Chlorella vulgaris - More Than Just a Natural Chelating Agent (P3) Trans-Resveratrol - A Multi- Mechanistic Approach to Optimal Vascular Protection (P5) Weight & Metabolic Control with White Kidney Beans (P6) Coptis chinensis - More Than Just Berberine (P9) Vegetarian Glucosamine (P15) A Unique Alternative To Commercial Glucosamine Supplements D-Limonene - A Promising Natural Medicine for GERD (P17) The Next BIG Thing in Gut-Healing: Zinc L-Carnosine (P19) Piperine - World’s First Bioavailability Clinical FOCUS Enhancer (P26) A Holistic TCM Approach to Chronic Viral A New Hope for Treating Neuropathy Hepatitis (P12) (P30) Harmonizing Shao Yang Pyrroloquinoline Quinone (PQQ) - A Novel, Multi-Faceted Approach A TCM Approach to Seasonal Allergy (P14) St. John’s Wort For Depression and Utilizing Digestive Enzymes in SIBO Anxiety (P32) Treatment (P16) Not All Standardized Extracts Are Treating PCOS with Myo-Inositol (P20) Created Equal An Insulin Sensitizer & Mood Stabilizer A Critical Look at Curcumin’s Target the “Heart” of Insomnia (P22) Bioavailability (P34) Restoring Yin-Yang Balance in Kidneys (P23) Research FOCUS Can Magnesium Supplements Be Used to Treat Both Migraines & Constipation The Science behind Apple Cider Simultaneously? (P24) Vinegar (P8) Two Opposing Indications of Magnesium Supplements Citrulline - “The Superior Arginine” in Nitric Oxide Synthesis and Vascular Recognizing and Treating TCM Patterns of Health (P10) Irritable Bowel Syndrome (IBS) (P27) What Does the Research Say about Enzyme Supplements: Benefit or Burden? Saccharomyces boulardii? (P28) (P33)

2 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

ChlorellaChlorella vulgarisvulgaris -- MoreMore ThanThan JustJust aa NaturalNatural ChelatingChelating AgentAgent

hlorella vulgaris (previously known as C. pyrenoidosa) is measures and enzyme activities, such as reduced Cknown for its use in heavy metal chelation. However, glutathione, superoxide dismutase, glutathione its toxin-binding ability works not only on heavy metals, peroxidase, and catalase [8] to help body eliminate toxins but also on common environmental toxins, such as dioxin and protect against oxidative stress. [1] aflatoxin. [2],[3] and In a clinical trial investigating correlations between the Chlorella contains high amounts of amino acids, dietary administration of Chlorella and dioxin concentrations fiber, chlorophyll, essential fatty acids, as well as various in breast milk, pregnant women treated with Chlorella vitamins, mixed carotenoids, antioxidants, and essential showed significant reduction in dioxin and its toxic minerals - making it more than just a chelating agent. equivalents in their breast milk compared to the control [10] Detoxification of Heavy Metals & Organic Toxins group (p=0.003). Heavy metals and organic toxins are two of the main Immune Tonic environmental pollutants affecting modern society, and Research has also demonstrated Chlorella’s ability to Chlorella is Mother Nature’s counteraction against them. enhance various immune cytokines and NK cells against [9] Chlorella exerts great binding ability to common heavy viral infection and tumors. metals, such as mercury [4], lead [5], and arsenic [6],[7]. So In the above-mentioned clinical trial involving pregnant much so that it is in fact largely used to clean up polluted women, [10] Chlorella significantly increased the bodies of water. immunoglobulin A concentration in the breast milk This attribute of Chlorella is due to its production of (p=0.03) of the experimental group. “phytochelatins” - thiol-rich peptides that interact very In another clinical trial involving chronic hepatitis C efficiently with heavy metal ions. This makes Chlorella a patients, Chlorella intake for 12 weeks significantly great potential oral chelating agent that helps render the lowered ALT liver enzyme levels & viral load and heavy metals in the GI tract. improved the quality of life in 77% of the subjects.[9] Moreover, thanks to its rich contents of various essential Nutritive Support for Cancer Patients an adjunct mineral minerals, Chlorella can be utilized as Chlorella has demonstrated its nourishing benefits support to intravenous chelation therapy, which often in chronic illnesses, such as cancers. A randomized removes significant amounts of minerals along with the controlled trial (RCT) involving patients with breast toxic elements. cancer demonstrated that Chlorella was able to Chlorella is also able to enhance many antioxidant significantly improve the overall quality of life scores

3 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com (i.e. mental/ emotional wellbeing, energy, appetite, skin, 2. Jubert C, Mata J, Bench G, Dashwood R, Pereira C, Tracewell etc) during the treatment period of one month (p=0.042). W, Turteltaub K, Williams D, Bailey G. Effects of chlorophyll and chlorophyllin on low-dose aflatoxin B(1) pharmacokinetics in [11] human volunteers. Cancer Prev Res (Phila). 2009. 2(12): 1015-22. Serum Lipid Profile 3. Egner PA, Wang JB, Zhu YR, Zhang BC, Wu Y, Zhang QN, Qian GS, Kuang SY, Gange SJ, Jacobson LP, Helzlsouer KJ, Bailey GS, Chlorella has also been shown to help improve serum lipid Groopman JD, Kensler TW. Chlorophyllin intervention reduces profile and reduce the risk of atherosclerosis via its rich aflatoxin-DNA adducts in individuals at high risk for liver cancer. levels of omega-3 and mixed carotenoids, as well as its Proc Natl Acad Sci USA (2001). 98(25): 140601-6. inhibitory effect on intestinal absorption of dietary and 4. Gomez-Jacinto V, Garcia-Barrera T, Gomez-Ariza JL, Garbayo- endogenous lipids.[8] Nores I, Vilchez-Lobato C. Elucidation of the defence mechanism in microalgae Chlorella sorokiniana under mercury exposure. In one RCT, adults with high cholesterol were administered Identification of Hg-phytochelatins. Chem Biol Interact. (2015). 238:82-90. 5 g of Chlorella per day for 4 weeks; the results showed significant reductions in total cholesterol (p=0.036), 5. Queiroz MLS, Torello CO, Perhs SMC, Rocha MC, Bechara BJH, Morgano MA, Valadares MC, Rodrigues APO, Ramos AL, Soares triglycerides (p=0.002), VLDL (p=0.006), apo B (p=0.044), CO. Chlorella vulgaris up-modulation of myelosuppression and non-HDL (p=0.032) levels.[12] induced by lead: the role of stromal cells. Food and Chemical Toxicology (2008). 3147-3154. How Clean is Chlorella? 6. Zahran E, Risha E. Modulatory role of dietary Chlorella vulgaris Due to Chlorella’s toxin-binding ability, its cultivation can powder against arsenic-induced immunotoxicity and oxidative be prone to environmental pollution. In other words, if stress in Nile tilapia (Oreochromis niloticus). Fish Shellfish Immunol. (2014). 41(2): 654-62. a cultivation region is heavily polluted, chances of the products being polluted will be very high. 7. Toxicity of arsenic species to three freshwater organisms and biotransformation of inorganic arsenic by freshwater There are 4 major countries of origin for all commercially phytoplankton (Chloreappa sp. CE-35). Ecotoxicol Environ Saf. sold Chlorella supplements in the world: China, Japan, (2014). 106:126-135. Korea, and Taiwan. Korea is the only country that utilizes 8. Panahi Y, Mostafazadeh B, Abrishami A, Saadat A, Beiraghdar F, Tavana S, Pishgoo B, Parvin S, Sahebkar A. Investigation of the a closed laboratory-controlled environment to grow effects of Chlorella vulgaris supplementation on the modulation Chlorella; however because of that, their Chlorella is NOT of oxidative stress in apparently healthy smokers. Clin Lab (2013). qualified as certified organic, and there is no regulation 53(5-6): 579-87. on addition of growth-enhanced substances. On the other 9. Azocar J, Diaz A. Efficacy and safety of Chlorella supplementation hand, China, Japan, and Taiwan cultivate their chlorella in adults with chronic hepatitis C virus infection. World J Gastroenterol (2013). 19(7): 1085-90. in open environments, and a few companies produce certified organicChlorella products. 10. Nakano S, Takekoshi H, Nakano M. Chlorella (Chlorella pyrenoidosa) supplementation decreases dioxin and increases Chlorella 3000 sources the cleanest certified organic, immunoglobulin A concentrations in breast milk. J Med Food (2007). 10(1):134-142. non-GMO, irradiation-free, broken cell (which increases absorbability) Chlorella from Taiwan (Table 1). We use 11. Noguchi N, Maruyama I, Yamada A. The influence of Chlorella and its hot water extract supplementation on quality of life in absolutely no fillers - nothing but 100% pure Chlorella is patients with breast cancer. Evidence-Based CAM (2014). enclosed in each bottle (168g; 56 doses). 12. Ryu NH, Lim Y, Park JE, Kim J, Kim JY, Kwon SW, Kwon O. Impact Table 1. Heavy Metal Specifications of Chlorella 3000 of daily Chlorella consumption on serum lipid and carotenoid profiles in mildly hypercholesterolemic adults: a double-blinded, Heavy Allowable Limits Results (per daily 6 g randomized, placebo-controlled study. Nutrition Journal (2014). Metals dose) 13:57. Mercury < 20 micrograms/day Non-detectable (<0.06 micrograms /day) Lead < 10 micrograms /day 0.54 micrograms /day Cadmium < 6 micrograms /day Non-detectable (<0.06 micrograms /day) Arsenic < 10 micrograms /day 0.3 micrograms /day

Reference: 1. Morita K, Ogata M, Hasegawa T. Chlorophyll derived from Chlorella inhibits dioxin absorption from the GI tract and accelerates dioxin excretion in rats. Environ Health Perspect (2001). 109(3): 289-294.

4 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

Trans-Resveratrol - A Multi-Mechanistic Approach to Optimal Vascular Protection

esveratrol has become one of promote endothelium nitric oxide Rthe most popular antioxidant synthase (eNOS) activity and Vita Aid’s R.O.S-Quench is a nutrients in the nutraceutical market. counteract reactive oxygen species synergistic blend of powerful It is most well known for its effect (ROS) to achieve overall systemic antioxidants in potent dosages, in reducing various risk factors in vasorelaxation.[4] specifically formulated to strengthen the vasculature, cardiovascular diseases. Resveratrol is A recent meta-analysis of 6 clinical a polyphenolic phytoalexin produced modulate immune function, and trials involving 247 subjects reduce inflammation. within plants in response to a range investigated the blood pressure of environmental stressors. (BP) lowering effect of resveratrol. • Protects against thrombosis, Trans-Form vs. Cis-Form It was reported that high doses of strengthens arteries and veins, promotes eye health, alleviates Resveratrol exists in either the cis resveratrol (> 150 mg/day) significantly reduced systolic BP (p=0.01).[5] systemic inflammation, and or trans form in nature, but it is the reduces the risk of CVD and trans-isomer that is known to be Anti-Atherosclerosis Effect stroke. more bioactive and more stable in The formation of atherosclerotic terms of free radical scavenging, anti- • Contains NATURAL TRANS- plaques is usually caused by high resveratrol (200 mg per proliferative, and cytotoxic activities. levels of LDL accumulating at the [1],[2],[3] capsule) from Japanese This could explain why some arterial wall followed by oxidation, research has shown mixed results of knotweed - the more stable inflammation, and activation of and bioavailable form. resveratrol in human subjects. immune cells and clotting factors. • Also included: A vast body of research has revealed Research has shown that resveratrol resveratrol’s multiple mechanisms of can not only reduce oxidation of LDL • Grape Seed Extract (95% action - including anti-hypertensive, and inflammation in the vasculature, OPCs) (100 mg per capsule) anti-atherosclerotic, and glycemic- but also lower levels of total • Quercetin (100 mg per modulating effects - making it an cholesterol, LDL, and triglycerides, capsule) excellent medicine for the many and increase the level of HDL complications of CVD and stroke. • Olive Leaf Extract (7:1) (20% cholesterol. The main mechanisms oleuropein) (60 mg per Anti-Hypertensive Action of action include down-regulating capsule) [6] Resveratrol has been shown to HMG-CoA reductase , promoting bile synthesis and secretion[7], • Vitamin C & Mixed activate several signaling pathways Carotenoids (i.e. AMPK, SIRT1, NRF2) that and increasing expression of LDL receptors in hepatocytes.[8] 5 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Glycemic Control Biochem. Biophys. Res. Commun. 367 Reference: (2008) 190-194. Resveratrol has demonstrated the 1. J.P. Basly, F. Marre-Fournier, J.C. Le Bail, 7. Q. Chen, E. Wang, L. Ma, P. Zhai, Dietary ability to help with glycemic control. G. Habrioux, A.J. Chulia, Estrogenic/ resveratrol increases the expression Its mechanisms of action include antiestrogenic and scavenging properties of hepatic 7alpha-hydroxylase and stimulation of insulin secretion of (E)- and (Z)-resveratrol, Life Sci. 66 ameliorates hypercholesterolemia in high- (2000) 769-777. fat fed C57BL/6J mice, Lipids Health Dis. 11 and activation of Sirtunin 1 Protein 2. L. Camont, C.H. Cottart, Y. Rhayem, V. (2012) 56. (SIRT1), which is one of the principle Nivet-Antoine, R. Djelidi, F. Collin, J.L. 8. T. Yashiro, M. Nanmoku, M. Shimizu, J. factors in glucose homeostasis and Beaudeux, D. Bonnefont-Rousselot, Inoue, R. Sato, Resveratrol increases the insulin sensitivity.[9] Simple spectrophotometric assessment of expression and activity of the low density the trans-/cis-resveratrol ratio in aqueous lipoprotein receptor in hepatocytes by In a randomized controlled trial solutions, Anal. Chim. Acta 634 (2009) 121- the proteolytic activation of the sterol involving patients with type 128. regulatory element-binding proteins, 2 diabetes, the subjects were 3. Anisimova NYU, Kiselevsky MV, Sosnov Atherosclerosis 220 (2012) 369-374. AV, Sadovnikov SV, Stankov IN, Gakh 9. Bhatt JK, Thomas S, Nanjan MJ. Resveratrol administered either 250 mg of AA. Trans-, Cis-, and dihydro-resveratrol: supplementation improves glycemic resveratrol daily along with their a comparative study. Chemistry Central control in type 2 diabetes mellitus. oral hypoglycemic agents or just their Journal (2011). 5: 88. Nutrition Research (2012). 32: 537-541. hypoglycemic agents. After a period 4. Zordoky BNM, Robertson IM, Dyck JRB. Preclinical and clinical evidence for the of 3 months, the resveratrol group role of resveratrol in the treatment of showed significant improvement in cardiovascular diseases. Biochimica et their hemoglobin A1c (p<0.05). [6] BIophysica Acta 1852 (2015): 1155-1177. 5. Y. Liu, W. Ma, P. Zhang, S. He, D. Huang, Inclusion of trans-resveratrol is an Effect of resveratrol on blood pressure: a effective adjunct therapy to treat meta-analysis of randomized controlled vascular diseases due to its multiple trials, Clin. Nutr. (2014), http://dx.doi. actions in reducing various risk org/10.1016/j.clnu.2014.03.009. 6. I.J. Cho, J.Y. Ahn, S. Kim, M.S. Choi, T.Y. Ha, factors. Resveratrol attenuates the expression of HMG-CoA reductase mRNA in hamsters,

Ingredient FOCUS

Weight & Metabolic Control with White Kidney Beans

besity has reached epidemic an effective strategy for weight loss, the embryos of their seeds. Oproportions in North America patient compliance can be an issue. The most common constituents with in recent decades, with 36% of U.S. One of the safest and effective means alpha-amylase inhibitory activity [1] adults being affected. to help cut down carbs is using alpha- are polyphenolic compounds and Until recent years, consumption amylase inhibiting agents to support glycoproteins.[2] For example, of fat was associated with weight patients’ progress of carbohydrate- anthocyanins from raspberries and gain, and fat-free products were the restricting diets. catechins found in green tea are both synonym of health. More recently, Alpha-Amylase Inhibitors shown to inhibit alpha-glucosidase over-consumption of carbohydrates and alpha-amylase activity. Alpha-amylase inhibitors are has been the main culprit behind the commonly found in fruits and seeds Nonetheless, thegreatest body obesity epidemic. of plants to prevent pollinators’ of research has beenon the While a low carbohydrate diet can be digestive enzymes from destroying glycoproteins extracted from white 6 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com kidney beans (Phaseolus vulgaris) for overweight subjects (BMI between weight control. The extraction of the 24 to 32 kg/m2) studied the effects Sveltagen is a comprehensive active glycoproteins, however, is a of Phase 2®. The subjects were weight management formula delicate process, and therefore, NOT administered either 1000 mg of Phase working via various mechanisms all white kidney bean extracts in the 2® or placebo before each meal. to control appetite, reduce market are made equal. There was statistically significant calorie uptake, and increase metabolic rate. Kidney Beans - A “Toxic Dilemma” weight reduction at weeks 6, 8, and 12 in the Phase 2® group (p<0.03). The • Each capsule supplies Kidney beans are known to contain mean weight loss was 6.9 lbs after 12 500 mg (1500 AAIU) of “phytohaemagglutinin” (PHA) - a weeks in the active group while the Phase 2® - the only natural toxic lectin that causes symptoms placebo group gained an average of ingredient approved by FDA of food poisoning, such as extreme 0.8 lb. [6] to claim its effect in weight nausea followed by severe vomiting Another RCT involving 101 subjects management. and diarrhea.[3] PHA is susceptible to with BMI ranging from 25 to 50 kg/ heat though, so well-cooked kidney • Contains Coleus forskohlii m2 showed significant average beans are safe to consume. for regulating body fat weight loss of 4.2 lbs after 60 days of metabolism. However, well-cooked kidney beans daily 3000 mg Phase 2®, compared • With potent thermogenic also contain little to none of its alpha- to the average loss of 0.9 lb in the agents - bitter orange & amylase inhibitors because these placebo group (p < 0.001). There was cayenne extracts. constituents are also susceptible to also a significant reduction in waist heat. So in order to obtain the desired measurement in Phase 2® group • Contains iodine from kelp to alpha-amylase inhibitor without the compared to the placebo group.[7] maintain normal production toxic PHA, we need another solution. of thyroid hormones and Utilizing Phase 2® is a great tool to ® regulate the metabolic rate. Phase 2 - Alpha-Amylase Inhibitor not only help restrict carb-absorption from White Kidney Beans but also monitor patients’ intake Phase 2® is a patent water-extract of carbohydrates because, with of non-GMO white kidney beans the intraluminal amylase being prepared using a specialized, inhibited, over-consumption of carbs proprietary process that substantially would cause more flatulence due to inactivates haemagglutinating the undigested carbohydrates being activity and trypsin inhibiting activity, fermented by the gut bacteria. while keeping its alpha-amylase Reference: inhibiting constituents intact. It is 1. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the standardized to 3,000 alpha-amylase distribution of body mass index among US inhibiting units (AAIU) per gram. adults, 1999-2010. Journal of the American

® Medical Association. 2012; 307(5):491-97. Phase 2 has been shown 2. Tundis R, Loizzo MR, Menichini F: to significantly reduce intra- Natural products as alpha-amylase and enteroluminal amylase activity by alpha-glucosidase inhibitors and their hypoglycaemic potential in the treatment postprandial gastrointestinal function in 95% and consequently speed up post- humans. Gastroenterology 1986, 91:41-48. prandial transit of carbohydrates of diabetes: an update. Mini Rev Med Chem 2010, 10:315-331. 6. Rothacker D: Reduction in body weight [4] ® by 24%. Phase 2 also helps reduce 3. Food Drug Administration. with a starch blocking diet aid: StarchAway postprandial levels of plasma Phytohaemagglutinin Toxicity. [Available comparison with placebo. Leiner Health Products; 2003 [http://www.phase2info. glucose, insulin, C-peptide, and Online] 4. Layer P, Carlson GL, DiMagno EP: Partially com/pdf/Phase2_Study6.pdf], Ref Type: gastric inhibitory polypeptide to help Online Source. [5] purified white bean amylase inhibitor stabilize the levels of blood sugar. reduces starch digestion in vitro and 7. Wu X, Xu X, Shen J, Perricone N, Preuss Its inhibitory effect acts as quickly as inactivates intraduodenal amylase in H: Enhanced weight loss from a dietary 15 minutes after consumption, and humans. Gastroenterology 1985, 88:1895- supplement containing standardized Phaseolus vulgaris extract in overweight lasts for as long as 2 hours.[3] 1902. 5. Layer P, Zinsmeister AR, DiMagno men and women. Journal of Applied A 12 week, double-blind, placebo- EP: Effects of decreasing intraluminal Research 2010, 10:73-79. controlled RCT involving 60 amylase activity on starch digestion and

7 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Research FOCUS

The Science behind Apple Cider Vinegar

pple cider vinegar (ACV) is randomized to 750 mg or 1500 mg 10 times more concentrated than Aone of the most popular folk of acetic acid (~15-30ml of ACV) regular liquid ACV; patients will remedies with many claimed health per day or the placebo group for only need to take 1-2 capsules to benefits, including aiding digestion, 12 weeks. The results showed reach therapeutic dose, making treating flu, “alkalinizing the body”, that both 750 mg and 1500 mg of their adherence to treatment much treating warts, blood sugar control, daily vinegar intakes were able to easier. lowering blood pressure, weight significantly (p<0.05 and p< 0.01, Reference: loss, and other touted benefits. respectively) lower BMI, visceral 1. Liljeberg HGM & Bjorck IME. Delayed While there is not scientific proof fat area, waist circumference, and gastric emptying rate may explain for all of these benefits, there serum triglycerides after 8 weeks improved glycaemia in healthy subjects is research backing some of the compared to the placebo group. to a starchy meal with added vinegar. Eur. J. Clin. Nutr (1998). 52: 368-371. medical uses. Anti-Hypertension 2. Johnston CS, Steplewska I, Long CA, Post-Prandial Blood Sugar & In the above-mentioned clinical Harris LN, Ryals RH. Examination of the Metabolic Control trial in Japan, daily 30 mL of vinegar antiglycemic properties of vinegar in healthy adults. Ann Nutr Metab (2010). ACV has been shown to lower (1500 mg acetic acid) was able 56:74-79. the glucose response to high to significantly decrease systolic carbohydrate meals [1],[2] due to blood pressure after 8 weeks of 3. Ostman E, Granfeldt Y, Persson L, Bjorck I. Vinegar supplementation lowers its acetic acid content (4-8%). The treatment. The mechanism of glucose and insulin responses and mechanism of action appears to action is suggested to be caused increases satiety after a bread meal be by lowering the rate of gastric by the significant reduction in in healthy subjects. Eur. J. Clin. Nutr. emptying and, consequently, renin activity and the subsequent (2005). 59:983-988. slowing digestion of complex decrease in angiotensin II. [5] 4. Kondo T, Kishi M, Fushimi T, Ugajin S, carbohydrate in the small intestine. Kaga T. Vinegar intake reduces body [1],[2] However, despite all the benefits, it weight, body fat mass, and serum can be difficult and inconvenient for triglyceride levels in obese Japanese Human clinical data have shown that patients to take adequate amounts subjects. Biosci Biotechnol Biochem ACV is able to significantly stabilize of ACV to reach the therapeutic (2009). 73(8): 1837-1843. post-prandial blood sugar and dose (15-30 mL). 5. Kondo S, Tayama K, Tsukamoto Y, Ikeda insulin levels after carbohydrate K, Yamori Y. Antihypertensive effects of The pH of average vinegar (5-8% acetic acid and vinegar on spontaneously meals in a dose-dependent manner. concentration) is about 2.4 hypertensive rats. Biosci Biotechnol [2],[3] , which is very acidic and can cause irritation Biochem (2001). 65(12): 2690-2694 Weight Management and even damage to the esophageal ACV can also help manage body lining if taken long-term. mass index and body fat mass in Vita Aid’s ACV 500 utilizes the obese individuals. It has been shown concentrated, crystallized powder to inhibit several lipogenic genes form of apple cider vinegar in (i.e. fatty acid synthase, acetyl-CoA capsules (500 mg/capsule) to carboxylase, and ATP citrate lyase). ensure easier passage through In a randomized controlled trial esophagus while exerting the in Japan involving 175 obese same beneficial effects as liquid individuals, the subjects were ACV. Moreover, our ACV powder is 8 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Coptis chinensis - More Than Just Berberine

Ingredient FOCUS optis chinensis (Huang Lian) is as inflammation in the body, whether gut flora and immune function. Cone of the most commonly used it is caused by environmental triggers Impaired sugar/lipid metabolism herbs for detoxification in Traditional or infections. can promote the growth of sugar- Chinese Medicine (TCM). Coptis has Coptis enters the Heart, Liver, thriving pathogens like Candida, and similar properties as Goldenseal, but Stomach, and the Large Intestine compromise vasculature and blood it is much richer in berberine content meridians to address infection circulation. (4-7%) than its counterpart (1.5-4%). and inflammation associated with In a randomized clinical trial involving Like many other berberine-containing these organ systems. Therefore, in thirty-six type 2 diabetic subjects, herbs, Coptis is largely used to treat addition to its antimicrobial effect, berberine was shown to exert various infections, such as vaginal it also exerts hepato-protective, comparable hypoglycemic and bacteriosis, fungal infections, acute hypotensive, anti-diabetic, anti- lipid-lowering effects to metformin gastroenteritis, cholera, bacterial inflammatory, anti-atherosclerotic, over 13 weeks of treatment.[5] The dysentery, and SIBO. It has been styptic/vulnerary, uterine-tonic, and proposed mechanisms of action shown to exert anti-microbial activity anti-diarrheal actions. include reducing insulin resistance, on a number of common pathogens, Coptis’ Inhibitory Potential Against stimulating glycolysis, and inhibiting such as E. coli, K. pneumonia, H. pylori alpha-glucosidase. Salmonella typhi, Enterobacteria, Research has shown that palmatine Palmatine and coptisine from Vibrio cholera, and Candida albicans. Coptis have both demonstrated [1],[2] from Coptis carries better potential in inhibitory activity against H. pylori hypolipidemic actions by reducing TCM Actions & Applications than berberine.[4] It also protects cholesterol synthesis, up-regulating Coptis provides a wider range of against gastric damage from HCl LDL receptors (i.e. promoting more applications in TCM than berberine and promotes healing of ulcers. The LDL-cholesterol to be internalized isolate due to its other constituents, study suggests that Coptis is the by cells) and down-regulating bile such as palmatine, coptisine, and more effective agent than berberine transporters embedded on the jateorrhizine. [3] in treating H. pylori-induced gastritis/ intestinal wall, preventing bile from [6],[7] [4] re-entering. Coptis is bitter and very cooling in gastric ulcer. nature and used in TCM to clear heat/ Hypoglycemic & Hypolipidemic Microcidin contains multiple fire, dry damp, descend Yang and Effects antimicrobial ingredients with eliminate toxins (i.e. pathogens). different mechanisms to inhibit and Blood sugar and lipid control is kill the pathogenic microbes, such From the western medical important in maintaining not only as bacteria, virus, fungi (e.g. Candida perspective, “heat/fire” can be seen vascular health but also healthy albicans), and parasites. 9 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com • Coptis (Huang Lian) contains high Reference: 4. Jung J, Choic JS, Jeong CS. Inhibitory activities of palmatine from Coptis levels of berberine. Coptis is the 1. Mekseepralard C, Poonpon P, Kamkaen chinensis against Helicobactor pylori and N. Antibacterial activities of Coptis king herb for detoxification in gastric damage. Toxicol. Res. (2014). 30(1): chinensis and Glycyrrhiza glabra against TCM, especially during infections 45-48. seven bacteria associated with human and Liver Fire. Coptis itself or gastrointestinal infections. Planta Med 5. Yin J, Xing H, Ye J. Efficacy of berberine combined with clove extract have (2007). 73: 140. in patients with type 2 diabetes mellitus. Metabolism (2008). 57(5): 712-717. been proven to inhibit fungal 2. Zhao YL, Yan D, Wang JB, Zhang P, Xiao growth and candidiasis. XH. Anti-fungal effect of berberine on 6. Ning N, He K, Wang Y, Zou Z, Wu H, Li X, • Contains lab-standardized high Candida albicans by microcalorimetry Ye X. Hypolipidemic effect and mechanism with correspondence analysis. Journal of of palmatine from Coptis chinensis in allicin content from freeze-dried Thermal Analysis and Calorimetry (2010). hamasters fed high-fat diet. Phytother garlic concentrate. 102(1):49-55. Res. (2015). 29(5): 668-673. • Synergized with highly 3. Liu SC, Zhang XF, Qui FR, Miao P, Shen 7. He K, Ye XL, Wu H, Wang YZ, Zou ZY, Ning concentrated oregano extract, SJ, Zhu LL, Zeng J, Jiang J. Metabolic N, Hu YR, Chen B, Fang XD, Li XG. The safety interaction of the active constituents of and anti-hypercholesterolemic effect of undecylenic acid and caprylic acid Coptis chinensis in human liver microsomes. coptisine in Syrian golden hamptsters. for broad spectrum microcidal Evidence-Based Complementary and Lipids (2015). 50:185-194. effect in prevention and eradication Alternative Medicine (2015). of microbial infections.

Research FOCUS

Citrulline - “The Superior Arginine” in Nitric Oxide Synthesis and Vascular Health

-arginine has long been L-arginine needs to be taken in high nitric oxide (NO) cycles. Lreputed as the key amino acid doses (10-20 g/day) to yield the Metabolism of L-Citrulline and for cardiovascular health and therapeutic effects. High doses of L-Arginine sexual dysfunction because of its L-arginine often cause unwanted involvement in the synthesis of side effects such as nausea, vomiting, L-citrulline was first identified and nitric oxide (NO). Nitric oxide (NO) diarrhea, headache, flushing and isolated from watermelon (Citrullus plays a key role in the maintenance numbness. vulgaris). In our body, L-citrulline of vascular tone, contributing to is readily turned into L-arginine Due to the downsides in dosing and via the enzymes of the NO-cycle the functional regulation of arterial side effects of arginine, attention has stiffness. (argininosuccinate synthase and turned to L-citrulline - the precursor argininosuccinate lyase), especially in Despite its potential benefits, oral of L-arginine in both the urea and the kidneys where >80% of L-citrulline 10 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com is converted. Therefore, L-citrulline of citrulline for 2 months was shown performance- and endurance- has a similar vasodilating effect as to significantly improve erection enhancing agent in healthy adults L-arginine. Nonetheless, L-arginine hardness score, overall satisfaction undergoing high-intensity exercises. was originally thought to be the score, as well as the frequency of In summary, current research direct factor in NO synthesis (Figure intercourse per month. suggests that oral L-citrulline 1); hence, it received more public Cardiovascular Health: Hypertension & supplementation is functionally and attention in the market. Atherosclerosis clinically superior to L-arginine in It was later discovered that orally L-citrulline has been shown to improving vascular health. administered L-arginine is mostly improve various parameters in Vita Aid’s L-Citrulline (powder) - 147 g/ converted to L-ornithine (not an hypertensive patients. In a clinical bottle. 3000 mg/teaspoon. 49 servings/ intermediate in the NO-cycle [Figure trial[1], it demonstrated effectiveness bottle. 1] upon absorption by the enzyme in patients with pulmonary arterial Reference: “arginase” found in both the small hypertension. In the trial pulmonary intestine and the liver. For that artery pressure and exercise capacity 1. Kashani BS, Pour PT, Malekmohammad M, Behzadnia N, Sheybani-Afshar F, reason, oral L-arginine intake does (i.e. mean walking distance) were NOT effectively elevate the blood Fakhri M, Chaibakhsh S, Naghashzadeh significantly improved after 3 g of F, Aidenlou S. Oral L-citrulline malate levels of L-arginine and NO in the L-citrulline daily for 2 weeks. arterial circulation. in patients with idiopathic pulmonary In another randomized-controlled arterial hypertension and Eisenmenger L-citrulline, on the other hand, does trial (RCT) [3] measuring the short- syndrome: a clinical trial. Journal of Cardiology (2014). 64:231-235. NOT undergo intestinal and hepatic term benefit of L-citrulline, 5.6 g/day metabolism because it is not a was administered to healthy male 2. Cormio L, Siati MD, Lorusso F, Selvaggio substrate for arginase. Research has subjects (mean age 58.3 years). After O, Mirabella L, Sanguedolce F, Carrieri shown that oral administration of only one week of treatment the index G. Oral L-citrulline supplementation L-citrulline is actually more effective of arterial stiffness (i.e. brachial-ankle improves erection hardness in men with mild erectile dysfunction. Urology than L-arginine itself in raising blood pulse wave velocity) was significantly [1] (2011). 77:119-122. levels of L-arginine. improved (p <0.01). Other vascular Moreover, unlike L-arginine, high health parameters including serum- 3. Ochiai M, Hayashi T, Morita M, Ina dose L-citrulline does not cause NO, serum-arginine, and arginine/ K, Maeda M, Watanabe F, Morishita K. Short-term effects of L-citrulline side effects (ie. nausea, vomiting, asymmetric dimethylarginine supplementation on arterial stiffness diarrhea, headache, flushing and (ADMA) ratio were all significantly in middle-aged men. International numbness), that are results of high- increased (p<0.05, p<0.01, p<0.05, Journal of Cardialogy (2012). 155:257- dose L-arginine being converted to respectively). 261. L-ornithine.[2] Athlete Support 4. Bailey SJ, Blackwell JR, Lord T, Clinical Applications of L-Citrulline L-citrulline has also been shown to Vanhatalo A, Winyard PG, Jones AM. L-citrulline supplementation improves Erectile Dysfunction improve pulmonary O2 uptake and O2 uptake kinetics and high-intensity In a human clinical trial involving male exercise performance in athletes. exercise performance in humans. [4] patients (mean age 56 years old) with One RCT found L-citrulline to be Journal of Applied Physiology (2015). mild erectile dysfunction, daily 1.5 g superior to L-arginine as a natural DOI: 10.1152/japplphysiol.00192.2014

Figure 1. Metabolism of Citrulline and Arginine in Urea & Nitric Oxide Cycles

11 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Clinical FOCUS

A Holistic TCM Approach to Chronic Viral Hepatitis - Harmonizing Shao Yang

Viral hepatitis is one of the leading TCM Pattern of Viral Hepatitis - symptoms commonly seen in causes of liver cancer and liver Disharmony in “Lesser Yang” patients with viral hepatitis: failure, second only to alcohol In TCM, pathogenic invasion goes • Abdominal pain (Qi Stagnation) abuse. Hepatitis B in particular through “Six Levels” - starting from infects more than 300 million • Fever and chills (alternating) the outer most layer - Greater Yang (Lesser-Yang level affected) people worldwide, with more than (Tai Yang) - to the inner most layer - one third of those people (120 Terminal Yin (Jue Yin). • Joint pain (Gallbladder heat) million) in China.[1] Complications • Loss of appetite, nausea and of chronic viral hepatitis may “Lesser Yang” or Shao Yang is the vomiting (Gallbladder heat include cirrhosis, hepatocarcinoma, middle layer, situated between invading Stomach) and liver failure, as well as kidney Yang & Yin or the exterior and disease and vasculitis.[2] interior; this level is closely related • Other symptoms: bitter taste in with Gallbladder and San Jiao the mouth, vertigo, dry throat, Conventional treatments for (Triple Burner) meridians. irritability (Gallbladder heat) chronic viral hepatitis include antiviral medications and interferon, When particular pathogens (i.e. • TCM Pulse & Tongue: wiry pulse, both of which can result in side hepatitis virus) invade, they often thin white tongue coating effects such as depression, severe stay at the “Lesser Yang” level for (exterior condition) a period of time as the immune lethargy, anemia, neutropenia, and Xiao Chai Hu Tang (Ventorrid) - [2] system attempts to ward them respiratory distress. Lesser-Yang Harmonizing Formula off. This “stand-off” gathers more Traditional Chinese Medicine (TCM), Qi (i.e. immune response) in the As pathogens reach the Lesser- in contrast, offers an effective and Gallbladder meridian and creates Yang level, they reside between the more holistic approach in treating Qi Stagnation, and consequently exterior and the interior, making it viral hepatitis - by harmonizing the may generate Gallbladder Heat inappropriate to use only exterior- “Lesser Yang” (Shao Yang) of the that invades Stomach, creating the releasing herbs or only heat- body. following “Lesser Yang Syndrome” clearing herbs.

12 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Using only exterior-releasing herbs regulate inflammatory mediators Reference: will not treat the interior condition; in hepatitis C patients to slow the 1. Qin XK, Li P, Han M, Liu JP. Xiao-chai-hu and using only heat-clearing progression of the disease. tang for treatment of chronic hepatitis B: a systemic review of randomized (downward-draining) herbs will All of these improved parameters bring the pathogens further trials. Journal of Chinese Integrative can help to prevent the progression Medicine (2010). Vol 8(4): 312-320. into the interior. Therefore, the to hepatocarcinoma or cirrhosis. best approach is to “harmonize” 2. Diseases and Conditions - Hepatitis B. Ventorrid has also been shown Mayo Clinic (2014). in patients with Lesser-Yang to target multiple cancer growth syndrome. pathways, such as VEGFR2, EGFR, 3. Hirayama C, Okumura M, Tanikawa [5] K, Yano M, Mizuta M, Ogawa N. A Xiao Chai Hu Tang (Ventorrid; and estrogen receptors. multicenter randomized controlled Minor Bupleurum Formula) is the Gastric Ulcers clinical trial of Shosaiko-to in chronic most commonly used formula to active hepatitis. Gastroenterol Jpn harmonize Lesser-Yang syndrome. Ventorrid also demonstrated (1989). Vol 24(6): 715-719. The herbs work synergistically to benefit in treating gastric ulcers 4. Zheng, N, Dai J, Cao H, Sun S, expel pathogens and strengthen with comparable efficacy to Fang J, Li Q, Su S, Zhang Y, Qiu M, bodily constitution. sucralfate in protecting the gastric Huang S. Current understanding on mucosa, as well as acid-regulatory antihepatocarcinoma effects of Xiao effect similar to that of the H2- Chai Hu Tang and its constituents. blocker cimetidine.[6],[7] Evidence-Based Complementary and Alternative Medicine (2013). P1-14. Other applications include 5. Zheng CS, Wu YS, Bao HJ, Xu XJ, cholelithiasis, reflux esophagitis, Chen XQ, Ye HZ, Wu GW, Xu HF, Li influenza, and Meniere’s syndrome. XH, Chen JS, Liu XX. Understanding [8] the polypharmacological anticancer effects of Xiao Chai Hu Tang via a Safety & Caution computational pharmacological Ventorrid is a safe formula with model. Experimental and Therapeutic a very low toxicology profile. Medicin (2014). Vol 7: 1777-1783. Chai Hu (Bupleurum root) is the [8] However, it should be used 6. Mtsuta M, Kanita R, Tsutsui F, chief herb that disperses stagnation with caution in patients with the Yamashita A. Antiulcer properties of and releases heat to the exterior. following TCM patterns/condition shosaiko-to. Nippon Yakurigaku Zasshi Huang Qin (Chinese Scutellaria), (1996). Vol 108(4): 217-225. because it has an ascending action the other chief herb, enters the on Qi: 7. Kase Y, Yuzurihara M, Iizuka S, Ishige Gallbladder meridian and clears A, Komatsu Y. The effects of hange- the internal Lesser-Yang heat. The • Yin and/or Blood deficiencies shashin-to on gastric function in rest of the herbs in the formula • Liver fire comparison with sho-saiko-to. Biol work together to harmonize the Pharm Bull (1997). Vol 20(110: 1155- Stomach and Spleen, tonify Qi, and • Upper excess and lower 1159. nourish body fluids. deficiency 8. Chen JK, Chen TT. Chinese Herbal • Hypertension Formulas and Applications: Modern Clinical Applications of Pharmacological Effects & Clinical Ventorrid Inappropriate use of this formula Research (2009). Chronic Viral Hepatitis & Cancer may result in headache, dizziness, and bleeding gums; in which case, Multiple RCT’s have demonstrated discontinue use.[8] Ventorrid’s therapeutic effect in treating chronic Hep B and C patients. It is important for clinicians to It was shown to significantly lower recognize symptoms of the Lesser the HBe antigens (the marker for Yang syndrome before prescribing high infectivity), increase anti-HBe this formula as the disease state may antibodies, normalize AST and ALT progress to a deeper level where levels[3], and reduce the fibrosis additional herbs/supplements may index of the liver.[4] It also helped be required.

13 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Clinical FOCUS

A TCM Approach to Seasonal Allergy

easonal allergy, or allergic rhinitis, body fluids to “leak out of the body” Astragalus. Sis one of the most common (i.e. runny nose and spontaneous It should be noted however that simply health concerns, with 40% of the US sweating), and pathogens (e.g. building a strong exterior is NOT always [1] population affected. The total direct allergens, viruses) to enter. the best course of action, especially when medical cost of allergic rhinitis in the Patients with Qi deficiency usually present a pathogen has invaded inside the body. US is estimated to be greater than $3.4 with frequent upper respiratory tract That is why Astragalus alone is often not billion annually, with the majority of infections (URTIs), pale face, pale tongue recommended in cases of ongoing URTIs, medications being antihistamines and with white tongue coating, and a floating & and Fang Feng is included in Imurex to intranasal corticosteroids for palliative deficient pulse. complement Astragalus. care.[2] Yu Ping Feng San (Imurex) Reference: While most natural remedies, such as quercetin and vitamin C, are also Yu Ping Feng San (aka Jade Screen 1. Chan RYP, Chien WT. The effects of two palliative, Traditional Chinese Medicine Powder) is one of the most widely used Chinese herbal medicinal formulae vs. (TCM) offers a different approach to Wei Qi tonifying formulas. It is traditionally placebo controls for treatment of allergic look at the root of allergic rhinitis and used to treat allergic rhinitis, asthma, rhinitis: a randomized controlled trial. Trials (2014). Vol15:261-280. effectively treat it - strengthening the atopic dermatitis, nephritis, and abnormal immune system. perspiration, as well as the prevention of 2. Law AW, Reed SD, Sundy JS, Schulman URTIs.[3],[4] KA. Direct costs of allergic rhinitis in the TCM Pattern of Allergic Rhinitis United States: estimates from the 1996 Research has shown that Yu Ping Feng “Strengthening” the immune system Medical Expenditure Panel Survey. J Allergy San (Imurex) has immune-modulatory may sound paradoxical at first in a Clin Immunol. 2003 Feb;111(2):296-300. actions by controlling the levels of discussion about treating seasonal various immune mediators, such as 3. Hsiao ELC; Hsiao LS; Vinjamury, Prasad allergy; however, we must differentiate S; Quyen La NH; Wu WS; Wang CN. histamine and IL-4.[5] it from “stimulating” the immune system. Immunological Effects of Yu Ping Feng San TCM strengthens immunity by In a randomized-controlled clinical trial - (Jade Windscreen Powder) - A Review. creating a balance in the system so involving 249 participants, Imurex has American Acupuncturist (2009), Vol48, p18. that it will only carry out appropriate been shown to significantly reduce the 4. Chen JK, Chen TT. Chinese Herbal Formulas actions; whereas simply stimulating severity of allergic rhinitis symptoms and Applications: Pharmacological Effects the immune system can potentially and improve the quality of life and & Clinical Research (2009). strengthen the body’s constitution.[1] worsen outcomes in the presence of a 5. Cheng GY, Lin JG, Chou CT, Kuo BJ, dysfunction. Synergism of Imurex Chang YS, Tsai MH. Research on the anti- In TCM, allergic rhinitis is mostly allergy and regulatory effects of Yu Ping Imurex is a simple formula consisted of 3 Feng San on the immunological mediators, caused by Qi Deficiency - especially herbs in a golden ratio that complement histamine and interleukin-4. the Defensive (Wei) Qi. Wei Qi (the each other. equivalence of immunity) acts like a protective layer of the body to help Astragalus (Huang Qi) is the chief herb regulate the pores (i.e. secretory that tonifies Wei Qi and the exterior. Bai tissues like the skin, GI tract, and Zhu (Atractylodes Rhizome), the deputy, respiratory tract) and protect the body assists Astragalus in strengthening the from pathogenic invasions. exterior to stop fluids from leaking. Fang Feng (Radix Saposhnikoviae) prevents When Wei Qi is deficient, the the retention of pathogens that can exterior becomes “porous” allowing be trapped by Qi-tonifying herbs like

14 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

Vegetarian Glucosamine - A Unique Alternative To Commercial Glucosamine Supplements

lucosamine supplements are one product is only the glucosamine element, receiving the best possible therapeutic Gof the most researched ingredients and the hydrochloride or sulphate salt effects. for joint health, which results in over- is purely a delivery vehicle. In short, Vita Aid’s Vegi-Glucosamine Complex saturation of the consumer market. the benefits delivered by a glucosamine contains patent vegetarian glucosamine Offering a vegetarian source of product will depend on its purity and HCl (Regenasure®), which is both glucosamine in your practice not stability, rather than its salt form. Kosher and Halal certified. It also only satisfies the needs of vegetarian The simple answer is that they both fare includes MSM and Vitamin C to further patients, it also provides a unique equally in their actions; the majority of enhance the anti-inflammatory and tissue alternative to commercially available early trials and studies primarily used regenerating effects. products. glucosamine in its sulphate form, rather Reference: Shellfish vs. Vegetarian than HCl, purely because of availability at the time. 1. Houpt JB, McMillan R, Wein C, Paget-Dellio 99% of glucosamine products in the SD. Effect of glucosamine hydrochloride in market are derived from shellfish, Only more recently has glucosamine the treatment of pain of osteoarthritis of the mainly because they are cheaper and hydrochloride been put to the test, and knee. J Rheumatol 1999; 26: 2423-30. easier to obtain. However, this source the results from several well conducted 2. McAlindon T, Formica M, LaValley M, of glucosamine is not optimal for those trials demonstrate that glucosamine Lehmer M, Kabbara K. Effectiveness who are allergic to shellfish, as well hydrochloride is as efficient as the of glucosamine for symptoms of knee as those who live a vegetarian/vegan sulphate form. [1],[2],[3] osteoarthritis: results from an internet- lifestyle. based randomized double-blind controlled The Problem with Adulteration in trial. Am J Med 2004; 117: 643-9. Although less well known, there Glucosamine Supplements 3. Clegg DO, Reda DJ, Harris CL et al. is in fact a vegetarian alternative Adulteration is a common problem, Glucosamine, chondroitin sulfate, and of glucosamine derived through a the two in combination for painful knee especially in popular commercial products fermentation process. The chemical osteoarthritis. N Engl J Med 2006; 354: structure and the clinical efficacy are such as joint care formulas. While non- 795-808. equal to glucosamine sourced from harmful filler ingredients are often added to shellfish. maximize profits, the result is that patients are not receiving the full therapeutic Glucosamine HCl vs. potential from the adulterated products. Glucosamine Sulfate It can be difficult for healthcare practitioners The vegetarian source of glucosamine to recommend a high quality glucosamine can be found in both hydrochloride supplement and explain the difference to (HCl) or sulfate forms. Some believe patients because such supplements are the sulfate form to be more efficacious accessible everywhere. because of its greater body of research Providing a vegetarian glucosamine data. formula in your practice offers a great However, it should be stressed that the alternative for practitioners to recommend active ingredient in any glucosamine to patients, while ensuring that they are 15 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Clinical FOCUS

Utilizing Digestive Enzymes in SIBO Treatment

mall intestine bacterial overgrowth Such a predicament creates a vicious S(SIBO) is a condition in which cycle as the damaged brush border Vita Aid offers products to support abnormally large high numbers of leaves more carbohydrates undigested every phase of the SIBO protocol. commensal bacteria are present in to feed the bacteria, which in turn causes ᐤᐤ Zyme-Aid Carbo Fort - Broad the small intestine; unlike the large the intestine to become more permeable, spectrum Carbohydrate-Digesting intestine, the small intestine is not resulting in more inflammation - both Enzyme Blend. designed for bacterial colonization. locally and systemically. ᐤ - Anti-Microbial SIBO is a common cause of IBS, ᐤ Microcidin Where Do Digestive Enzymes Come Formula containing potent doses involved in about 84% of all IBS in? of Allicin, Berberine (from Coptis cases.[1],[2] The overgrowing bacteria chinensis), Clove, and Oregano. consequently damage the digestive Starve the Bacteria and absorptive function of the small One of the principle mechanisms in ᐤᐤ 5-HTP - to support the Prokinetic intestine. Key damaging factors preventing/treating SIBO is to starve Phase include: [3],[4],[5],[6] the bacteria by limiting the intake of ᐤᐤ Probiotics for Preventative ᐤᐤ increase in inflammatory carbohydrates with diets such as the Phase: Specific Carbohydrate Diet (SCD) and cytokines causing direct damage ᐤ (can also be low FODMAP (Fermentable, Oligo-, Di-, ᐤ S.boulardii to the brush border; incorporated in the Anti- Mono-saccharides And Polyols) diet. ᐤᐤ increased intestinal permeability microbial Phase as an adjunct (leaky gut), which leads to However, compliance with these diets to prevent dysbiosis) can sometimes be very difficult for systemic symptoms such as food ᐤ patients. For that reason, broad-spectrum ᐤ Supreme-PB30+ DF (Dairy allergies and skin issues; - multi-strain, 30+ billion carbohydrate-digesting enzymes could Free) per cap ᐤᐤ bacterial deconjugation of bile, play a pivotal role in SIBO treatment. causing fat and fat-soluble ᐤᐤ GI-Restore - contains Zinc Choose Broad-Spectrum Carbohydrate- vitamin malabsorption; and L-Carnosine and L-Glutamine to Digesting Enzymes ᐤᐤ bacterial digestion of disaccharide support the brush-border healing in enzymes at the brush borders, Carbohydrate-digesting enzymes can the Preventative Phase. which leads to carbohydrate help break down complex sugars to malabsorption, fermentation, and monosaccharides, which are easily gas. absorbed into the body; this creates more competition for nutrients with the Diets high in carbohydrates such overgrowing bacteria in the small intestine. as disaccharides (eg. lactose, sucrose, maltose), oligosaccharides Due to the fact that each carbohydrate- (FOS, inulin), and polysaccharides digesting enzyme breaks specific types of (starch, mucilage, soluble fibre) can glycoside bonds, incorporating as many aggravate the symptoms of SIBO of them as possible in treating SIBO is because these nutrients would important in helping limit the available feed the bacteria before they can be di-/oligo-/polysaccharides in the gut. digested and absorbed in the small Common carbohydrate-digesting enzyme intestine or transited into the large supplements usually include lactase, intestine. amylase, beta-glucanase, phytase, and

16 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com cellulase. Some of the less commonly FODMAP diets. The enzymes may be Reference: seen, yet crucial in SIBO treatment, tapered off once the patients become fully 1. Peralta S et al. Small intestine bacterial enzymes include: accustomed to the diet. overgrowth and irritable bowel syndrome- related symptoms: experience with ᐤᐤ alpha-galactosidase - the enzyme Comprehensive Approach to SIBO Rifaximin. World J Gastroenterol. 2009 used in the product “Beano” to digest Jun 7;15(21):2628-2631. 1. Dietary Restrictions - for at least 1 raffinose (trisaccharide) that is 2. Lin HC et al. Small intestinal year. SCD and low FODMAP Diets. bacterial overgrowth: a framework for commonly found in beans, legumes, With incorporation of broad spectrum yam, and cruciferous vegetables understanding irritable bowel syndrome. carbohydrate-digesting enzymes to JAMA. 2004 Aug 18;292(7):852-858. ᐤᐤ maltase - breaks down maltose, a improve compliance. 3. DiBaise JK. Nutritional consequences of disaccharide from the break-down small intestinal bacterial overgrowth. Prac 2. Anti-microbial Phase - 30 days of of starch by amylase Gastroenterol. 2008;69:15-28. herbal anti-microbials that should 4. Prizont R. Glycoprotein degradation in ᐤᐤ hemicellulase - breaks down include berberine and allicin. the blind loop syndrome: identification of various polysaccahrides 3. Prokinetic (GI Motility) Phase - > 3 glycosidases in jejunal contents. J Clin ᐤᐤ pectinase - breaks down pectin months after the anti-microbial phase. Invest. 1981 Feb;67(2):336-344. 5. Lauritano EC, Valenza V, Sparano L, et (mucuopolysaccharides) May use 5-HTP or bitter herbs. al. Small intestinal bacterial overgrowth ᐤᐤ invertase - breaks down sucrose 4. Preventative Phase - > 3 months after and intestinal permeability. Scand J (table sugar) the anti-microbial phase. May include: Gastroenterol. 2010 Sep;45(9):1131- 1132. With the aid of broad-spectrum hydrochloric acid (if hypochlorhydria is the case), probiotics, and brush- 6. Resnick C. Nutritional protocol for the carbohydrate-digesting enzymes, treatment of intestinal permeability defects border repair ingredients (eg. compliance can be greatly improved and related conditions. Nat Med J. March as patients ease into the SCD or low L-glutamine, zinc carnosine) 2010.

Ingredient FOCUS

D-Limonene - A Promising Natural Medicine for GERD

astroesophageal Reflux Disease used to treat GERD, d-limonene is one of to support healthy peristalsis.[4],[5] G(GERD) is one of the most common the less commonly recognized remedies. In a double-blind, placebo-controlled study gastrointestinal (GI) disorders affecting D-limonene is a monocyclic monoterpene (n=13), 1,000 mg d-limonene once daily or 18-28% of North Americans, and the (Figure 1) that contributes to the aroma of every other day for 2 weeks was shown to prevalence has been increasing every citrus oils. D-limonene is commonly used as yield complete relief of GERD symptoms [1] year. Proton pump inhibitors (PPIs) are a fragrance and flavoring agent in esthetic in 86% of the subjects. Moreover, the medication of choice in conventional products and beverages, and therefore, it improvement was noticeable after only 4 medicine. While PPIs are somewhat is generally recognized as safe (GRAS) days of administration.[4] effective at reducing GERD symptoms, for ingestion. It is also commonly used as In another clinical trial, 19 patients suffering this class of medications have been a natural cleaning agent due to its organic from chronic heartburn or GERD were associated with increased incidence solvent property. prescribed 1000 mg d-limonene every day of enteric infections and a decrease in D-limonene has been clinically used to or every other day after discontinuing any calcium and B12 absorption.[2],[3] relieve heartburn due to its potential to OTC or prescription heartburn medications. Among the various natural alternatives protect mucosal surfaces and its ability After 14 days, 89% of subjects reported 17 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com complete relief of symptoms.[4] orange. Multiple vacuum distillations (VD) important to ensure all of the dispensed Figure 1. D-limonene chemical structure. can be done to remove almost all of the medicine is ingested. Mixing it with water or impurities (e.g. pesticides, herbicides). other beverages is actually NOT the best Purity of D-Limonene = Safety of way of taking it for 2 reasons: D-Limonene A single VD can produce a 95% purity of d-limonene (regular food-grade); double ᐤᐤ A significant amount of d-limonene will Non-Food Grade vs. Food Grade vs. VD can achieve High-Purified Grade stick to the container (ie. cup, glass, (98.5%); and Ultra-Purified Grade (99.5%) blender) or your lips. is obtained from triple vacuum distillation ᐤᐤ D-limonene will be diluted too much to yield the purest form of d-limonene. The proper way of taking Limonen-E is Other Applications dispensing indicated dosage (24 drops) Potential Cancer Prevention & Tumor directly into your mouth on an empty Therapy stomach and washing it down with 1-2 D-limonene was able to prevent sips of water. This way, all of the desired progression of both breast and liver dosage is ingested and not too diluted. High-Purified vs. Ultra-Purified Grade cancers in cancer-induced animal models. Reference: D-limonene can be categorized into 4 [vi] It was also tested as a mammary tumor 1. EI-Serag HB, Sweet S, Winchester C. C., Dent J., Update on the epideminology of gastro- grades of purity: therapy in preclinical models and resulted oesophageal reflux disease: a systematic review. ᐤᐤ non-food grade (aka technical in regression of >80% of the carcinoma Gut. 2014 Jun;63(6):871-80. grade) with little host toxicity.[1] 2. Attwood SE, Galmiche JP. A debate on the Gallstone Dissolution roles of antireflux surgery and long term acid ᐤᐤ regular food-grade suppression in the management of GERD. ᐤᐤ high-purified grade D-limonene is known to be a good solvent Frontline Gastroenterol. 2011. 2(4):206-211. to dissolve cholesterol. In a study involving 3. Lam JR, Schneider JL, Zhao W, Corley DA. ᐤᐤ ultra-purified grade (Figure 2) 200 patients with gallstones, d-limonene Proton pump inhibitor and histamine 2 receptor Non-food grade d-limonene is produced administered via direct infusion was shown antagonist use and vitamin B12 deficiency. from the citrus peel via steam distillation. JAMA 2013. 310(22):2435-2442. to significantly dissolve the stones in 141 4. Wilkins JS Jr. Method for treating gastrointestinal The purity is usually not standardized of the patients, and resulted in complete disorders. U.S. Patent (6,420,435). July 16, 2002. and, therefore, significant amounts of dissolution in 96 patients.[7] 5. Lis-Balchin M, Ochocka RJ, Deans SG, et al. residual pesticides/herbicides may Bioactivity of the enantiomers of limonene. Med Vita Aid’s Limonen-E uses the ultra-purified be present. This grade of d-limonene is Sci Res 1996;24:309-310. grade (>99.5%) d-limonene with inclusion usually used for cleaning purposes. 6. Gould MN. Cancer chemoprevention and therapy of vitamin E to stabilize d-limonene from by monoterpenes. Environ Health Perspect 1997; Food grade d-limonene is obtained from oxidation. 105(4): 977-979. vacuum distillation (VD) of fragrance 7. Igimi H, Tamura R, Toraishi K, et al. Medical How to Take Liquid d-Limonene compounds from cold-pressed citrus oil, dissolution of gallstones. Clinical experience Properly? which is derived from the flesh of the of d-limonene as a simple, safe, and effective When taking liquid d-limonene, it is solvent. Dig Dis Sci 1991;36:200-208.

Figure 2. D-limonene manufacturing process.

18 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

The Next BIG Thing in Gut-Healing - Zinc L-Carnosine

very year, digestive disorders ᐤᐤ life-prolonging effect on Ecost more than $18 billion in fibroblasts, GI-Restore is a comprehensive formula health care [1] and impact Canadians’ to help relieve inflammatory conditions of ᐤᐤ stimulatory effect on nitric oxide quality of life on both personal the GI tract and repair the linings of the production in endothelial cells and professional levels. The most gut via multiple mechanisms: promoting blood circulation to the 1. Support intercellular tight junctions common digestive disorders include affected area, and stomatitis, GERD, gastritis/gastric 2. Increase mucus secretion in the ulcers, duodenal ulcers, IBD (Crohn’s ᐤᐤ antioxidant and anti-inflammatory stomach disease and ulcerative colitis), and actions via inhibition of TNF-alpha 3. Coat gut linings to soothe and protect diverticulitis. signaling [3] to protect against damaged/ inflamed tissue oxidative stress implicated in the 4. Anti-inflammatory and anti-histamine There are many conventional pathogenesis of non-healing ulcers. actions - ensure gut lining integrity treatments addressing all of the and regulate acid secretion above conditions ranging from ᐤᐤ stimulatory effect on mucus 5. Promote proper tissue formation and medications, such as corticosteroids, protection regeneration PPI and antibiotics, to surgeries that Zinc is the most important cofactor in Key Features: remove reactive tissues. However, the immune system and in epithelial ᐤᐤ Zinc L-Carnosine - helps to protect there is often no follow-up treatment tissue formation. It supports normal in the conventional model to help the intercellular tight junctions and reduce development and function of neutrophils, gut hyperpermeability. process of tissue healing. As a result, lymphocytes and NK cells, as well as recurrences and post-treatment ᐤᐤ Combination of herbal demulcents stabilizing cellular membranes of the - complications often follow. - DGL (10:1) and Slippery Elm (4:1) epithelial cells, which are often damaged to coat and soothe inflamed GI linings. by the use of NSAIDs.[4] Polaprezinc - a chelate compound ᐤᐤ L-glutamine to promote tissue consisting of zinc and L-carnosine - Clinical Applications regeneration in the GI tract. is commonly used for the treatment of NSAID-Induced Small Bowel Injury ᐤᐤ Quercetin to exert anti-histamine and gastric ulcers in Japan. Polaprezinc anti-inflammatory effects in the gut. is indicated in all types of tissue A human clinical study showed that ᐤᐤ Powder form to ensure contact healing along the GI tract as it polaprezinc was able to counteract throughout the entire GI tract. is shown to restore intercellular the small bowel damage caused by Indications: stomatitis, GERD, gastritis, tight junctions to promote indomethacin (first-line NSAID for peptic ulcer, intestinal hyperpermeability wound-healing and reduce gout arthritis). Participants treated with (leaky gut syndrome), IBD, post-bowel gut permeability from chronic indomethacin saw a 3-fold increase in gut surgery or post-chemotherapy recovery inflammation. permeability. In contrast, those treated Mechanisms of Action with indomethacin plus polaprezinc (75 mg daily) did NOT show any increase in L-carnosine is a naturally occurring small intestinal permeability.[5] dipeptide abundant in muscles and nerves as these tissues are In a randomized controlled trial constantly under oxidative stress involving patients with low-dose and require fast repair mechanism. aspirin- induced small bowel injury, L-carnosine’s healing properties polaprezinc therapy for 4 weeks was include: [2],[7] able to significantly decrease erosions/ 19 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com ulcers and inflammation (p < 0.05), (p=0.004), sigmoid colon (p=0.03), and Clin Nutr (1998). 68: 447S-463S. [6] as identified by capsule endoscopy. descending colon (p=0.04) in patients 5. Mahmood A, FitzGerald AJ, Marchbank administered with the polaprezinc Prevention of Stomatitis Post- T, Ntatsaki E, Murray D, Ghosh S, enema. Radiation/Chemotherapy Playford RJ. Zinc carnosine a health Reference: food supplement that stabilises small In another randomized controlled bowel integrity and stimulates gut repair trial, 31 post-radiation/chemotherapy 1. Statistics Canada (2000). Canadian processes. Gut 2007. 56: 168-175. patients with head/neck tumors were Digestive Health Foundation. administered polaprezinc as an 6. Watari I, Oka S, Tanaka S, Aoyama 2. Sakae K, Agata T, Kamide R, T, Imagawa H, Shishido T, Yoshida oral rinse. The results showed that Yanagisawa H. Effects of L-carnosine S, Chayama K. Effectiveness of polaprezinc was able to significantly and its zinc complex (polaprezinc) on polarprezinc for lowdose-aspirin- reduce the incidence of symptoms pressure ulcer healing. Nutrition in induced small bowel mucosal injuries associated with oral mucositis, Clinical Practice (2013). 28(5):610-618. as evaluated by capsule endoscopy: a such as pain, xerostomia, and 3. Watanabe T, Ishihara M, Matsuura pilot randomized controlled study. BMC [2] taste disturbances. K, Mizuta K, Yoshinori I. Polaprezinc Gastroent 2013. 13:108. Promote Healing in Ulcerative Colitis prevents oral mucositis associated with 7. Itagaki M, Saruta M, Saijo H, Mitobe J, radiochemotherapy in patients with Polaprezinc has also been Arihiro S, Matsuoka M, Kato T, Ikegami head and neck cancer. Int J Cancer M, Tajiri H. Efficacy of zinc-carnosine administered as an enema in patients 2010. 127:1984-1990. with ulcerative colitis (n=18) in a chelate compound, Polaprezinc, enemas in patients with ulcerative placebo-controlled trial.[7] Significant 4. Shankar AH, Prasad AS. Zinc and colitis. Scandinavian Journal of improvements of the endoscopic immune function: the biological basis of altered resistance to infection. Am J Gastroenterology 2014. 49:164-172. scores were seen for the rectum

Clinical FOCUS

Treating PCOS with Myo-Inositol - An Insulin Sensitizer & Mood Stabilizer

olycystic ovarian syndrome Insulin plays a direct role in causing in each ovary measuring 2-9 mm in P(PCOS) is the most common cause hyperandrogenemia of PCOS. First, diameter, and/or increased ovarian of ovulatory disorders and female it acts synergistically with luteinizing volume (>10 ml). infertility. It affects approximately 10% hormone (LH) to enhance the Conventional Treatment of PCOS of women in their childbearing age. [1] androgen production of theca cells. [3] Metformin is the first line medication While the exact pathogenesis of PCOS Furthermore, insulin reduces the used to treat PCOS. It helps modulate has yet to be elucidated, studies circulating levels of sex hormone serum glucose by improving insulin have evaluated potential contributors binding globulin (SHBG), which in sensitivity and glucose uptake via its including abnormal gonadotropin turn causes a relative increase of [4] action on GLUT4 receptors. While secretion, ovarian factors, and free testosterone. metformin is generally well tolerated, insulin resistance, which appears The current PCOS diagnosis criteria about 25% of people experience to be the main theme and affects are: [1] side effects, such as abdominal 50-80% of PCOS patients.[2] In fact, ᐤᐤ oligo-anovulation, discomfort, cramping, diarrhea, and multiple metabolic issues have been ᐤᐤ hyperandrogenism (clinical or nausea/vomiting. identified in PCOS, including early biochemical) and diabetes, obesity, high blood pressure, Clomifene - a selective estrogen ᐤ the presence of 12 or more follicles dyslipidemia and fatty liver. ᐤ receptor modulator - is sometimes

20 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com included in the treatment to induce placebo-controlled clinical study, 12 A, Baillargeon JP. Insulin and ovulation sooner. However, clomifene g of MI daily for six menstrual cycles hyperandrogenism in women with is associated with increased risk of showed significant improvements in polycystic ovary syndrome. J Steroid ovarian cancer, especially in those all three mood scales in patients with Biochem Mol Biol, 2010; 122: 42-52. with no history of pregnancy.[5] Premenstrual Dysphoric Disorder, a 5. Gadducci A, Guerrieri ME, Genazzani severe depressive form of PMS.[11] AR. Fertility drug use and risk of ovarian Myo-inositol (MI) Improves Insulin tumors: a debated clinical challenge. Sensitivity and Oocyte Quality Current research on PCOS barely Gynecological Endocrinology, 2013; addresses the psychosocial aspect of Similar to metformin, myo-inositol (MI) 29(1): 30-35. the condition; however, women with is an insulin sensitizer due to its role 6. Zacche MM, Caputo L, Filippis S, as the second messenger of the insulin PCOS appear to have a prevalence Zacche G, Dindelli M, Ferrari A. Efficacy signaling pathway. Myo-inositol (MI) of depressive disorders that is about of myo-inositol in the treatment of

has been clinically shown to reduce 3 times higher than seen in controls cutaneous disorders in young women (35% vs. 11%, respectively, p<0.001). hirsutism, improve acne, normalize with polycystic ovary syndrome. Gynecol Eating disorders are also more common Endocrinol, 2009; 25: 508-513. hypertension and dyslipidemia, and in women with PCOS, reduce the hyperandrogenemic and particularly 7. Costantino D, Minozzi G, Minozzi E, (12.6% of women with hyperinsulinemic states common binge eating Guaraldi C. Metabolic and hormonal PCOS vs. 1.9% in controls, p<0.01).[10] in PCOS. [6],[7] By reducing the serum effects of myo-inositol in women with polycystic ovary syndrome: a doubleblind insulin, MI can normalize the LH levels, In conclusion, myo-inositol (MI) is an trial. Eur Rev Med Pharmacol Sci, 2009; allowing LH surge and ovulation to invaluable natural medicine that offers 13: 105-110. occur. multi-factorial approaches to PCOS by addressing both the “psycho” and 8. Genazzani AD, Lanzoni C, Ricchieri F, MI administration of 4 g with 200 “somatic” aspects of the condition. Jasonni VM. Myo-inositol administration mcg of folic acid per day for at least positively affects hyperinsulinemia and 3 months has been shown to: [1],[8],[9] Vita Aid’s Inositol+ includes folic acid hormonal parameters in overweight to provide synergistic patients with polycystic ovary syndrome. ᐤᐤ normalize various hormonal & chromium support to blood sugar metabolism and parameters (ie. FSH/LH, prolactin, Gynecological Endocrinology, 2008; 24(3): 139-144. DHEA, testosterone, progesterone, insulin sensitivity. estradiol) involved in the 9. Zacche MM, Caputo L, Filippis S, reproductive axis, Zacche G, Dindelli M, Ferrari A. Efficacy of myo-inositol in the treatment of ᐤᐤ induce ovulation, and cutaneous disorders in young women ᐤᐤ improve oocyte function and with polycystic ovary syndrome. quality. Gynecological Endocrinology, 2009; Myo-inositol (MI) Helps with Mood 25(8): 508-513. Disorders 10. Gelber D, Levine J, Belmaker RH. Effect of inositol on Bulimia Nervosa and Binge Myo-inositol (MI) has also been proven Eating. Int J Eat Disord, 2001; 29:345- beneficial for various mood disorders. It is Reference: 348. the precursor of the phosphatidylinositol 1. Baillargeon JP, Iuorno MJ, Nestler JE. cycle, which is important for the normal 11. Gianfranco C, Vittorio U, Silvia B, Insulin sensitizers for polycystic ovary Francesco DA. Myo-inositol in the signaling of neurotransmitters in the syndrome. Clin Obstet Gynecol, 2003; treatment of premenstrual dysphoric brain. MI (at daily doses of 12-18 g) 46: 325-340. disorder. Hum Psychopharmacol Clin has been shown to be therapeutic 2. Unfer V, Carlomagno G, Rizzo P, Exp, 2011; 26:526-230. for depression, panic disorder, and Raffone E, Roseff S. Myo-inositol rather [10] 12. Hollinrake E, Abreu A, Maifield M, et al. obsessive-compulsive disorder. than D-chiro-inositol is able to improve Increased risk of depressive disorders in Its mechanism of action appears to be oocyte quality in intracytoplasmic women with polycystic ovary syndrome. through MI’s involvement in signaling of sperm injection cycles. A prospective, Fertil Steril. 2007;87:1369-1376. 5-HT2a/5-HT2c receptors.[11] controlled, randomized trial. Eur Rev Med Pharmacol Sci, 2011; 15: 452-457. 13. Mansson M, Holte J, Landin- In a placebo-controlled, crossover Wilhelmsen K. Women with polycystic 3. Baillargeon JP, Nestler JE. Commentary: clinical study, 18 g of MI daily for 6 ovary syndrome are often depressed polycystic ovary syndrome: a syndrome or anxious - A case control study. weeks was shown to exert comparable of ovarian hypersensitivity to insulin? J benefits to SSRIs in patients with Psychoneuroendocrinology. Clin Endocrinol Metab, 2006; 91: 22-24. 2008;33:1132-1138. Bulimia Nervosa.[10] In another 4. Baptiste CG, Battista MC, Trottier

21 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Clinical FOCUS

Target the “Heart” of Insomnia

Chronic insomnia affects >15% of nourish the Heart. While the signs of to regulate the flow of Liver blood, the Canadian population and is a Heart Blood Deficiency (ie. palpitations, calm the spirit, moisten the dryness, common reason patients seek health vertigo) will be seen clinically in patients and clear heat. [1] care. Research has shown that with this pattern, the true underlying Clinical Application: Stage 1 Adrenal long-standing insomnia is associated cause is Liver Blood Deficiency. Fatigue - restlessness, anxiety, stress with complications such as obesity, This inadequate nourishment is cardiovascular disease, diabetes, Heart-Kidney Disharmony = Heart often accompanied by Fire from Yin- depression, and substance abuse. Deficiency, which travels upward into the Blood Deficiency + Kidney Yin Insomnia is typically classified into [2],[3],[4] chest and disturbs the Heart. Moreover, Deficiency four categories: 1) sleep-onset, the deficient Liver blood can result As mentioned above, the Heart governs 2) sleep maintenance, 3) non- in excess in Yang, which rises and blood and houses “spirit”. Kidney, in restorative, and 4) sleep-offset (ie. causes dizziness and vertigo. contrary, governs “essence” and houses early waking). Symptoms may include insomnia, “will”. In Traditional Chinese Medicine restless sleep, dry eyes, dry skin, dry Heart’s Fire normally descends to (TCM), the pathological patterns of mouth and throat, palpitations, irritability, meet with the Kidney, and Kidney’s insomnia are centralized around the dizziness, vertigo and night sweats. Water normally rises to meet with “Heart”, which encompasses both the Heart to create this harmonious emotional and physical aspects. In ᐤᐤ Tongue: dry, red tongue flow. However, when chronicexcessive TCM, the Heart contains “Shen” ᐤᐤ Pulse: wiry & thin (typical of Liver thinking injures Heart and Kidney, (aka “spirit” or “conscious mind”) blood deficiency), rapid the blood and essence become and governs blood vessels. A depleted. Such depletion leads to fire disruption in the ability of the Heart to .:Treatment Strategy:. Nourishes the from deficiency, which ascends to the hold “Spirit” or an aggravation of the Heart & Liver and Calms the Spirit Heart. “Spirit” itself can lead to insomnia, Serenomind (Suan Zao Ren Tang; especially the sleep-onset, sleep- Wild Jujube Decoction) is widely used Patients with this pathological pattern maintenance, and non-restorative in TCM to treat insomnia associated would have signs and symptoms of insomnia types. with Liver Blood Deficiency. Kidney Yin Deficiency on top of the Heart Blood Deficiency. The two most common TCM patterns of insomnia are: Common signs and symptoms are insomnia, restless sleep, ulcer & 1. Heart & Liver Blood Deficiencies sores in the mouth and tongue, night 2. Heart-Kidney Disharmony sweat, nocturnal emission, irritability, forgetfulness, and inability to think or Liver Blood Deficiency >> Heart concentrate. Blood Deficiency >> Heart Fire from Deficiency [2],[3],[4] ᐤᐤ Tongue: Red with yellow coat, red at tip Liver (wood) is mother of the Heart The chief ingredient - Wild Jujube Seed (fire), and it is in charge of the flow (Suan Zao Ren) - nourishes blood of ᐤᐤ Pulse: full, rapid, overflowing (Heart of blood and Qi. When the Liver is the Heart and Liver and calms the position) deficient due to chronic stress, Spirit. The deputy herbs work together there is not enough blood to 22 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com .:Treatment Strategy:. To Enrich calm the Spirit. Medical Publishing House. China. 4. Chen JK, Chen TT. Chinese Yin, Nourish the blood, tonify the Clinical Application: Stage 2 Adrenal Heart, and Calm the Spirit Herbal Formulas and Applications: Fatigue - chronic exhaustion depleting Pharmacological Effects & Clinical Harmovex (Tian Wang Bu Xin Wan; their Kidney & Heart Yin; lethargy; Research (2009). Heaven’s Emperor Heart Tonifying chronic lower back pain. 5. Jiang JG, Huang XJ, Chen J. Separation Pills) is the go-to formula for Heart Wild Jujube Seed - A Phyto-GABA and purification of saponins from Semen and Kidney disharmony. With Raw Ziziphus jujuba and their sedative and Rehmannia as its chief ingredient, Agonist hypnotic effects. J Pharm Pharmacol . Harmovex’s main action is to nourish Both Serenomind and Harmovex 2007;59(8):1175-1180. Yin (Heart & Kidney) and clear heat. contain wild jujube seed as chief and 6. Han H, Ma Y, Eun JS, Li RH, Hong JT, deputy ingredients, respectively, to Lee MK, Oh KW. Anxiollytic-like effects The deputy herbs - including Wild of sanjoinine A isolated from Ziziphi Jujube Seed - work together to help calm the Spirit. Research findings have attributed that wild jujube seed’s Spinosi Semen: Possible involvement of reinforce the following actions: 1) GABAergic transmission. Pharmacology anxiolytic effect to one of its main tonify the Qi & blood in the Heart, 2) Biochemistry and Behavior (2009). Vol regulate proper flow of blood, and 3) alkaloid constituents -sanjoinine A - 92 (2): 206-213. acting on the GABA-receptors. [5],[6] Reference: 1. Statistics Canada. Health Reports (2005). 17(1): 9-25. 2. Bensky D, Barolet R. Chinese Herbal Medicine: Formulas & Strategies (1990). 3. Pharmacopoeia of the People’s Republic of China. Volume 1 (2005). Chinese Pharmacopoeia Commission. People’s

Clinical FOCUS Restoring Yin-Yang Balance in Kidneys

idneys, in TCM, are considered resulting in cold dampness. »» Dizziness and Vertigo - Kidneys the foundation of all organs. They produce marrow and the brain is K What Can You See in Patients with are the organ system of growth, known as “the sea of marrow”. Kidney Yin Deficiency? maturation, sexuality, fertility, and »» Tinnitus (low-pitched) and aging. Kidneys also hold Essence - Kidney Yin Deficiency is diagnosed via Impaired Hearing - The ear is the the genetic blueprint of who you are Tongue and Pulse, accompanied by sensory organ of Kidneys. some keynote symptoms. and how healthy and strong you will »» Sexual Dysfunctions including be. ᐤᐤ Tongue: red body, scanty coating immature ejaculation & seminal It is important to ensure the balance with cracks emission - Semen is equivalent to of Yin & Yang in Kidneys in order to ᐤᐤ Pulse: fine & rapid Essence in men; KD Yin deficiency protect Essence. A good analogy ᐤᐤ Keynote Symptoms: can cause Essence to leak out of the body (ie. “pot damaged by fire to illustrate the importance of such »» Hot flash, night sweat, heat balance is a pot of water boiled on a sensations in the palms & soles; due to too little water”). bonfire. Yin is the water; Essence is thirst, dry mouth & throat - Yin- »» Blurred Vision - Since Kidneys the pot; and Yang is the fire. When deficiency fire rising nourish Liver (ie. Water Generates Yin (water) is deficient, Essence (pot) Wood), Liver Yin Deficiency »» Weakness of knees & lower back can get too hot and potentially be and osteoporosis - Kidneys reside often accompanies Kidney Yin damaged by Yang (fire). On the other in the lower back and govern the Deficiency. hand, when Yang (fire) is deficient, bone. What about Kidney Yang Deficiency? Yin (water) will become stagnant

23 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com ᐤᐤ Tongue: pale, puffy body, thin Treating Kidney Yang Deficiency - *Cinnamon Bark vs. Cinnamon Twig white coating. Spirityang (Eight Rehmannia Pills) Cinnamon barks are from the bigger ᐤᐤ Pulse: deep & fine pulses in the Spirityang (“Eight Rehmannia Pills”) branches of the plant while cinnamon Chi positions. or traditionally known as Ba Wei Di twigs are the younger and newly Huang Wan is the best TCM formula for sprouted branches. Cinnamon bark, in ᐤᐤ Keynote Symptoms of Kidney Kidney Yang deficiency. It is essentially TCM, is a warmer herb because of its Yang Deficiency: the modified formula of Spirityin with higher essential oil content compared to »» Weakness of knees & lower the addition of two warming (ie. yang- cinnamon twig. back tonifying) herbs - Chinese aconite »» Cold sensations, especially and cinnamon bark. Because TCM in the lower back & lower formulas are all about maintaining abdominal pain & cramps balance in our body, Spirityang is »» Dysuria or polyuria (eg. designed to tonify both Yin and Yang diabetes mellitus) - unable to to prevent over-tonifying of Yang and regulate water circulation and ensure Yin-Yang balance. metabolism What about Jin Gui Shen Qi Wan Treating Kidney Yin Deficiency - (Golden Cabinet Kidney Qi Pills)? Spirityin (Six Rehmannia Pills) “Golden Cabinet Kidney Qi Pills”, The most commonly used TCM also known as Jin Gui Shen Qi Wan, patent formula to address Kidney is another well-known Kidney Yang- Yin Deficiency is Spirityin (“Six tonifying formula. It is in fact the Rehmannia Pills”) or traditionally predecessor of Spirityang. However, if known as Liu Wei Di Huang Wan. we compare these two formulas head- to-head, Spirityang would be the is the Chief Rehmannia root STRONGER of the two. herb in Spirityin; it is the most representative herb to tonify Kidney Spirityang is stronger because of two Yin and Essence, and replenish modifications on the “Golden Cabinet the marrow. Other Deputy herbs Kidney Qi Pills”: 1) Cinnamon Bark are included to further support the in the place of Cinnamon Twig to Kidneys, while nourishing Liver and increase Yang-tonifying, warming Spleen because Liver and Spleen effect* and 2) Processed Rehmannia are often affected by Kidney Yin in the place of Raw Rehmannia to deficiency. enhance Yin-tonic property with less draining effect.

Clinical FOCUS Can Magnesium Supplements Be Used to Treat Both Migraines & Constipation Simultaneously? Two Opposing Indications of Magnesium Supplements

agnesium is one of the Different absorption rates of various facilitated diffusion. Mmost frequently prescribed magnesium supplements are the Magnesium citrate and malate are supplements in practice. Two of reason for this opposing relationship considered two of the better absorbable the common uses of magnesium between treatments of migraines and salts because of their good solubility, supplements are to treat migraines constipation. but their absorption rates only range and constipation. However, these Magnesium salts are in general poorly from 30-40%. two indications are actually opposed absorbed because their absorbability to each other in clinical settings. On the other hand, Magnesium They depends on their solubility. Bisglycinate Chelate (Mg-BC) is NOT need to first dissociate into their ionic Absorbability - The Cause of a SALT. It is a unique chelate form of Opposition forms before they can be absorbed via 24 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com magnesium that is recognized by conventional medicine as a stool by chronic constipation while Mg-Lax our body as food (dipeptide) and softener, as the fractional absorption is not. absorbed directly via a different rate is only 4% because of its poor ᐤᐤ Mg-Lax yields better clinical pathway from that of the ionic Mg. solubility. Other magnesium salts with outcomes than lubricant laxatives higher absorption rates, such as citrate Therefore, Mg-BC’s absorption rate (eg. slippery elm, marshmallow, DGL, and sulfate (30-35%), will still draw is much higher than that of ionic glycerin) taken orally. Some patients water into the lumen to cause soft stool Mg and NOT dependent to on the may experience more benefits from due to their ionic nature. pH in the stomach or food intake. combining lubricant laxatives and Studies have shown that Mg-BC’s Vita Aid’s Mg-Lax is specifically Mg-Lax to promote better passage of absorption rate is about 228% of formulated to promote regular bowel stool. [1] movements, loosen stools, and aid in that of Magnesium Citrate. ᐤᐤ Mg-Lax is much gentler on the bowel In addition, because serum Mg2+ constipation. than stimulant laxatives. It doesn’t levels are highly regulated by the ᐤᐤ Contains MgO and Mg citrate, which cause cramping, sporadic urgencies, body via globulin-binding of these act as an osmotic laxative, increasing or electrolyte imbalance like a ions, Mg-BC’s absorption mechanism stool volume while also making stools stimulant laxative would. enables better incorporation of itself softer. ᐤᐤ Using stimulant laxatives long- into the targeted tissues, such as ᐤᐤ Promote the bowel movement term can also desensitize the nerve muscle and bone. without causing abdominal cramping; endings on the colon linings, requiring All of the above merits of Mg-BC well-tolerated with long-term use. an increase in dosage over time. make it the magnesium supplement ᐤᐤ Can be used in the elderly with ᐤᐤ Mg-Lax can be used on daily basis of choice in treating muscle spasms, habitual constipation caused by without causing dependency, as it anxiety and migraines, but is Mg-BC hypotonic bowel. utilizes a simple physics phenomenon a good form to treat constipation? - osmosis - to draw water into the ᐤᐤ Useful in individuals with high risk The answer is “NO” because a well- lumen to soften the stool. absorbed magnesium supplement of stroke to prevent straining during like Mg-BC may cause relaxation of defecation, which is one of the leading In conclusion, choosing ONE the smooth muscle of the gut and causes of hemorrhagic stroke . magnesium supplement with “Two in actually provide little to no benefit One” action to effectively treat migraine in promoting bowel peristalsis. and constipation is difficult to achieve. The most effective treatment is to use A Good Laxative Magnesium Mg bisglycinate for migraine/muscle Supplement MUST Have POOR spasms and Mg salt (eg. MgO, Mg Absorption Rate citrate) for constipation to yield the best The laxative effect of magnesium clinical outcomes. salts is due to the osmotic gradient Reference: created by the ingested molecules in their passage through the gut lumen. 1. Supakatisant C, Phupong V. Oral Mg-Lax vs. Other Types of Laxatives When magnesium salt is not readily magnesium for relief in pregnancy- absorbed in the gut, it can draw water ᐤᐤ Unlike bulk-forming laxatives (eg. induced leg cramps: a RCT. Maternal from the interstitial space into the psyllium husk and flaxseed), Mg- & Child Nutrition (2012). Lax does not require drinking a lot of lumen resulting in softened stool or 2. Elias A. Giraldo, MD, MS. diarrhea. water with administration. Also, bulk- Hemorrhagic Stroke. The Merck forming laxatives are contraindicated Manual: Home Health Handbook Magnesium oxide (MgO), for in partial bowel obstruction caused instance, is often used in (2007).

25 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

Piperine - World’s First Bioavailability Enhancer

Piperine is the major alkaloid constituent Piperine - A Supreme Anti- present in P. nigrum (black pepper) Inflammatory Agent Vita Aid’s Verlusan+ is a and P. logum (long pepper). Piperine synergistic anti-inflammatory Piperine has been demonstrated ® has been scientifically validated as a formula enhanced by Bioperine to possess anti-inflammatory and (piperine isolate) supplying: bioavailability enhancer. There are a by immune-modulatory actions ᐤᐤ Daily 1000 mg of Perluxan® - few possible mechanisms by which inhibiting the maturation, migration, and piperine acts as bio-enhancers: the supercritical CO2-extracted T-cell stimulatory capacity of dendritic hops to yield 30% of iso-alpha ᐤᐤ Promoting rapid absorption of cells (DC) in vivo and in vitro, as well acids (resin); lab-tested to nutrients/ medicines as affecting T cell cytokine secretion. contain NON-DETECTABLE ᐤᐤ Increasing blood supply to the GI [6] These findings suggest that amount of estrogenic and tract piperine can be an excellent adjunct sedative constituents. 1000 mg ᐤᐤ Increasing emulsifying content of ingredient for various autoimmune and Perluxan® is shown to exert the gut inflammatory disorders (eg. SLE, RA, comparable Cox-2 inhibiting IBD). effect as 400 mg of ibuprofen. Curcumin + Piperine = Bioavailability Increased by 2000% Is piperine contraindicated in ᐤᐤ Curcuminoids (1200 mg) & Rosemary - anti-inflammatory In a human clinical trial evaluating arthritic patients with a nightshade (Solanacea) allergy? and anti-oxidative effects. the bioavailability of curcumin (2g) ᐤᐤ Boswellia (360 mg) - The with the addition of piperine (20mg) Some practitioners are concerned resinous boswellic acids have administered orally, the serum samples about giving piperine-containing been shown to provide anti- showed that curcumin with piperine supplements to arthritic patients inflammatory, anti-arthritic had 2000% better bioavailability than with a nightshade allergy under the and analgesic activity and curcumin taken alone (P<0.001).[1] consensus that nightshade family significantly lower the total ( ) includes potatoes In addition, piperine has been shown Solanaceae WBC count in the joint fluid. ( ), tomatoes to enhance curcumin’s neuro- Solanum tuberosum ᐤᐤ Clinical Applications: (Lycopersicon esculentum), eggplants protective effect against anti-psychotic ᐤᐤ Reduce inflammation and (Solanum melongena), tobaccos medications (ie. haloperidol).[2] pain of joints caused by (Nicotinana tabacum), and all types Piperine also increases the absorption autoimmune conditions of peppers (Capsicum sp.) - EXCEPT (eg. RA, Psoriasis, SLE) and bioavailability of various other black pepper. nutrients. ᐤᐤ Relieve inflammation and Most people are not aware of the pain from OA, tendonitis In a double-blind clinical study, beta- fact that black pepper (Piper sp.) and fibromalgia. carotene plus piperine was shown belongs to the Piperaceae family, ᐤᐤ Noticeably reduce the [7] to yield 160% greater area under the NOT the nightshade. Piperine can hsCRP levels. curve (AUC) of serum beta-carotene actually be an excellent medicine than beta-carotene plus placebo over working synergistically with other anti- a course of 14 days.[3] inflammatory medicines eg. curcumin, In other clinical studies, piperine boswellia to treat arthritis patients, was shown to enhance the and should not pose any problem with bioavailability of coenzyme Q10 nightshade allergic individuals. (ubiquinone) by 130% over 21 days Reference: of supplementation,[4] as well as 1. Shoba G, Joy D, Joseph T, Majeed M, selenium (145%), vitamin B6 (216%), Rajendra R, Srinvas PSSR. Influence and resveratrol (229%).[5] of Piperine on the Pharmacokinetics 26 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com of Curcumin in Animals and Human pepper increases serum response of of resveratrol by combining it with Volunteers. Planta Medica (1998). Vol beta-carotene during 14-days of oral piperine. Mol. Nutr. Food Res. (2011). 64: 353-356. beta-carotene supplementation. Nutrition Vol55:1169-1176. 2. Bishnoi M, Chopra K, Lu RZ, Kulkarni Research (1999). Vol19(3):381-388. 6. Rogers GA. Immunomodulatory effects SK. Protective effect of curcumin and its 4. Badmaev V, Majeed M, Prakash L. of piperine on dendritic cell function. combination with piperine (bioavailability Piperine derived from black pepper Immunol. (2011). Vol30(4):1233-1242. enhancer) against haloperidol- increases the plasma levels of coenzyme 7. Childers NF, Margoles MS. An Apparent associated neurotoxicity: cellular and Q10 following oral supplementation. J Relation of Nightshades (Solanaceae) neurochemical evidence. Neurotox Res Nutr. Biochem. (2000). Vol11:109-113. to Arthritis. J Neuro Ortho Med Surgery (2011). Vol20:215-225. 5. Johnson JJ, Nihal M, Siddiqui IA, (1993). Vol12:227-231. 3. Badmaev V, Majeed M, Norkus EP. Scarlett CO, Bailey HH, Mukhtar H, Piperine, an alkaloid derived from black Ahmad N. Enhancing the bioavailability

Clinical FOCUS

Recognizing and Treating TCM Patterns of Irritable Bowel Syndrome (IBS)

rritable Bowel Syndrome (IBS) is one Diarrhea-Dominant IBS consuming too much greasy or mucus- Iof the most common and toughest GI Spleen Qi Deficiency + Dampness forming food (eg. refined sugar, dairy, conditions and makes up about 20% (+Cold) wheat). of all GI complaints seen by general IBS patients with Spleen Qi deficiency If there is an associated severe practitioners. There are 3 subtypes often suffer from fatigue, diarrhea/ cramping pain in the abdomen, it of IBS: 1) constipation-dominant loose stool, and abdominal pain with could indicate excess Cold in Spleen. IBS 2) diarrhea-dominant and 3) gas and bloating after meal that is The pain is characterized by patient’s diarrhea-constipation-alternating relieved by applying pressure over and doubling-over to try to alleviate the pain. IBS - the latter two being more after defection. These symptoms are This pattern can be caused by eating Symptoms of IBS commonly seen. often aggravated by over-thinking, over- too much cold/raw foods or Yang often have emotional triggers, and worrying, and/or over-exertion. Deficiency. hence, IBS is also often described as a psychosomatic condition. As the Spleen Qi deficiency progresses, ᐤᐤ Tongue: pale body; thick sticky the body’s ability to transport and white coating There are different approaches in transform fluid is compromised resulting TCM to address IBS depending ᐤᐤ Pulse: slippery, slow (when there is in Dampness. These IBS patients on each patient’s presenting excess Cold) may suffer from symptoms of Spleen pathological pattern(s), which are Qi deficiency with looser and/or Treatment: Tonify the Middle Jiao and centralized around Spleen and sticky stool. Other symptoms may Clear Dampness and Cold In TCM, Spleen governs the Liver. include mild to moderate abdominal digestive system (ie. transport and MJ+ - also known as Xiao Jian Zhong cramping, nausea, heavy limbs, and transform nutrients), and both Spleen Tang (Middle Construct Decoction) - is feeling of incomplete stool voiding. the most commonly used formula to and Liver are closely associated with Symptoms are often aggravated by emotional distress. treat IBS associated with Spleen Qi 27 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Deficiency with Dampness (Cold), Qi also becomes stagnant. Reference: where patients usually experience As the Liver Qi stagnation progresses, 1. Bensky D, Barolet R. Chinese Herbal loose/watery stool with or without the Liver Excess could start to invade Medicine: Formulas & Strategies (1990). abdominal pain. The chief ingredients the Spleen resulting in Liver/Spleen 2. Pharmacopoeia of the People’s Republic - cinnamon and the brown rice Disharmony. These IBS patients often of China. Volume 1 (2005). Chinese syrup - help warm and tonify the have symptoms of Spleen Qi Deficiency Pharmacopoeia Commission. People’s Medical Publishing House. China. Middle Jiao to disperse cold. accompanied by abdominal distending Chinese date - the assistant - helps 3. Chen JK, Chen TT. Chinese pain with alternating constipation (ie. tonify Spleen Qi. Herbal Formulas and Applications: stools in pellets) and diarrhea, which Pharmacological Effects & Clinical The deputy herb - white peony are aggravated by stress, frustration Research (2009). (Peonia lactiflora) - works together and anger. There may also be nausea, with licorice (processed) to alleviate belching or acid reflux, and PMS. spasmodic pain in the abdomen. ᐤᐤ Tongue: Red on the sides Ginger - the other assistant herb - further helps warm the middle jiao ᐤᐤ Pulse: weak (Spleen position), wiry and alleviate the bowel spasm. (Liver position) Diarrhea-Constipation Alternating Treatment: Spread Liver Qi and Tonify IBS Spleen Spleen & Liver Disharmony Femalance (Jia Wei Xiao Yao Wan; Free & Easy Wanderer +) is the go- Spleen can also be affected by to formula for Liver Qi stagnation Liver because Liver (Wood) controls & Spleen and Liver Disharmony, Spleen (Earth). In IBS patients under especially when there are signs of chronic emotional distresses such interior heat. It helps spread Liver Qi, as over-thinking or over-worrying, tonifies Spleen, nourishes the blood, irritability, and frustration, not only is and clear heat. Spleen Qi heavily taxed, but Liver

Research FOCUS

What Does the Research Say about Saccharomyces boulardii?

accharomyces boulardii is the only In a review of two randomized controlled by a specific alteration of the migratory Sprobiotic yeast strain that has been trials testing S. boulardii for antibiotic- behavior of T cells, causing them to extensively studied and used in clinical associated diarrhea (AAD), it showed a accumulate in the mesenteric lymph nodes. practice. It has been shown to exert 30% risk reduction in the disease. [10] Consequently, it limits the infiltration of various actions in our gastrointestinal T-helper 1 cells in the inflamed colon and Another RCT looked at the efficacy of tract, as well as our immune function. the amplification of inflammation induced S. boulardii in the treatment of acute The following brief summary presents by pro-inflammatory cytokines production. diarrhea caused by Entamoeba what research has shown so far of S. [5] histolytica, and found that at the end of boulardii’s therapeutic capabilities. 4 weeks, amebic cysts were detected S. boulardii added to conventional therapy Antibiotic-Associated, Acute in 19% of control cases compared to was able to decrease the relapse rate Traveler’s Diarrhea none in the S. boulardii group [11]. in patients with Crohn’s disease over a 6-month period (6% in adjunct S. Saccharomyces boulardii has been Inflammatory Bowel Disease (IBD), boulardii group vs. 38% in conventional extensively studied and found to be Crohn’s and IBS treatment alone). [6] This could be partly effective for the treatment of various S. boulardii has a unique action on IBD due to the ability of S. boulardii to improve forms of diarrhea. 28 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com the integrity of the intestinal mucosal namely direct anti-toxin activity and 2. Buts JP, DeKeyser N, Stilmant C, et al. barrier [9]. inhibition of growth and invasion of Saccharomyces boulardii produces in rat pathogens. small intestine a novel protein phosphatase S. boualrdii has also been shown that inhibits Echerichia coli endotoxin by to improve quality of life in IBS In vitro, S. boulardii directly inhibits the dephosphorylation. Pediatr Res 2006; 60:24 patients. In one trial 67 patients with growth of several pathogens (Candida - 9. IBS were randomized to receive S. albicans, E. coli, Shigella, Pseudomonas 3. Castagluolo I, Riegler MF, Valenick L, et al. boulardii or a placebo for 4 weeks. The aeruginosa, Staphylococcus aureus, Saccharomyces boulardii protease inhibits overall improvement in quality of Entamoeba hystolitica), and cell invasion effects of Clostridium difficile toxins A and B in human colonic mucosa. Infect Immun life was more than twice as high in by Salmonella typhimurium and Yersinia 1999;67:302-7. the S. boulardii group as that in the enterocolitica. placebo-treated group (15.4% vs. 4. McFarland et al. A randomized placebo- S. boulardii also secretes a enzymatic controlled trial of Saccharomyces boulardii [7] 7.0%). protein - phosphatase that is able to in combination with standard antibiotics for C. difficileInfection dephosphorylate and inactivate the Clostridium difficile disease. JAMA 1994; 271: 1913-1918. endotoxin of E coli. [2] In a double blind RCT, three antibiotic 5. Dalmasso et al. Saccharomyces boulardii regimens were used over a 10-day Trophic Action inhibits inflammatory bowel disease by period (either a high or low-dose There is evidence to suggest that S. trapping T cells in mesenteric lymph nodes. of vancomycin or metronidazole) Gastroenterology (2006). Vol 131: 1812-1825. boulardii acts partly by enhancing the combined with S. boulardii or placebo. integrity of the tight junction between 6. Guslandim et al. Saccharomyces boulardii in After a 2-month follow-up, maintenance treatment of Crohn’s disease. a significant enterocytes, thus preserving intestinal Dig Dis Sci 2000; 45: 1462- 1464. decrease of CDI recurrences was integrity and function. observed only in patients treated 7. Choi et al. A Randomized, Double-blind, with a high-dose of vancomycin and Studies have also shown that when S. Placebo-controlled Multicenter Trial of S. boulardii compared with antibiotic boulardii is given to antibiotic-shocked Saccharomyces boulardii in Irritable Bowel and placebo-treated patients. [4] animals or patients with diarrhea, normal Syndrome: Effect on Quality of Life. J Clin microbiota is re-established more rapidly. Gastroenterol 2011. The protective effects of S. boulardii This effect is tightly linked to a stimulation 8. Saint-Marc et al. AIDS related diarrhea: a on C. difficile infection in humans are of short chain fatty acid (SCFA) production, double-blind trial of Saccharomyces boulardii. mainly due to the release of a serine especially butyrate. The production of Sem Hop Paris 1995; 71: 735-741. protease that degrades toxin A and SCFAs is significantly decreased in 9. Vilela et al. Influence of Saccharomyces B of C. difficile. The protease also patients receiving antibiotics, so these boulardii on the intestinal permeability of disrupts the binding of toxin A to effects may be especially relevant in the patients with Crohn’s disease in remission. Scandinavian Journal of Gastroenterology, its receptor and the brush border management of antibiotic-associated [3] 2008; 43: 842-848. membrane receptor itself. diarrhea (AAD). 10. Canani et al. Saccharomyces boulardii: a *Honorable Mention: Anti-Candida Immuno-regulation and Anti-inflammatory summary of the evidence for gastroenterology Action Activity clinical practice in adults and children. Some practitioner’s are hesitant to use European Review for Medical and S. boulardii has been shown to exert anti- Pharmacological Sciences. 2011; 15: 809-822. a probiotic yeast such as S. boulardii inflammatory effects in the GI tract via in patients with suspected candidiasis; 11. Mansour-Ghanaei et al. Efficacy of different mechanisms. however, research has shown that S. Saccharomyces boulardii with antibiotics in acute amoebiasis. World J Gastroenterol inhibits MAP kinase and NF- boulardii is actually beneficial in the S. boulardii 2003; 9: 1832-1833. treatment of candida overgrowth. kB signal transduction pathways and decreases the secretion of IL-8, thereby 12. Berg R, Bernasconi P, Fowler D, Gautreaux Research has shown that S. M (1993) Inhibition of Candida albicans reducing inflammatory diarrhea. boulardii decreases colonization translocation from the gastrointestinal tract of of the intestine by the C. albicans S. boulardii also activates the expression mice by oral administration of Saccharomyces boulardii. J Infect Dis 168: 1314- 1318. infection [13], and also inhibits of peroxisome proliferator-activated the translocation of C. albicans receptor-G, which protects from GI 13. Jawhara S, Poulain D (2007) Saccharomyces from the gastrointestinal tract in inflammation in the host. [1] boulardii decreases inflammation and [12] intestinal colonization by Candida albicans in immunosuppressed rats. a mouse model of chemically-induced colitis. Another study demonstrated that S. Med Mycol 45: 691-700. boulardii reduces the virulence of 14. Murzyn et al. Capric Acid Secreted by S. C. albicans by secreting active boulardii Inhibits C. albicans Filamentous compounds such as capric acid Growth, Adhesion and Biofilm Formation. PLoS ONE;2010, Vol. 5 Issue 8, p1. that reduce candidal adhesion and biofilm formation and inhibit hyphae 15. Guslandi, Giollo, Testoni. A pilot trial of formation. [14] Saccharomyces boulardii in ulcerative colitis. Eur J Gastroenterol Hepatol. 2003 Mechanisms of Action Reference: Jun;15(6):697-8. Anti-Microbial Action 1. Pothoulakis C. Review article: anti- inflammatory mechanisms of action of S. boulardii exerts anti-microbial Saccharomyces boulardii. Aliment Pharmacol activities via two main mechanisms, Ther 2009;30: 826 - 33.

29 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Ingredient FOCUS

A New Hope for Treating Neuropathy Pyrroloquinoline Quinone (PQQ) - A Novel, Multi-Faceted Approach

europathy is a multi-factorial stress.[4] DJ-1 mutations have been Ncondition that has numerous linked to the onset of inherited forms of Vita Aid’s Neuromin is a potential risk factors/triggers, including Parkinson’s disease.[5] comprehensive formula with diabetes, alcohol abuse, B vitamin essential nutrients that support Enhancing Mitochondrial Biogenesis deficiencies, autoimmune diseases, all of the above treatment & Decreasing Inflammatory Markers infections, and exposure to toxins/drugs. principles. The cellular organelle loaded with the While the causes of neuropathy ᐤᐤ Supplies daily dosage of 20 most oxidative stress is the mitochondria, are varied, many of the underlying mg PQQ where intensive oxidative reactions dysfunctions are shared. Common ᐤᐤ Active methylcobalamin, take place (ie. beta-oxidation, oxidative themes may include: 5-MTFR, and P-5-P to support overloaded phosphorylation). Mitochondria are also methylation & myelination oxidative stress, damaged micro- involved in various signaling pathways processes in neurons. & macro-vasculature, neuro- & and are therefore extremely crucial for excito-toxicity, demyelination of the cell survival. In fact, mitochondrial ᐤᐤ Benfotiamine combined nerve axons, and impaired neuro- dysfunctions have been linked with folate and B12 resulted regeneration mechanisms. to various illnesses including in significant improvement Pyrroloquinoline quinone (PQQ) fibromyalgia, chronic fatigue in nerve conduction - a naturally occurring antioxidant syndrome, autoimmune conditions, velocity and is efficacious and cofactor for redox reactions - is and cancer. in the treatment of diabetic commonly found in vegetables and neuropathy. Research has demonstrated that PQQ fermented products. It is one of the few ᐤ not only protects mitochondria from ᐤ Active R-alpha lipoic novel ingredients that address multiple acid provides additional oxidative stress, it also promotes pathophysiologies in neuropathy. antioxidant effects and spontaneous mitochondrial protects nerves and Protecting against Oxidative Damage biogenesis via distinctive cell- mitochondria from damage. PQQ has been shown to protect brain signaling pathways - including ᐤᐤ Phosphatidylserine has cells against oxidative damage resulting activation of CREB (cAMP response element-binding) protein and PGC-1- been shown to enhance from ischemia-reperfusion injury - post- memory and cognitive stroke inflammation and damage that alpha (peroxisome proliferator-activated [6] function in elderly patients. follows the sudden return of blood to receptor-gamma coactivator-1-alpha). ischemic tissues.[1] The mechanism of PQQ enhances mitochondrial function action of PQQ - on top of being a potent and additionally leads to a significant decrease in inflammatory markers antioxidant -involves suppression of [7] reactive nitrogen species (RNS) and such as CRP and IL-6. inhibition of inducible nitric oxide Protection against Neurotoxicity & synthase (iNOS).[2],[3] Neurodegenerative Diseases PQQ also regulates a cell signaling PQQ has been shown to affect part of protein called DJ-1, which is involved the brain’s neurotransmitter system. in cell function and survival and has It protects neurons by modulating been shown to prevent cell death the N-methyl-D-aspartate (NMDA) by combating intensive oxidative receptors [8] and, hence, reducing 30 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com excitotoxicity caused by excessive neuroprotective in a rodent model and the excitotoxic path to motor stimulation by neurotransmitters such of hypoxic/ischemic brain injury. neuron degeneration in amyotrophic as glutamate and aspartate. Long- Neuroscience (1994). 62(2): 399-406. lateral sclerosis. Antioxidants & Redox term excitotoxicity is associated 2. Zhang Y, Rosenberg PA. The essential Signaling (2009). 11(7): 1587-1602. nutrient pyrroloquinoline quinone may with numerous neurodegenerative 12. Dong XX, Wang Y, Qin ZH. Molecular act as a neuroprotectant by suppressing [9],[10],[11],[12] mechanisms of excitotoxicity and diseases and seizures. peroxynitrite formation. The European their relevance to pathogenesis of Journal of Neuroscience (2002).16 (6): PQQ also protects the brain against neurodegenerative diseases. Acta 1015-24. neurotoxicity induced by agents Pharmacologica Sinica (2009) 30(4): 3. Hirakawa A, Shimizu K, Fukumitsu such as mercury (a potential factor 379-387. H, Furukawa S. (2009-01-09). in the development of Alzheimer’s Pyrroloquinoline quinone attenuates 13. Zhang P, Xu Y, Sun J, Li X, Wang L, disease) and oxidopamine (a iNOS gene expression in the Jin L. Protection of pyrroloquinoline potent dopaminergic neurotoxin). injured spinal cord. Biochemical and quinone against methylmercury- [13],[14],[15] PQQ has further been Biophysical Research Communications induced neurotoxicity via reducing shown to prevent the aggregation (2009). 378(2): 308-312. oxidative stress. Free Radical Research of alpha-synuclein (associated with 4. Mitsumoto A1, Nakagawa Y. DJ-1 is (2009). 43(3): 224-233. Parkinson’s disease) and beta- an indicator for endogenous reactive 14. Mutter JCA. Does inorganic mercury amyloid (Alzheimer’s disease) and oxygen species elicited by endotoxin. play a role in Alzheimer’s disease? A protect nerve cells against toxic effects Free Radic Res (2001). 35(6):885-893. systematic review and an integrated 5. Bonifati V, Rizzu P, van Baren MJ, of these proteins. molecular mechanism. Journal of Schaap O, Breedveld GJ, Krieger Alzheimer’s Disease (2010). 22(2): Human Clinical Study - PQQ E, Dekker MC, Squitieri F, Ibanez P, 357-374. Enhances Higher Brain Function in Joosse M, van Dongen JW, Vanacore 15. Hara H, Hiramatsu H, Adachi, Elderly N, van Swieten JC, Brice A, Meco G, van Duijn CM, Oostra BA, Heutink P. T. Pyrroloquinoline quinone is a In a placebo-controlled, double-blind Mutations in the DJ-1 gene associated potent neuroprotective nutrient clinical study in Japan [16], 43 subjects with autosomal recessive early-onset against 6-hydroxydopamine-induced aged 50-70 years old with self- parkinsonism. Science (2003). 299 neurotoxicity. Neurochemical Research identified or close-relative-identified (5604): 256-259. (2007). 32(3): 489-495. forgetfulness were selected. They 6. Chowanadisai W, Bauerly KA, 16. Koikeda T, Nakano M, Masuda K. were then administered either 20 mg of Tchaparian E, Wong A, Cortopassi GA, Pyrroloquinoline quinone disodium salt Rucker RB. Pyrroloquinoline quinone improves higher brain function. Japan J PQQ + placebo or 20 mg PQQ + 100 stimulates mitochondrial biogenesis mg CoQ10 for 24 weeks. Throughout Therapeutics & Pharmacology (2011). through cAMP response element- 48 (5): 519-527. the study, the subjects underwent binding protein phosphorylation and evaluations of higher brain functions increased PGC-1alpha expression. (ie. Immediate Memory, Visuospatial/ Journal of Biological Chemistry (2010). Constructional, Language, Attention, 285(1): 142-152 and Delayed Memory) every 8 weeks 7. Harris CB, Chowanadisai W, Mishchuk using the Repeatable Battery for the DO, Satre MA, Slupsky CM, Rucker Assessment of Neuropsychological RB. Dietary pyrroloquinoline quinone (PQQ) alters indicators of inflammation Status (RBANS). The results and mitochondrial-related metabolism showed that PQQ alone was able to in human subjects. J Nutr Biochem. significantly improve the RBANS (2013). 24(12):2076-84. scores in tested subjects. 8. Aizenman E1, Hartnett KA, Zhong C, Gallop PM, Rosenberg PA. Interaction Neuropathy Treatment Principle of the putative essential nutrient Summary pyrroloquinoline quinone with the ᐤᐤ Reduces oxidative stress N-methyl-D-aspartate receptor redox ᐤᐤ Protects mitochondria and modulatory site. J Neurosci (1992). promotes its biogenesis 12(6):2362-2369. ᐤᐤ Supports methylation pathways 9. Scanlon JM, Aizenman E, Reynolds ᐤᐤ Supports neurotransmitter IJ. Effects of pyrroloquinoline quinone metabolism on glutamate-induced production of ᐤᐤ Supports myelination & conduction reactive oxygen species in neurons. ᐤᐤ Supports neuro-regeneration European Journal of Pharmacology (1997). 326 (1): 67-74. 10. Hossain MA. Molecular mediators of Reference: hypoxic-ischemic injury and implications 1. Jensen FE, Gardner GJ, Williams for epilepsy in the developing brain. AP, Gallops PM, Aizenman E, Epilepsy & Behavior (2005). 7(2): 204- Rosenberg PA. The putative essential 213. nutrient pyrroloquinoline quinone is 11. Foran E, Trotti D. Glutamate transporters

31 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com Ingredient FOCUS St. John’s Wort For Depression and Anxiety Not All Standardized Extracts Are Created Equal

t. John’s Wort (Hypericum perforatum to standardize SJW extract because the SL.) is known to contain a number of content will be changed by its storage time. Vita Aid’s SJW 450 is laboratory- active constituents including hypericin, tested to contain 3% of hyperforin What about Hypericin? hyperforin, pseudohypericin, adhyperforin upon extraction. and flavonoids that its medicinal effects have Hypericin possesses a weak inhibitory In order to retain as much hyperforin been attributed to. effect on MAO. It also increases dopamine content as possible, each batch of levels via its inhibition of dopamine beta- Before you take a look at the label of the St. our SJW extract is freshly, custom- hydroxylase, and exerts anti-viral & anti- John’s Wort (SJW) product on your shelf, extracted; the manufacturing bacterial effects by inducing photosensitivity which constituent do you think the SJW process from extraction and in the pathogens (though host cells are also extract is standardized to? encapsulation to packaging is affected - hence the photosensitivity warning [5] completed within 60 days to The answer will most likely be “hypericin”. on SJW supplements). minimize its exposure to light and For years, hypericin was thought to be the Despite having little clinical significance oxygen. primary active compound responsible for the in depression, hypericin is a much In addition, we utilize high-density antidepressant and anxiolytic properties of more resistant compound to light and polyethylene bottles to pack our the St. John’s Wort (SJW) extracts. oxygen, making it a more ideal marker to SJW extract to further prevent standardize SJW extract than hyperforin. However, hypericin in fact plays a SMALL light and air exposure throughout role in SJW’s anti-depressant & anxiolytic How much hyperforin is present in its shelf life. properties according to more recent hypericin-standardized SJW extract? research. Even though most SJW extracts are It is now believed that “hyperforin” is the standardized in hypericin, it does not mean primary antidepressant and anxiolytic that they do not also contain hyperforin. Most constituent in SJW. It acts as a reuptake 0.3% hypericin standardized SJW extracts inhibitor of monoamines, including would in fact contain 1-3% of hyperforin serotonin, norepinephrine, dopamine, upon extraction, but the exact numbers and of GABA and glutamate.[1] would change largely depending on the manufacture and storage environment. It is also believed that hyperforin may be This could possibly explain why some SJW 3. Orth HCJ, Rentel C, Schmidt PC. Isolation, responsible for inducing the cytochrome extracts in the market would yield better Purity Analysis and Stability of Hyperforin P450 (CYP3A4) liver enzymes[2], which may clinical outcomes than others in patients with as a Standard Material from Hypericum increase the metabolism of other drugs in perforatum L. Journal of Pharmacy and depression and anxiety. the body. Pharmacology (1999). Vol51(2): 193-200. Reference: So, if hyperforin is as good as research has 4. Ang CYW, Hu LH, Heinze TM, Cui YY , shown, why is it often not standardized in 1. Zanoli P. Role of hyperforin in the Freeman JP, Kozak K, Luo WH. Instability SJW extracts? pharmacological activities of St. John’s Wort. of St. John’s Wort (Hypericum perforatum L.) CNS Drug Rev. (2004). Vol 10(3):203-18. and Degradation of Hyperforin in Aqueous Hyperforin - A Volatile Constituent Solutions and Functional Beverage. J Agric 2. Komoroski BJ, Zhang SM, Cai HB, Hutzler JM, Food Chem. 2004) 6;52(20):6156-64. Despite its strong antidepressant and Frye R, Tracy TS, Strom SC, Lehmann T, Ang anxiolytic properties, hyperforin is a very CYW, Cui YY, Venkataramanan R. Induction 5. Brockmoller J, Reum T, Bauer S, Kerb R, Hubner WD, Roots I. Hypericin and unstable compound and is degraded by and inhibition of cytochromes p450 by the St. John’s wort constituent hyperforin in human Pseudohypericin: Pharmacokinetics and light and oxygen exposure very quickly. Effects on Photosensitivity in Humans. [3],[4] hepatocyte cultures. Drug Metabolism and Therefore, hyperforin is often not used Distribution (2004). Vol32(5): 512-518. Pharmacopsychiatry (1997). Vol30: 94-101. 32 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com Clinical FOCUS

Enzyme Supplements: Benefit or Burden? nzyme supplements are commonly formula, it not only defeats the purpose Eused to aid in digestive issues and of including fibre but also increases Vita Aid Featured Enzyme food allergies, as well as in inflammatory glucose uptake. Supplements conditions and to promote fibrin Supreme Zyme-Aid Extra Fort Which Enzymes Should Be Used for breakdown. Food Intolerances? ᐤᐤ Does NOT contain Cellulase However, not all enzyme supplements ᐤᐤ Contains a spectrum of proteases Food intolerances are mostly due to are beneficial - and used incorrectly, (work in different pH and insufficiency of digestive enzymes to they can become a burden on the body. breakdown different proteins) break down certain food components, ᐤᐤ Includes efficacious dosage of Cellulase - Do we really need it? commonly lactose and complex branch alpha- & beta-galactosidase to Cellulase is an essential enzyme found carbohydrates with alpha-galactoside help food intolerance symptoms in herbivores to break down crude fibre chain (bean and yam). The symptoms from complex carbohydrates (ie. beans, sweet potatoes/yams) into glucose. Unlike herbivores, humans of intolerance typically occur within and lactose consumptions. DO NOT produce cellulase because we 1-2 hours after ingestion, and include ᐤ Indicated for individuals with do not utilize cellulose as our energy flatulence, bloating, cramping and/ ᐤ multiple food sensitivities source; rather, we need cellulose or diarrhea. Unlike food sensitivities, intact in our digestive tract to help food intolerance symptoms are limited Optizyme bulk our stools and prevent any toxic to within the GI tract and pose less of ᐤᐤ Includes full-spectrum, high reabsorption. As a matter of fact, long- a systemic concern. Alpha- & beta- potency enzymes to address various digestion issues term use of cellulase not only provides galactosidase (lactase) are two of the little benefit but can also cause extra more common enzyme deficiencies; ᐤᐤ Indicated for individuals with loading of sugars in the gut by breaking therefore, when choosing an enzyme multiple food sensitivities, food intolerances, and malabsorption. down cellulose into glucose. Choosing product for food intolerances, these 2 an enzyme product containing cellulase enzymes should be included. Nattozimes would only be practical for individuals Proteases Help Reduce Food Systemic protease that exerts who are malnourished/ underweight Sensitivities fibrinolytic activity to help clean or consume a lot of fibre in their diet up abnormal clot formations and Food sensitivities or allergies are damaged tissue debris caused by causing them to have GI upsets. induced by particular compounds - inflammation and oxidative stress. Enzymes + Probiotics + Fibre = commonly proteins - that provoke an Additive Effect for GI Health?? immune response. Food allergies Including many GI-beneficial ingredients can be mediated IgE, IgG, and IgA, in one product may sound quite which can cause oxidative stress and appealing; however, we have to consider consequently systemic inflammation. the possible interactions between these Symptoms of food sensitivities can ingredients. We CANNOT assume that occur from within minutes (IgE) up to the digestive enzymes would not affect 72 hours (IgG, IgA) after ingestion, the viability of probiotics. As for including and may include skin rashes, fatigue, both fibre and cellulase in the same brain fog, migraine, muscle/joint aches, 33 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com and GI discomforts. In these cases, Systemic breakdown of pro- able to break down gluten in your gut proteases are useful in reducing and inflammatory debris from damaged to help Celiac patients or those with preventing hypersensitivities, leaky gut, tissues in the blood stream - ie. fibrins - gluten-sensitivity. However, DDP-4 and inflammation by breaking down the that may cause secondary inflammation is also known to break down incretin; allergens. and promote scar tissue formation & incretin is a gastrointestinal hormone calcification of tissues. responsible for stimulating insulin Proteases Can Function as Anti- release and inhibiting glucagon release inflammatory Agents Supplementing a broad spectrum of digestive & systemic proteases in our body. Therefore, supplementing Protein digestive enzymes, such as DDP-4 can potentially be a problem nattokinase, serrapeptidase, bromelain, can be used to treat many types of inflammation, including both systemic in obese, PCOS, and/or diabetic and other digestive proteases, can patients. In fact, DDP-4 inhibitor is a potentially yield anti-inflammatory (eg. autoimmune diseases) or localized (eg. osteoarthritis) conditions. category of drug for the treatment of benefits via two main mechanisms: type 2 diabetes mellitus. Local breakdown of pro-inflammatory DPP-4 (Dipeptidyl Peptidase IV) allergens in the GI tract into amino breaks down Gluten, BUT it can also acids or small peptides to prevent leaky potentially induce Hyperglycemia gut syndrome & systemic inflammatory DDP-4 is a recently emerged reaction. supplemental enzyme claimed to be

Ingredient FOCUS

A Critical Look at Curcumin’s Bioavailability

urcumin is one of the darling of the modified curcumin with pure (blood levels) and pharmacodynamics Cingredients in natural medicine thanks turmeric powder and demonstrated great (clinical effects) cannot simply be to its multiple indications. However, low discrepancies in the bioavailability. correlated because of the extensive bioavailability has always been a concern. bio-transformation of curcumin in the The terms - curcumin and pure Therefore, different modified forms of intestine and liver. turmeric powder - have often been curcumin have been developed to help used interchangeably. However, In other words, just because the remediate the poor bioavailability. a standardized curcumin isolate blood levels of specific metabolites of That being said, some “fuzzy mathematics (commonly 95% curcuminoids, 50:1 curcumin - eg. demethoxycurcumin and and comparisons” are involved in these extraction) is NOT equivalent to bisdemethoxycurcumin - are higher does modifications’ claimed enhancements, pure turmeric powder. Pure turmeric NOT indicate one form is clinically more and all of these modifications have never powder, on average, contains only ~3% effective than the other. been compared head-to-head. Plus, a few of curcumin. [1] For that reason, when a Another factor often not taken into other important parameters, such as cost- modified curcumin form is said to have > account is curcumin’s possible effectiveness and interactions with other 30 times the bioavailability of the turmeric interactions with other ingredients ingredients/foods, have not been brought powder, we should start wondering if the and/or foods. For example, 20 mg of to attention. modified curcumin is simply equivalent to piperine from black pepper has been the isolated curcumin form. Now, let’s take a closer look at Curcumin. shown to increase the bioavailability What really happens to curcumin in the of curcumin by 2000% (ie. enhanced Turmeric Powder is NOT equivalent to body? serum level of curcumin + decreased Curcumin clearance of curcumin).[2] The relationship between blood levels Some pharmacokinetic studies have of curcumin and its clinical effects has Types of modifications made to compared the serum curcumin levels yet to be studied. Pharmacokinetics enhance curcumin’s bioavailability 34 TherapeuticFOCUS Volume 3 Issued by: Vita Aid® Professional Therapeutics www.vitaaid.com There are currently 3 major modified forms Should cost-effectiveness be the in the market: determining factor? Vita Aid’s Verlusan+ supplies: TM 1. Phospholipids-modified form: By From what has been discussed so far, the ᐤᐤ Daily 1000 mg of Perluxan - embedding curcumin into phospholipids, following conclusions can be drawn: the supercritical CO2-extracted it allows the rapid exchange of hops; lab-tested to contain non- ᐤᐤ Pure turmeric powder (contains ~3% detectable amount of estrogenic phospholipids between biological pure curcumin) is NOT equivalent to and sedative constituents. membranes and the extracellular fluids, standardized curcumin isolate (95%, boosting curcumin’s cellular capitation. ᐤᐤ Boswellia (360 mg/day) - The 50:1). This has been shown to increase total resinous boswellic acids have been shown to provide anti- serum curcuminoids ~7 times more ᐤᐤ The correlation between inflammatory, anti-arthritic and than standardized curcumin isolate. Pharmacokinetic (blood levels) and analgesic activity and significantly (Each 100 mg of phospholipid-modified Pharmcodynamic (clinical effect) of lower the total WBC count in the each form of curcumin has yet to be curcumin contains 18-20 mg (18-20%) joint fluid. of curcumin & 80-82 mg (80-82%) of determined. phospholipids.) ᐤᐤ Curcumin isolate (1200 mg/day) ᐤᐤ Adding 20 mg piperine to curcumin can & Rosemary (90 mg/day) - anti- 2. Fine-granulation & suspension increase its bioavailability by 2000% inflammatory and anti-oxidative technology: finer particles & (20 fold). effects. suspension = increased dispersing ᐤᐤ Research has yet to show any modified ᐤᐤ Enhanced bioavailability by the and permeating rate of curcumin. This form of curcumin to be more effective addition of Bioperine® (piperine has been shown to increase serum than the standardized curcumin isolate from black pepper). curcumin ~27 times more than non- or one another in a clinical setting. standardized curcumin powder. (Each 100 mg of fine-granules contains Modified forms of curcumin are generally 10 mg (10%) of curcumin & 90 mg 5-10 times more expensive than the (90%) non-medicinal carrier) standardized curcumin isolate because they only contain 10-20% of pure 3. Reduced form: the reductase system curcumin (as shown above) with the at the cellular level converts the other 80-90% being the modifying curcumin to tetrahydrocurcumin. In agents. other words, tetrahydrocurcumin is Reference: an active metabolite of the curcumin Therefore, when choosing the right 1. Tayyem RF, Heath DD, Al-Delaimy WK, Rock (2x more potent than curcumin). curcumin product for your patients, it really comes down to cost-effectiveness (based CL. Curcumin content of turmeric and curry (Curcumin may not show up in the powders. Nutr Cancer. 2006;55(2):126-31. blood) on dosage) and the clinical outcomes. 2. Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS. Influence of Whether one form is clinically more piperine on the pharmacokinetics of curcumin effective than the others has yet to be in animals and human volunteers. Planta studied and determined. Med. 1998 May;64(4):353-6.

SYNERPLEX Top Choice of TCM Formula for Your Practice Traditional Chinese Formulas with Western Pharmaceutical Standards

»» Special extraction and granulation technique; the activity of medicinal ingredients does not involve carriers such as corn starch/ »» Fully follows the extraction process of the Traditional maltodextrin often used as diluting agents. Chinese herbal pharmacy, all herbs are prepared »» Highly concentrated 8 : 1 extraction ratio, into proper ratios and are decocted and extracted meaning that fewer capsules are needed to reach together to enhance synergism and natural effective dosage. chelation between the herbs. »» Made in Canada by NHPD-GMP site licence holder and all products are licensed with NPNs. »» Tested by 3rd party independent and in-house laboratory for heavy metals and pesticides. Kosher Ceritified raw materials. »» Free of processed excipients such as magnesium stearate, or microcyrstalline cellulose. Instead, certified organic apple fibreis the only non- medicinal ingredient used as filler in a capsule. »» Low temperature extraction technique to preserve

35 TherapeuticFOCUS Volume 3 Issued by: Vita Aid ® Professional Therapeutics www.vitaaid.com

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