05), visceral somatic index (P ≤ 0.001), relative gut length (P ≤ 0.001), Fulton's factor (P ≤ 0.01), along with a reduction in mortality rate (P ≤ 0.01) across dietary groups compared to the control one. Nonetheless, proximate body composition and hepato-renal function measures were not significantly affected (P > 0.05). Whereas lymphocytes, neutrophils, globulin, lipid profile, phagocytic activities, and lysozyme activities exhibited significant improvements (P < 0.05 to ≤ 0.001) due to the herbal supplementation. The herbal supplements displayed prebiotic-like effects by significant (P < 0.05 to ≤ 0.0001) reducing the count of Vibrio spp. and total fecal coliform together with significant enhancing (P ≤ 0.01–0.001) colonization of lactic acid bacteria in Sea bass's gut. These findings emphasize that seed powder can enhance growth performance, biometry indices, innate immunity, lipid metabolism, and modulate gut microbiota without adverse effects on the haemato-biochemical profile of fish.

Herbal weight loss supplements are widely used in the management of obesity, but consistent data to support long-term weight loss efficacy and safety are missing. Besides, legal framework for food supplements is less restrictive than regulation of medications. The objective of this review is to give weight to the fact that many weight loss supplements contain herbal compounds with unknown mechanism of action, increasing the risk for adverse effects, even toxicity, especially in co-administration with prescribed drugs. Hepatotoxicity ranging from elevated transaminases and autoimmune-like hepatitis to acute liver failure appears to be underrecognized, but is not uncommonly encountered. Another and even more serious concern is adulteration of weight loss supplements by illegal addition of unauthorized substances or medications to provide quick effects and to increase sales. Here are some significant data regarding the possible hepatotoxicity of frequently used herbal extracts, as well as the health risks related to some common adulterants. Towards safer use of supplements, a comprehensive and critical discussion of current regulatory principles is essential to address the existing gap between the increased use of food supplements and the lack of knowledge about their benefits, providing better protection for consumers.

Global warming is a key challenge subjecting animals to heat stress conditions resulting in multiple physiological alterations in tropical climate. Dietary approach seems to be the more friendly approach to curb the adverse effects of heat stress in rabbits. Some herbs have been categorized to have high potential for promotion of immune responses for amelioration of heat stress. Thus, this research aims to evaluate the potential of Mistletoe (Viscum album), Moringa (Moringa oleifera) and Phyllanthus (Phyllanthus amarus) leaf meal as herbal supplements for the alleviation of heat stress in female rabbits by measuring improvement in sex and stress hormonal responses in serum biochemistry. 80 Rabbit does were exposed to 4 dietary groups supplemented with each of Mistletoe, Moringa, Phyllanthus and a control in an 84-day trial at the summit of thermal stress in South west Nigeria. Growth indices were monitored throughout the study, blood samples were compiled at the end of the trial to assess serum biochemistry, stress and sex hormonal responses of the Does using standard protocols. The results revealed that final weight and weight gain of Does fed on Phyllanthus were significantly (p < 0.05) higher (11.46% and 14.25%, respectively) than Does on control. The herbal supplements enhance glucose, protein, albumin and globulin, reduced cholesterol, and creatinine of Does under heat stress conditions. Among the herbal treatment groups, mistletoe, moringa and phyllanthus had 12.42%, 18.39% and 16.90%, respectively, lower corticosterone than control groups which had 39.76ng/ml. Triiodothyronine of Does fed control were significantly (p < 0.05) lower than Does on Moringa oleifera and Phyllanthus amarus supplements. Estradiol and Follicle stimulating hormone of rabbit Does fed on moringa supplement were significantly (p < 0.05) higher than other treatments. In conclusion, the herbal supplements tend to mitigate the detrimental outcome of thermal stress on Does by suppressing stress hormones. Moringa oleifera and Phyllanthus amarus enhanced sex hormones while Phyllanthus amarus confered growth promoting effects on the Does.

Oat grain is characterized by the presence of a number of biologically active substances that contribute to the normalization of the gastrointestinal tract and maintain vascular health. Oat grains are used in diet food as they do not contain gluten. The germination of oat grains contributes to increasing the content of biologically active substances in it. The proposed method for producing cereal drinks based on oats includes the stages of washing the grains, disinfecting, germinating the grains, obtaining a liquid grain base, stabilizing the structure of the grain base, sterilization, adding flavoring components. The developed technology makes it possible to produce oat-based cereal drinks with a stable structure and improved organoleptic characteristics without additives and with vegetable additives, which are dried chokeberry meal (2 %) and rosehip syrup (16 %). The organoleptic characteristics of the drinks obtained correspond to the requirements of regulatory documentation. Drinks with herbal additives are superior to drinks without additives in taste, aroma, color and texture. The storage capacity of drinks established in the course of microbiological examination and analysis of viscosity and acidity is five days.

Summary: Background and aim: The outbreak of coronavirus (COVID-19) has made a global public health disaster. Little information is known about how to combat this infection. Therefore, preventive health measures that can reduce the severity and progression of this disease are needed. Some dietary supplements and herbal products have antiviral and anti-inflammatory effects. Thus, it may be used to enhance immunity and reduce the risk of COVID-19 infection. In this study, we reviewed selected supplements that may play a key role in the prevention and management of COVID-19 (e.g. vitamin D, vitamin C, and zinc), and that was to determine the level of knowledge and attitudes toward them by the adult population in Jordan. Methodology: This is a cross-sectional study design, in which an online questionnaire was conducted and distributed on different social media websites. People who are above 18 years old were included in this study. Demographic, Attitudes, and knowledge data were collected and then analyzed using the Statistical Package for Social Sciences (SPSS 23). Results: In this study, (62.8%) of participants became more concerned with their health during the COVID-19 pandemic, and (49.2%) of them used dietary and herbal supplements to protect themselves from the coronavirus. In addition, (18.5%) of participants reported that they had used these supplements for a while and then stopped. Conclusion: The findings of our study provided evidence that the general population in Jordan has a reasonable level of knowledge and acceptance of dietary and herbal supplements used during the COVID-19 pandemic.

An herbal supplement made with thyme, mint, cilantro, and rowan and viburnum fruit has been used to fortify wheat bread with antioxidants. The antioxidant activity of raw materials and bread was determined by the spectrophotometric method. To determine substances with antioxidant properties, the HPLC method was used. The chromatogram of the alcoholic extract of the herbal supplement showed that the supplement contains organic acids, flavonoids and anthocyanins. The HPLC method was used to determine the amount of flavonoids in the supplement and bread. Micrographs of the surface of slices of bread with a phytonutrient were obtained by scanning electron microscopy. The presence of chemical elements with antioxidant properties was determined using an X-ray EMF detector in the scanning electron microscope system. The use of phytonutrients in bread technology has been found to lead to an increase in the quality of the product and its antioxidant activity. [ABSTRACT FROM AUTHOR]

Objective: Understanding the changes in consumer use of herbal products and what has influenced these changes is key in the promotion of evidence informed use. The last analysis of evidence informed herbal supplement use involved the 2002 National Health Interview Survey (NHIS) analysis. This study reproduces and expands upon that earlier analysis, with the most recent NHIS dataset to report herb use patterns. It also explores the guiding resources consulted by consumers in their decision to use. Methods: Secondary analysis of cross-sectional data from the NHIS identified the 10 herbal supplements with the most reported use in 2012. The reasons reported by the NHIS for taking herbal supplements were compared with the 2019 Natural Medicines Comprehensive Database (NMCD) to determine whether reasons cited in consumption were supported by evidence. Logistic regression models were fit according to NHIS sampling weights to examine the relationship between evidence-based use and user characteristics, guiding resources, and health care professional engagement surrounding use. Results: Of the 181 reported uses of herb supplements for a specific health condition, 62.5% were for reasons supported by evidence-based indications (EBIs). The odds of herb use consistent with evidence significantly increased for those reporting higher education status (odds ratio [OR] = 3.01, 95% confidence interval [CI] [1.70–5.34]). Herbal supplement use consistent with EBIs was more likely among those who disclosed their herb use to a health care professional (OR = 1.77, 95% CI [1.26–2.49]). Evidence-based herb use was also less frequently informed by Media sources (OR = 0.43, 95% CI [0.28–0.66]) compared with non-EBI use. Conclusion: Approximately 62% of the reasons cited for taking the most consumed herbs in 2012 were in alignment with 2019 EBIs. This increase may be due to improved awareness of health care professionals and/or an increase of evidence for traditional uses of herbal products. Future research should explore the role of each of these stakeholders in improving evidence-based herb use in the general population. [ABSTRACT FROM AUTHOR]

Pyrrolizidine alkaloids (PAs) are noted for their hepatotoxic, genotoxic, and carcinogenic effects in animals and humans following metabolic activation in the liver. In this study, herbal supplements sold in Ghana for sexual improvement were analysed for the presence of 64 PAs using LC-MS/MS analysis. Up to 17 different PAs were identified in 19 out of the 37 samples analysed. The sum of PAs in samples ranged from 5 to 3204 μg kg−1. Since the PA content in the herbal medicinal preparations was generally lower than in honey samples, their presence was mainly attributed to cross-contamination. The observed levels would result in estimated daily intakes from 0.01 to 12 μg per day or 0.0002 to 0.2 μg kg−1 bw day−1 for a person weighing 70 kg. The margins of exposure ranged from 1200 to 1,400,000 with eight samples showing values below 10,000, thus indicating a health concern. [ABSTRACT FROM AUTHOR]

Objective: To address the knowledge gap surrounding herbal medicine and supplement usage patterns and supplement-prescription medication interactions among patients seeking treatment for infertility. Design: Cross-sectional survey study. Setting: Academic infertility practice. Patient(s): Ninety-five reproductive-aged patients. Intervention(s): Not applicable. Main Outcome Measure(s): Use of herbal medications and supplements, baseline demographics, history of infertility treatments, and potential supplement-medication interactions. Result(s): We surveyed 95 participants with a median age of 35 years. Overall, 68.4% of patients reported ever having used supplements or herbal medicines in the past. Current use of herbal supplements and vitamins was reported by 53.7% and 93.7% of participants, respectively, with a median of 2 (range 19) supplements used per person. There were no significant associations between patient demographics, comorbidities, or infertility treatments with increased rates of supplement use. The most commonly used herbal supplements were: green tea (n = 14), chamomile (n = 12), peppermint (n = 9), turmeric (n = 8), elderberry (n = 7), ginger (n = 7), maca (6) with the most common modalities being pills/capsules (23.8%) and tea (42.3%). The most common reasons for use were: general health and wellness (24.5%), immune support (16.2%), stress (14.0%), and fertility (15.0%). Patients used maca (n = 5), chasteberry (n = 3), goji berry (n = 2), ginger (n = 2), yam-based progesterone (n = 2), and combination product (n = 2) for fertility purposes. A total of 7.9% of patients learned about these products from their general health care provider, and 33.3% of supplements were disclosed by patients to their provider. We identified 41 moderate-risk supplement-drug interactions, with 12 of these interactions attributed to infertility therapies. Based on the interaction checker, the most commonly proposed mechanisms of interaction were CYP3A4 and CYP2C19 inhibition. In terms of safety in pregnancy, cannabidiol and chasteberry were suggested to be “possibly unsafe in pregnancy,” and red raspberry leaf “likely unsafe in pregnancy” without direct medical supervision. Conclusion(s): We found over two thirds of women seeking treatment for infertility reported past and over half reported current herbal medicine and supplement use. Notably, the Natural Medicines Interaction Checker suggested high rates of moderate-risk supplement-drug interactions and possible harmful effects in early pregnancy. Our results call for further investigation of clinically relevant supplement interactions with infertility therapies.

Cancer-related pain (C-RP) is a prevalent and debilitating concern among patients with cancer, with conventional treatments limited in their ability to provide adequate relief, and by the adverse effects associated with their use. Complementary and integrative medicine (CIM) modalities have been shown to be potentially effective and safe for the treatment of pain and related symptoms, when used in conjunction with conventional medications and under medical supervision. An increasing number of oncology centers provide CIM within their conventional supportive and palliative care service, in an “Integrative Oncology” (IO) setting. A large body of clinical research, including systematic reviews and guidelines such as those published in 2022 by the Society for Integrative Oncology (SIO), in collaboration with the American Society for Clinical Oncology (ASCO), support the use of some CIM modalities for C-RP and related concerns. These include acupuncture for general and peri-operative/procedural pain, as well as aromatase inhibitor-associated arthralgia (AIA); reflexology or acupressure for pain during systemic therapy for cancer; hypnosis for procedural pain or pain due to diagnostic workup; and massage for pain experienced by patients during palliative and hospice care. Further research is needed, within both randomized control trials and pragmatic non-controlled studies which are more reflective of the real-life IO setting. This review summarizes the evidence supporting the use of CIM for C-RP; the analgesic mechanism of the modalities presented; and the challenges facing IO researchers, as well as the implementation of the 2022 SIO-ASCO guideline recommendations.

Acute liver failure (ALF) is a potentially fatal illness marked by the abrupt development of jaundice, coagulopathy, and hepatic encephalopathy (HE) in persons having no previous history of hepatic disease. It is a relatively uncommon illness, having an incidence of 1 to 8 per million people. Hepatitis A, B, and E viruses have been documented as the most prevalent etiologies of acute liver failure in Pakistan and other developing nations. However, ALF may also occur secondary to toxicity caused by the unmonitored overdosing and toxicity of traditional medicines, herbal supplements, and alcohol. Similarly, in some instances, the etiology remains unknown. Herbal products, alternative, and complementary therapies are frequently practiced across the globe for treating various illnesses. In recent times, their use has gained much popularity. Indications and the use of these supplementary drugs vary significantly. The majority of these products have not gained approval from Food and Drug Administration (FDA). Unfortunately, the incidence of documented adverse effects linked to the usage of herbal products has increased recently, but still, these events are underreported, and the condition is known as drug-induced liver injury (DILI) and herb-induced liver injury (HILI). The estimated total herbal retail sales increased from $4230 million in 2000 to $6032 million in 2013, representing a total of 42 and 3.3% per annum increase. To reduce the occurrence of HILI and DILI, physicians in general practice settings should inquire about patients' understanding of potential toxicity with the consumption of hepatotoxic and herbal medicines. [ABSTRACT FROM AUTHOR]

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires—one focusing on pharmacists and the other focusing on pharmacy students—were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area. [ABSTRACT FROM AUTHOR]

Background/Objective: Exogenous Cushing syndrome is usually diagnosed in the setting of known glucocorticoid exposure; however, occult glucocorticoid use is possible. We present 2 cases of patients who developed Cushing syndrome while taking Artri King (AK), an over-the-counter “herbal” supplement for joint pains reported to contain glucocorticoids. Case Report: Patient 1, a 49-year-old woman, reported rapid weight gain, large stretch marks, poor wound healing, and recent diagnoses of type 2 diabetes mellitus and hypertension over a course of 1 year. Her serum am cortisol level was

Herbal and dietary supplement (HDS) use has grown exponentially in the United States. Unfortunately, the incidence of HDS-related liver injury has proportionally increased. Despite the potential for certain HDSs to cause clinically significant liver injury, they are not regulated by the Food and Drug Administration. Recent efforts have been made to regulate HDSs but are far removed from the scrutiny of prescription medications. Scant literature exists on HDSs and their risks of causing liver injury. In this comprehensive review, we examine trends of HDS use in the United States and the pathophysiologic mechanisms of drug-induced liver injury (DILI) of certain HDSs. Finally, we review usage rates; benefits, if any; purported pathophysiology of DILI; and propensity for progression to fulminant hepatic failure of nine HDSs linked to clinically significant DILI.

The research was carried out on the possibility of using potherbs in bakery industry. Powder of plants were used to replace 0.5%, 2%, 5%, 10% and 15% of wheat flour: Chenopōdium quīnoa L.; Cyperus esculentus L.; Physalis tomentous L.; Cosmos sulphureus Cav.; Pycnanthemum virginianum L.; Pycnanthemum trifolium L.; Agastache rugosa (Fisch. & C.A. Mey.) Kuntze; Agastache urticifolia (Benth.) Kuntze, cv. Weide Kerze; Mentha spicаta L. 'Moroccan'; Achillea setacea Waldst. Et Kit.; Isodon japonicus var. Glaucocalyx (Maxim.) H. W. Li; Satureja montana L.; Teucrium scorodonia L.; Ruta montana L.; Népeta argolica Bory et Chaub.; Népeta grandiflora L.; Népeta mussinii Spreng. Ex Henckel., cv. Posviata Meisu; Népeta nepetelia L. In order to develop an effective technology for its use, creating new types of products with properties that meet current needs of consumers in Ukraine and the world, it is necessary to clarify the relation of potherbs with other components. Baking properties determine the behavior of flour in technological process, namely, they form the quality of bread and depend on the state of carbohydrate-amylase, protein-proteinase, lipidlipolytic complexes, as well as the content of compounds that cause darkening of flour during the process of bread making. Use of herbs in bakery is promising. The data obtained allows manufacturers to recommend the use of herbs during the production of bread. [ABSTRACT FROM AUTHOR]

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Reactive oxygen and nitrogen species (ROS/RNS) are known to cause oxidative damage to cells and macromolecules. Intake of antioxidant-rich fruits and vegetables has been touted as a strategy to mitigate oxidative stress, but this is not always accommodated in modern diets. Augmentation with antioxidant-rich herbal supplements may be a preventive measure against the negative effects of ROS/RNS. In this study, we verify and compare the antioxidant claims of herbal supplements by measuring their phytochemical content and antioxidant capacities through the oxygen radical absorption capacity-multi-radical (ORAC MR5) assays. ORAC MR5 measures antioxidant activity against five biologically relevant ROS/RNS (peroxyl and hydroxyl radical, superoxide anion, singlet oxygen, and peroxynitrite). Four products were tested: two multi-herbal capsules (INT and Oxxy), a mangosteen fruit pulp powder capsule (MPC), and a mixed herbal drink (MHD). Phytochemical content was quantified through total phenolic and flavonoid content assays. Oxxy had the highest flavonoid content per serving (106.4 mg catechin eq/450 mg capsule) and ORAC MR5 value (37,503 μmol Trolox eq/450 mg capsule), followed by INT (53.5 mg catechin eq and 17,298 μmol Trolox eq/200 mg capsule), MPC (48.1 mg catechin eq and 7,675 μmol Trolox eq/500 mg capsule), and then MHD (7.4 mg catechin eq and 146.7 μmol Trolox eq/30 mL drink). Significant antioxidant activities against peroxyl radicals and singlet oxygen were observed for INT and Oxxy, whereas the antioxidant activity of MPC and MHD were mostly towards peroxyl radicals. A strong correlation was found between phenolic and flavonoid contents and ORAC MR5 values, and we confirmed supplier claims on standardized phenolic content or antioxidant activity of INT and Oxxy. This study demonstrated the utility of ORAC MR5 as a measure of in vitro antioxidant activity of herbal supplements against biologically relevant ROS/RNS and may be used for the development and quality control of herbal supplements. [ABSTRACT FROM AUTHOR]

During the first year of the COVID-19 pandemic, the lack of cure and the intensity of the global spread raised a common awareness of health. The aim of this scoping review is to summarize dietary supplement use globally during first two years of the COVID-19 pandemic. A systematic search was conducted in December 2021 following PRISMA guidelines. PubMed, ERIC, and Scopus databases were searched, and 956 results were screened for eligibility. Fourteen cross-sectional studies from 11 countries and 3 continents were examined. All studies were large population surveys investigating healthy eating and supplement use during COVID-19. Vitamin C, vitamin D, zinc and multivitamins were the most widely reported, as well as natural/herbal products such as ginger and honey. The most common reason cited for supplements use was to strengthen immune system and to prevent infection of COVID-19. These studies reported that populations are relying on healthcare providers, family, friends, and social media to learn about supplement use. Future studies on the treatment of COVID-19 should include more evidence for supplement use. [ABSTRACT FROM AUTHOR]

The advent of Corona virus Disease 2019 (COVID-19) distorted health systems of many countries. Efforts have been made to either develop new treatment solutions such as vaccines or repurpose previously adopted drugs. Challenges in accessing available treatment, inadequate, non-existent, or overstretched healthcare facilities, long COVID disease, cultural practices and beliefs about vaccination, vaccine hesitancy, availability, accessibility and perceived safety of herbal supplements seem to be major factors propelling individuals to use herbal supplements. Published reports advocating for clinical development of herbal supplements for COVID-19 and other emerging and re-emerging viral diseases are sparse. This paper aims to review the pathogenesis of COVID-19, use of herbal products during the pandemic and make case for clinical development of herbal supplements through the adoption of modern and acceptable technologies and research processes.This was a scoping review. Database searches of Google Scholar, PubMed and ResearchGate among others were performed using related keywords to identify relevant journals and lists of primary articles. Clinical trial databases:-Clinicaltrial.gov, Pan African Clinical Trial Registry (PACTR) and WHO international clinical trial registry (ICTRP) were reviewed to extract data.The use of herbal supplements during COVID-19 was not only peculiar to individuals living in Sub-Saharan Africa, but a global practice. Herbal supplements recommended to manage COVID-19 have not been validated using clinical trials. Available data showed that the number of herbal supplements undergoing clinical trial for COVID-19 indication in Africa was low.The availability of medicinal plants in Sub-Saharan Africa if well explored has great potentials to address various emerging and re-emerging viral diseases confronting the region. The economic potential of clinically validated herbal supplements are huge, and tapping into this opportunity created by preference of population to herbal supplement could increase export of herbal supplement and gross domestic product (GDP) of respective countries in Africa.

This study aimed at assessing the effects of dietary Pennyroyal essential oil (PE) supplementation on growth performance, digestive enzymes, and stress, antioxidant, and immunological responses to an acute stress. Four experimental diets containing 0 (C), 100 (100PE), 250 (250PE), and 500 (500PE) mg/kg PE were used in this experiment. The fish were fed with these diets for eight weeks, followed by a 3-h crowding stress (40 kg/m3) and 24-h recovery. Growth performance, intestinal amylase, lipase, and protease activities, plasma total protein, albumin, and globulin levels were determined before stress, whereas plasma cortisol, glucose, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lysozyme, alternative complement (ACH50), total immunoglobulin (Ig), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) were measured before and after stress. Dietary PE supplementation significantly increased growth performance and digestive enzymes of the fish. The highest growth performance was observed in 250PE treatment. Highest amylase, lipase and protease activities were observed in 500PE, 250PE, and 250PE/500PE treatments, respectively. Dietary PE significantly increased plasma total protein, albumin, and globulin and decreased plasma triglyceride and cholesterol levels. Dietary PE supplementation significantly decreased cortisol, glucose, ALT, AST, and MDA before the crowding stress and mitigated the elevations in these parameters after stress. On the other hand, dietary PE significantly increased plasma lysozyme, ACH50, total Ig, SOD, CAT, and GPx before stress and mitigated the alteration in these parameters after stress. In conclusion, dietary PE at 250 mg/kg is recommended for common carp feed, as it improve growth performance, digestive enzymes’ activities, and physiological and immunological responses to acute stress in fish.

An estimated one-third of US adults use herbal supplements, often without reporting that use to their physicians. These supplements can potentially alter bleeding and coagulation during surgery and when used concomitantly with anticoagulants. Our objective was to provide a comprehensive review of the evidence of bleeding risks of the most popular herbal and dietary supplements. A PubMed search and review of the literature was performed. We found that garlic and hawthorn supplementation is strongly associated with surgical bleeding independent of anticoagulants. Cordyceps sinensis, echinacea, and aloe vera are loosely associated with surgical bleeding independent of anticoagulants. In patients on anticoagulants, ginkgo biloba, chondroitin-glucosamine, melatonin, turmeric, bilberry, chamomile, fenugreek, milk thistle, and peppermint are associated with bleeding risk. No evidence was found for bleeding with these supplements independent of anticoagulants. Fish oil, ginseng, and saw palmetto are not associated with bleeding. Evidence for overall bleeding risk associated with St. John's wort, ginger, ginkgo biloba, or cranberry supplementation is conflicting. In conclusion, physicians must be aware of the potential anticoagulant effects of these supplements. It is imperative to report dietary and herbal supplement usage to physicians and is best to discontinue nonessential supplement use 2 weeks prior to surgery. [ABSTRACT FROM AUTHOR]

In most cases, herbal supplements found in illegal centers and herbal medicine stores have harmful content that causes irreparable damage to people. As a representative of the green chemistry method, a rapid and efficient dispersive micro solid-phase extraction (D-mSPE) method was applied to extract dexamethasone adulterant from handmade supplements sold as power natural enhancing materials. The quantification of the analyte was performed by high performance liquid chromatography with an ultraviolet detector. Effective parameters on the extraction recovery, including the type and amount of adsorbent, the kind of elution solvent, and the time of extraction and elution, were systematically investigated. The limit of detection of the method was 0.05 μg mL–1. Furthermore, inter-day precisions calculated as relative standard deviations were better than 10%. Ten dietary supplements, including liquid, capsule, tablet forms, and powder, were analyzed using the developed method, and four of them were detected as adulterated with dexamethasone. The developed method purifies the complex plant-based samples and results in a clean analysis with separation instruments. [ABSTRACT FROM AUTHOR]

Herbal and dietary supplement (HDS) use has grown exponentially in the United States. Unfortunately, the incidence of HDS-related liver injury has proportionally increased. Despite the potential for certain HDSs to cause clinically significant liver injury, they are not regulated by the Food and Drug Administration. Recent efforts have been made to regulate HDSs but are far removed from the scrutiny of prescription medications. Scant literature exists on HDSs and their risks of causing liver injury. In this comprehensive review, we examine trends of HDS use in the United States and the pathophysiologic mechanisms of drug-induced liver injury (DILI) of certain HDSs. Finally, we review usage rates; benefits, if any; purported pathophysiology of DILI; and propensity for progression to fulminant hepatic failure of nine HDSs linked to clinically significant DILI. [ABSTRACT FROM AUTHOR]

Objective: Herbal and natural supplements have gained popularity as alternative treatments to insomnia and sleep disorders due to their perceived safety and potential effectiveness. This literature review summarizes the current evidence on the efficacy, safety, and mechanisms of action of commonly used supplements for sleep, including valerian, hops, kava, German chamomile, cherry, tryptophan, theanine, melatonin, magnesium, and zinc., Methods: We conducted literature review of clinical research on herbal and supplements for sleep reported to date. We summarized key findings and reviewed outcomes related to clinical efficacy and side effects., Results: Findings suggest that certain supplements, particularly valerian, hops, and melatonin, could be effective in improving sleep quality and reducing insomnia symptoms through modulation of neurotransmitter systems and regulation of sleep-wake cycles. However, the strength of the evidence varies with unestablished optimal dosages, formulations, and treatment durations. Although generally considered safe, these supplements are not without risks, such as rare but serious adverse effects associated with kava and potential interactions with prescription medications. The quality and purity of supplements also vary widely due to a lack of strict regulations., Conclusion: Healthcare providers should remain informed about the latest research and work closely with patients to develop personalized treatment plans. Herbal and natural supplements may offer promising alternatives or adjunct treatments for insomnia and sleep disorders, but their use should be guided by the best available evidence and individual patient requirements. Larger, well-designed clinical trials are needed to establish the efficacy and safety of these supplements for clinical decision-making.

Abstract Background The use of dietary and herbal supplements (DIHES) is widespread among people with multiple sclerosis (PwMS). PwMS are a highly informed patient group, and they use several types of sources to seek information on subjects related to their disease. However, it is still unknown where PwMS seek information about DIHES. It is important that PwMS make decisions about DIHES based on accurate, useful and accessible information. Therefore, the aim of this study was to explore where PwMS seek information on DIHES and how they experience and engage with this information. Methods Semi-structured interviews were conducted with eighteen PwMS using DIHES. Participants were selected from a cross-sectional survey. Diversity sampling was used, based on relevant characteristics such as gender and number of DIHES used during the past 12 months. The interviews were conducted face-to-face or over the telephone and lasted between 30 min and 1 hour. The interviews were recorded, transcribed verbatim, and analyzed using thematic network analysis in NVivo 12 Pro software. Results Three main themes emerged in the analysis: i) engaging with healthcare professionals (HCPs) regarding DIHES, ii) social networks as a source of information regarding DIHES, and iii) reliance on bodily sensations. Most participants navigated all three types of sources. All participants had at some point discussed DIHES with an HCP. Information from HCPs was considered reliable and valuable, but HCPs were viewed as uncommitted to the dialogue about DIHES. Recommendations from others were often the driver of decisions regarding use of DIHES. However, the information from PwMS’ networks could be overwhelming and difficult to navigate. Finally, PwMS relied on their own experiences regarding DIHES and let their bodily sensations guide their use of DIHES. Conclusions Participants often rely on all three types of information sources to create a nuanced and comprehensive information base. However, PwMS may feel overwhelmed or confused with all the information they have gathered. These findings indicate the need for better guidance for PwMS concerning DIHES and an openness among HCPs to engage in dialogue.

We aimed to collect parallel perspectives from pharmacists and pharmacy students on their use, knowledge, attitudes, and perceptions about herbal supplements/natural products. Two cross-sectional descriptive survey questionnaires—one focusing on pharmacists and the other focusing on pharmacy students—were administered from March to June 2021 via Qualtrics. The surveys were sent out to preceptor pharmacists and pharmacy students currently enrolled at a single U.S. school of pharmacy. The questionnaires were composed of five main sections, including (1) demographics; (2) attitudes/perceptions; (3) educational experience; (4) resource availability; and (5) objective knowledge of herbal supplements/natural products. Data analysis primarily utilized descriptive statistics with relevant comparisons across domains. A total of 73 pharmacists and 92 pharmacy students participated, with response rates of 8.8% and 19.3%, respectively. A total of 59.2% of pharmacists and 50% of pharmacy students stated they personally used herbal supplements/natural products. Most respondents (>95% for both groups) considered vitamins/minerals safe, although a lower percentage agreed on this for herbal supplements/natural products (60% and 79.3% for pharmacists and pharmacy students, respectively). Patient inquiries in the pharmacy setting were most seen for vitamin D, zinc, cannabidiol, and omega-3. A total of 34.2% of pharmacists reported having training in herbal supplements/natural products as a required part of their Pharm.D. training, and 89.1% of pharmacy students desired to learn more. The median score on the objective knowledge quiz was 50% for pharmacists and 45% for pharmacy students. Ultimately, herbal supplements/natural products are recognized by pharmacists/pharmacy students as a consistent and embedded part of pharmacy practice, although there is a need to enhance knowledge and skills in this area.