Supplements under

the microscope
An evidence-based guide to what
works and what doesn’t
2 Coenzyme Q10
4 Astaxanthin
6 Krill oil
8 Chlorella
10 Spirulina
11 Emu oil
13 Cetylated fatty acids
15 Serrapeptase
17 Natural slimming supplements
21 Conjugated linoleic acid
23 Colloidal silver
24 Glyconutrients
26 Aloe vera
27 Bee propolis
29 Rhodiola rosea
31 Butterbur
33 Milk thistle

WDDTY
publication

WWW.WDDTY.COM
Coenzyme Q10
As the use of this
supplement grows in
popularity, do the
impressive claims stack
up?
ccording to a survey by
A ConsumerLab.com, an inde-
pendent lab that tests health and
nutrition products, coenzyme Q10
(CoQ10) is now the third most popular
dietary supplement in the US—after
omega-3 supplements in the number-
one slot and multivitamins at number
two. A massive 55 per cent of the more
than 6000 respondents reported using
CoQ10, up from 50.9 per cent last year.
Given the impressive claims for the
nutrient, it’s not surprising that it’s so
popular. It’s long been famous for its
heart-health benefits, but CoQ10 is
also purported to boost energy, reduce
migraines, aid weight loss, heal
periodontal (gum) disease, counteract
infertility and slow the development of
Parkinson’s.
So, should CoQ10 be a staple sup-
plement for all of us?
What is CoQ10?
CoQ10, also called ‘ubiquinone’, is a
vitamin-like compound found in
practically every cell of the human
body, but especially in the heart. Since
its discovery and isolation over 50
years ago, hundreds of studies have
been carried out on it, and it’s now
clear that this nutrient is absolutely
vital to health. Not only does it play a
crucial role in the production of
adenosine triphosphate (ATP), the
body’s major form of stored energy,
but it’s also a powerful antioxidant—
with a free-radical-fighting ability 50
times greater than that of vitamin E.
Research shows that the tissues and
blood of an adult human contain a
total of around 2000 mg of CoQ10,
while 500 mg/day is required to
maintain this body pool. The average
diet provides barely 5 mg/day, so the
rest has to be synthesized internally.
However, our ability to synthesize
CoQ10 appears to decline with age and
when we are ill or stressed. Indeed, low
CoQ10 levels have been found in a wide
range of medical conditions, including
2 WDDTY Supplements under the microscope
heart disease, hypertension (high
blood pressure), gum disease and
acquired immunodeficiency syndrome
(AIDS) (Altern Med Rev, 1996; 1: 11–7). This
may explain why supplementing
with CoQ10—shown to
raise tissue levels of
the nutrient—appears
to be beneficial for a
wide diversity of health
problems.
What does it do?
Much of the research into CoQ10
supplementation has been for heart-
related problems, so there’s now an
impressive body of research showing more effective than a placebo for
that the nutrient is invaluable for reducing the frequency of attacks,
patients with cardiomyopathy (heart and the number of days with head-
muscle dysfunction), congestive heart ache and/or nausea (Neurology, 2005;
failure, angina and hypertension, and 64: 713–5).
for those undergoing heart surgery u Male infertility. CoQ10 may play an
(Altern Med Rev, 1996; 1: 168–75). But important role in sperm quality,
CoQ10’s benefits go far beyond heart with low levels having an adverse
health, as the latest findings suggest. effect on both sperm counts and
u Migraines. A recent study of more motility (movement), which can
than 1500 young migraine sufferers have a negative impact on fertility
(aged 3–22 years) found that one- (J Endocrinol Invest, 2009; 32: 626–32).
third had abnormally low CoQ10 Recently, scientists have begun to
levels. These patients were asked to investigate whether oral CoQ10
take liquid gel capsules of CoQ10 supplements improve sperm
at a dose of 1–3 mg/kg/day to see if quality in infertile men. When 60
their headaches improved. After men with infertility due to
three months, as the patients’ asthenozoospermia—poor sperm
CoQ10 levels increased, their head- motility—were given 200 mg/day of
ache frequency decreased (Headache, CoQ10 or a placebo for six months,
2007; 47: 73–80). levels of CoQ10 were significantly
In another, randomized control- increased in the patients’ sperm,
led trial, CoQ10 at 100 mg three while sperm motility was improved.
times a day was well tolerated and What’s more, of nine pregnancies
Dosage and safety
In adults, the dosage of coenzyme Q10 is usually 30–90 mg/day, although
people with specific health conditions should perhaps supplement with
larger doses (but only with the guidance of a qualified practitioner). Most of
the research on heart conditions has used 90–150 mg/day of CoQ10.
Studies also suggest that solubilized formulations of CoQ10 (using either
ubiquinone, the oxidized form, or ubiquinol, the reduced form) are the most
bioavailable—in other words, they are readily taken up by the body to be put
to use (Mitochondrion, 2007; 7 Suppl: S78–88).
CoQ10 causes no serious adverse effects in humans (Expert Opin Investig
Drugs, 2010; 19: 535–54), although minor side-effects have included nausea,
heartburn and stomach upset.
 that occurred during the study, six
were by men treated with CoQ10
(Fertil Steril, 2009; 91: 1785–92).
u Parkinson’s disease. CoQ10 may
also be a ray of hope in Parkinson’s
and other neurodegenerative dis-
orders. When 80 patients with early
Parkinson’s were randomly assigned
to receive CoQ10 at a dose of 300,
600 or 1200 mg/day, or a
placebo, after 16 months,
those taking the placebo
showed a slight progression
of their disease, whereas all
of those taking CoQ10 saw
less disease progression. This
was most striking in those taking
the highest dosage, who
experienced 44-per-cent less
disability due to their symptoms
(Arch Neurol, 2002; 59: 1541–50).
Preliminary evidence also shows
that CoQ10 supplements might be
able to slow the decline of patients
with Huntington’s disease and
Friedreich’s ataxia (Neuropsychiatr Dis
Treat, 2009; 5: 597–610).
u Gum disease. CoQ10 may be help-
ful for periodontal disease, which
affects around 60 per cent of young
adults and 90 per cent of those over
age 65. Low CoQ10 levels have been
reported in as much as 96 per cent
of patients with the problem, so
supplementation may be beneficial
in most cases. When 18 patients
with gum disease took either 50
mg/day of CoQ10 or a placebo in
a three-week double-blind trial, all
eight of those taking CoQ10
improved compared with only three
of the 10 taking the placebo. The
dentists, who did not know they
were in a study, consistently noted
that the rate of healing in patients
treated with CoQ10 was “very
impressive” (Altern Med Rev, 1996; 1:
11–7).
u Obesity. The tendency towards being
overweight is, in some people,
related to energy production. As
CoQ10 is an essential cofactor in
energy production, it’s been
suggested that CoQ10 deficiency
might be involved in some cases of
obesity. Indeed, a study of 27 obese
patients found that half had low
CoQ10 levels. When five of these
deficient patients took 100 mg/day
of CoQ10 with a daily diet of 650
calories, all lost more than twice as
much weight as those who were not
low in CoQ10 and on the same
diet–supplement protocol (Altern Med
Rev, 1996; 1: 11–7).
However, another study found no
differences between CoQ10 levels in
obese and normal-weight children
(Clin Chim Acta, 2004; 349: 121–7).
Evidently, more research is needed
to evaluate the precise role of
CoQ10 in obesity.
u Chronic fatigue syndrome (CFS).
Belgian researchers found that
almost half of their CFS patients
were CoQ10-deficient, and that
there was a significant relationship
between CoQ10 levels and patients’
symptoms. Those with the lowest
levels reported more fatigue, and
concentration and memory distur-
bances (Neuro Endocrinol Lett, 2009; 30:
470–6). However, it’s not clear that
CoQ10 supplements would work in
CFS patients, although one study
found that 100 mg/day for three
months improved exercise tolerance
in 20 women with CFS compared
with 20 non-CFS controls. Moreover,
90 per cent saw a reduction or even
disappearance of clinical symptoms,
while 85 per cent showed less post-
exercise fatigue (Altern Med Rev, 2000; 5:
93–108).
u Cancer. So far, evidence suggests
that CoQ10 might help people with
cancer. In one study, 32 women
classified as having a ‘high risk’ of
breast cancer were given 90 mg/day
of CoQ10, to be taken with other
antioxidants (vitamins C and E,
beta-carotene and selenium) and
essential fatty acids. During the 18-
month treatment period, the main
observations were: (1) no patients
died (the expected number was
four); (2) no patients showed signs
of further metastases (spread); (3)
quality of life was improved (no
weight loss, less use of painkillers);
and (4) six patients saw a partial
remission of their cancer (Mol Aspects
Med, 1994; 15 Suppl: s231–40).
Also, in the case of a 49-year-old
woman with breast cancer that had
spread to around the lungs, after six
months of high-dose CoQ10 therapy
(390 mg/day), there were no signs
of tumour in the pleural cavity, and
her condition was reported to be
“excellent” (Biochem Biophys Res
Commun, 1995; 212: 172–7).
WDDTY Supplements under the microscope 3
More recently, a pilot study
looked at the survival of 41 patients
with end-stage cancer who were
given supplements of CoQ10 and
other antioxidants. Their average
survival time was 40-per-cent longer
than the average predicted survival
time. In total, 76 per cent of the
patients survived for longer than
predicted (J Int Med Res, 2009; 37:
1961–71).
However, until the next stage of
controlled trials are done, we can’t
really tell whether or not CoQ10 is
truly an effective anticancer agent—
although the results so far are
promising.
CoQ10 for all?
Clearly, CoQ10 appears to be useful in
a wide variety of common conditions,
and the list is by no means complete.
The people most likely to benefit are
those who are deficient in the nutrient.
As CoQ10 plays a vital role in the body,
not getting enough is likely to have
detrimental effects.
Nevertheless, it’s unclear whether
CoQ10 supplements are of any benefit
in healthy people. Although one recent
trial found that CoQ10 at 100 mg/day
improved exercise performance in
healthy, sedentary men (J Strength Cond
Res, 2010; 24: 97–102), another found that
the nutrient (150 mg/day, with or
without 1000 IU/day of vitamin E) had
no performance-enhancing effects in
healthy, physically active men (J Sports
Med Phys Fitness, 2005; 45: 337–46).
Also, in mouse studies, while some
of the findings suggest that CoQ10
may play a significant anti-ageing
function—apparently prolonging life
by reducing oxidative stress—others
have failed to show any such effects
(Free Radic Biol Med, 2006; 40: 480–7).
Indeed, one study even found that the
long-term intake of high-dose CoQ10
made the age-related cognitive and
sensory impairment in these animals
worse (J Nutr, 2009; 139: 1926–32). Of
course, these results may not apply to
humans.
There’s no doubt that more studies
are needed to ascertain the role of
CoQ10 supplementation. So far,
however, it appears to be a potentially
useful supplement for many of us—
and one that actually appears to live
up to (most of) its claims.
Joanna Evans
 Astaxanthin
Although it’s
still early
days, there’s
evidence
that this
antioxidant
from the sea
may well do
all it claims
to

little-known pigment from the

A bottom of the ocean is making

waves in the supplement world
due to its alleged anti-ageing
properties. Astaxanthin, a dark-red
pigment produced by microscopic
algae, is being touted as a ‘super
antioxidant’ and the answer to
everything from wrinkles to dementia
to failing eyesight. But does the science
stack up?
What is astaxanthin?
Astaxanthin is a member of the
carotenoid family and a close relative of
the more familiar beta-carotene and
lutein. The most abundant natural
source of astaxanthin is the marine
microalgae Haematococcus pluvialis,
but it’s also found in a variety of
seafood, including salmon, shrimp,
100-fold higher than that of vitamin E key roles in ageing (Mech Ageing Dev, 2004;
(Pure Appl Chem, 1991; 63: 141–6). 125: 811–26), a growing number of
These antioxidant capabilities, supplement suppliers and man-
coupled with its ability to cross the ufacturers are promoting astaxanthin
blood–brain barrier (Pharmacol Biochem as an anti-ageing ‘super nutrient’.
Behav, 2011 May 17; Epub ahead of print),
make astaxanthin an ideal candidate
for the prevention and treatment of a
The scientific evidence
range of diseases and conditions. In
Numerous studies, including several
clinical trials, show that the nutrient
particular, as free-radical formation
may be beneficial for a variety of
and oxidative stress are thought to play
conditions associated with ageing.
Other benefits
Infertility. In a double-blind randomized controlled trial (RCT), 30 men with
u
infertility were given either 16 mg/day of astaxanthin or a placebo for three months.

At the end of the study, sperm quality improved in the astaxanthin group, but not in
lobster and crab—where it’s

the placebo group. Moreover, more than half of the astaxanthin group’s partners
responsible for their distinctive pink

became pregnant during the trial, while only 10 per cent of the placebo group’s
hue.

partners achieved pregnancy (Asian J Androl, 2005; 7: 257–62).

Being a carotenoid, astaxanthin is a

Heart health. In another RCT, astaxanthin was given in doses of 0, 6, 12 and 18 mg

powerful antioxidant—a molecule that
u
per day for three months to healthy adults.Those taking astaxanthin—at any dose—
can protect cells against damage

saw their triglyceride (a type of fat) levels decrease and their high-density lipoprotein
caused by unstable molecules known as

(HDL or ‘good’) cholesterol increase (Atherosclerosis, 2010; 209: 520–3).

‘free radicals’. However, unlike other

Reflux.A high dose of astaxanthin (40 mg/day) significantly reduced reflux symptoms
carotenoids, which can show potentially
u
in people with dyspepsia (indigestion) after four weeks. The effect was particularly
damaging pro-oxidative properties

pronounced in those with Helicobacter pylori infection, which is commonly associated

under certain conditions (for example,

with dyspepsia (Phytomedicine, 2008; 15: 391–9).

if other antioxidants are lacking),

Cancer.Although the results may not apply to humans, astaxanthin showed cancer-
astaxanthin is a ‘pure antioxidant’
u
preventative effects in a mouse model of bladder cancer (Carcinogenesis, 1994; 15: 15–9).
(Biosci Biotechnol Biochem, 2009; 73: 1928–32).

Also promising were the findings of a test-tube study showing that astaxanthin can
Studies demonstrate that asta-

inhibit the growth of human colon cancer cells (Cancer Lett, 2009; 283: 108–17).
xanthin’s antioxidant ability surpasses

Exercise/sports performance. A study of healthy male adult volunteers taking

that of other carotenoids such as beta-
u
6 mg/day of astaxanthin for four weeks suggests that the supplement can improve
catotene, lycopene and lutein, as well as

visual acuity and muscle fatigue, which may lead to sports performance benefits (J Clin
vitamin E (J Agric Food Chem, 2000, 48:

Ther Med, 2002; 18: 1085–100).

1150–4). In neutralizing singlet oxygen,
a highly reactive oxygen compound,
astaxanthin has a potency more than

4 WDDTY Supplements under the microscope

u Dementia. A Japanese study found
that astaxanthin can reduce the
buildup of compounds called
‘phospholipid hydroperoxides’
(PLOOH), which are known to
accumulate abnormally in the red
blood cells (erythrocytes) of people
with dementia. In this randomized
double-blind trial, 30 healthy volun-
teers aged 50–69 years were given
an astaxanthin supplement (6 or 12
mg) or a placebo pill every
day for 12 weeks. The results showed
that PLOOH levels in erythrocytes
declined by 40 and 50 per cent with
6 and 12 mg of astaxanthin,
respectively, whereas there was no
change with the placebo. The
researchers concluded that
astaxanthin “may contribute to the
prevention of dementia” (Br J Nutr,
2011; Jan 31: 1–9; Epub ahead of print).
Another study—albeit a enzyme trigged by UVA exposure.
preliminary investigation—found
that astaxanthin supplements may
be useful for age-related
forgetfulness and cognitive decline
(J Clin Biochem Nutr, 2009; 44: 280–4).
u Poor eyesight. In a trial published in
the Japanese journal Medical
Consultation & New Remedies,
astaxanthin (6 mg/day) was given to
22 middle-aged and older people
with signs of presbyopia—where the
lens of the eye loses its ability to
focus (known as ‘accommodation’),
making it difficult to see objects up
close. The researchers found a
significant improvement in eye
accommodation ability after
astaxanthin supplementation for
four weeks (Med Consult N Rem, 2009; 46:
89–93). However, it should be borne
in mind that the study was
sponsored by Fuji Chemical Industry
(FCI), the company that
manufactures the astaxanthin
supplement AstaReal.
Another trial—a year-long Italian
study—reported that taking 4 mg of
astaxanthin daily in combination
with other carotenoids and
antioxidants (180 mg of vitamin C,
30 mg of vitamin E, 22.5 mg of zinc,
1 mg of copper, 10 mg of lutein and
1 mg of zeaxanthin) improved visual
function in patients with age-related
macular degeneration (Ophthalmology,
2008; 115: 324–33.e2).
u Skin ageing. Several studies show
that astaxanthin offers natural
protection against the sun’s harmful
ultraviolet (UV) rays, which are the
number-one cause of premature
skin ageing. A recent test-tube study
reported that astaxanthin displayed
superior protective effects against
UVA-induced oxidative damage in
human skin cells compared with the
carotenoids canthaxanthin and
beta-carotene (Exp Dermatol, 2009; 18:
222–31). Another laboratory study
revealed that astaxanthin slows the
increased production of the
collagen enzyme matrix-
metalloproteinase-1 (MMP-1) and
skin fibroblast elastase (SFE)
As these enzymes break down skin
collagen, elastin fibres and
connective tissue, the researchers
hypothesized that astaxanthin
might offer significant protection
against skin sagging and wrinkling
(J Dermatol Sci, 2010; 58: 136–42).
Even more exciting, clinical trials
suggest that taking astaxanthin may
actually improve the condition of
the skin. In a double-blind study
funded by FCI, 16 women with dry
skin, aged around 40 years, were
split into two groups. One received a
daily supplement containing 2 mg of
astaxanthin and 40 mg of
tocotrienol (vitamin E), while the
other received a placebo capsule
containing canola oil.
After just two weeks, the women
in the test group saw numerous
improvements in their skin’s
condition, including fewer wrinkles,
better moisture and elasticity, a
smoother surface, and less under-
eye darkness and flabbiness. The
results were even better after four
weeks, with various skin
measurements showing a one of the best supplements around to
statistically significant change
compared with the control group
(Food Style 21, 2002; 6: 112–7).
WDDTY Supplements under the microscope 5
A more recent study by FCI using
a larger sample size (49 American
women) investigated the effects of
astaxanthin alone (4 mg daily) on
skin condition. After six weeks,
marked improvements were again
noted in the astaxanthin group
compared with the placebo group,
including a significant improvement
in elasticity and fine lines/wrinkles,
as assessed by a dermatologist
(Carotenoid Sci, 2006; 10: 91–5).
Small dose, big benefits
Besides these promising anti-ageing
benefits, astaxanthin may also be able
to prevent cancer, boost fertility and
improve heart health (see box, page 4).
However, much larger clinical trials are
needed, particularly ones that examine
the long-term safety of consuming
astaxanthin on a daily basis.
Nevertheless, so far there have been no
reports of adverse effects, and studies
have used oral astaxanthin at dosages
ranging from 1.8 mg to 100 mg per
day, administered from a single dose up
to daily dosing for a year (Mar Drugs, 2011;
9: 447–65).
What’s more, a human safety study
concluded that 6 mg/day of
astaxanthin—extracted from H.
pluvialis—is safe for healthy adults (J
Med Food, 2003; 6: 51–6).
If you do wish to try it, make sure
you choose a natural astaxanthin
supplement from an unpolluted source
of the microalgae, such as Higher
Nature’s AstaPure Timeless Beauty
(£15.95 for 30 4-mg gel capsules;
www.highernature. co.uk).
The usual dose of astaxanthin is 2–4
mg/day and, as it’s fat-soluble, it
appears to be absorbed best when
taken after a fat-containing meal (Biosci
Biotechnol Biochem, 2009; 73: 1928–32). In
general, it’s recommended to take it
with a dietary source of healthy fats,
such as olive or flaxseed oil.
When combined with a healthy diet
and lifestyle, astaxanthin may well be
help delay those dreaded signs of
ageing.
Joanna Evans
Krill oil
Is the oil of this shrimp-like plankton really better than
fish oil?
rill oil is the fastest growing
K product in the omega-3
market, with reported sales of
over $100 million last year. Extracted
from tiny shrimp-like zooplankton
crustaceans (with the scientific name
of Euphausia superba) that live at
the bottom of the world’s coldest
oceans, krill oil is sold as premium-
priced capsules with claims that it’s
superior to fish oil as a source of
omega-3s.
Like fish oil, krill oil contains the
omega-3 fatty acids eicosapentaenoic
acid (EPA) and docosahexaenoic acid
(DHA), famous for their heart-healthy
and brain-boosting properties. But
these fats are supposedly better
absorbed from krill oil. Krill oil also
contains potent antioxidants that,
proponents claim, give it the edge over
fish oil. Other purported advantages of
krill oil are that it’s pollution-free and
comes with no fishy aftertaste.
Numerous websites are now promoting
krill oil as the ‘ultimate’ source of
omega-3s.
Let’s take a closer look at krill oil
and see if the claims really do stack up.
Better bioavailability
The research into krill oil is still in its
infancy but, so far, studies suggest
that it may well be a superior source
of omega-3 fatty acids.
For starters, while fish oil contains
omega-3 fats in triglyceride form, a
significant proportion of the omega-3
found in krill oil is in the form of
phospholipids—fat-like molecules
that deliver the fatty acids directly to
the body’s cells. Animal and human
studies show that phospholipid-
bound fatty acids have better
absorption and delivery to the brain
compared with triglyceride-bound
fatty acids.
In one primate study, twice as
many phospholipid-bound fatty acids
accumulated in the brain compared
with triglyceride-bound fatty acids
(Pediatr Res, 2002; 51: 265–72). In another
animal (pig) study, phospholipid-
bound fatty acids increased brain
6 WDDTY Supplements under the microscope
DHA levels more than did fish oil
(Lipids, 1999; 34: 5–16).
In a human trial, daily doses of
216 mg EPA and 90 mg DHA from
krill oil provided greater fatty-acid
increases than did daily doses of 212
mg EPA and 178 mg DHA derived
from fish oil. At the end of the four-
week study, average blood levels of
EPA were 377 µmol/L in the krill-oil
group and 293 µmol/L in the fish-oil
group. And although the krill oil
supplement provided just half as
much DHA as the fish oil, average
blood levels of DHA were around the
same in both groups—476 µmol/L in
the krill-oil group and 478 µmol/L in
the fish-oil group (Nutr Res, 2009; 29:
609–15).
Another study in humans
compared the bioavailability of
omega-3s from krill and fish oils
providing almost identical doses of
EPA and DHA. Although the results
were not statistically significant, the
study found that krill oil consump-
tion was associated with the highest
levels of EPA and DHA in the blood,
again suggesting better bioavailablity
compared with fish oil (Lipids Health Dis,
2011; 10: 145).
Krill-oil proponents point out that,
because omega-3s from krill oil are
better absorbed, less is needed for a
beneficial effect.
Natural antioxidants
Another difference between krill and
fish oils is that krill oil is naturally
rich in antioxidants, including
vitamins A and E, and the carotenoid
astaxanthin (Altern Med Rev, 2003; 8:
171–9). These free-radical fighters
provide the omega-3 fatty acids with
natural protection against oxidation,
so no additives are needed to
maintain krill oil’s stability. In
contrast, fish oil commonly contains
added antioxidants to prevent it from
going rancid during production and
on the shelf.
The natural antioxidants in krill
oil may also offer additional health
benefits. Astaxanthin, for example,
has a potency more than 100-fold
higher than vitamin E, and is
showing promise for dementia,
infertility, vision problems and
ageing skin (for more information,
see WDDTY vol 22 no 4).
Krill oil’s antioxidant content
might explain why the supplement
has outperformed fish oil in terms of
health effects in a couple of
preliminary trials.
Proven benefits
One particular brand of krill oil—
Neptune Krill Oil (NKO)—has been
put to the test in a handful of
clinical trials. One, a double-blind
randomized controlled trial,
compared the effects of NKO and fish
oil in 70 healthy women suffering
from premenstrual syndrome (PMS).
For 30 days, half the women took 2
g/day of krill oil while the other half
took 2 g/day of fish oil. Following
this, they took the supplements for
just 10 days per month over the next
two months. Over this period, the
women tracked their mental
and physical symptoms on a
questionnaire developed by the
American College of Obstetrics and
Gynecology.
At the end of the study, the results
revealed that both groups improved
in weight, abdominal discomfort and
swelling, but only the krill-oil group
saw statistically significant
improvements in breast tenderness,
feelings of inadequacy, stress,
irritability, depression, joint
discomfort and bloating. Moreover,
the krill-oil group reported greater
improvements in alertness, energy
and well-being, and took significantly
less analgesic medication around the
time of their period compared with
the fish-oil group. The researchers
also noted that “[p]atients taking
 and functional impairment (J Am Coll
Nutr, 2007; 26: 39–48).
Although the study didn’t
compare krill and fish oils, fish oil
has failed to lower CRP in at least
four separate studies (Altern Med Rev,
2007; 12: 207–27).

The bottom line

Unlike many much-hyped
supplements, krill oil actually has a
reasonable amount of science behind
it, including studies that appear to
support the impressive claims being
made for it. However, it’s still early
days, and it would be useful to have
some independent, non-
manufacturer-led clinical studies of
krill oil to rule out any potential
biases.
NKO did not experience any
Also lacking is any research on
gastrointestinal difficulties such as
3 g/day failed to provide any pollution levels in krill oil. Although
regurgitation, while 64 per cent of
additional benefit vs 2 g/day. In proponents claim that krill oil is free
the women in the fish oil group
contrast, the fish oil lowered of the contaminants that are
complained of unpleasant reflux”
cholesterol only marginally and failed sometimes associated with low-
(Altern Med Rev, 2003; 8: 171–9).
to reduce triglycerides below quality fish oil, such as mercury and
Another randomized controlled
baseline values (Altern Med Rev, 2004; 9: polychlorinated biphenyls (PCBs),
trial compared the effects of NKO,
420–8). there don’t appear to be any
fish oil and a placebo on blood lipids
In another trial, NKO was tested scientific studies of the subjcct.
(fats) in 120 patients with
against placebo for its anti- According to the NKO website, the
hyperlipidaemia (abnormally high
inflammatory effects. Ninety patients fact that krill is at the bottom of the
levels of blood lipids). In this 90-day
with cardiovascular disease, food chain means that it doesn’t
trial, two groups received krill oil at
rheumatoid arthritis and/or accumulate as many toxins and heavy
either 1–1.5 g/day or 2–3 g/day,
osteoarthritis, along with high levels metals as fish do. “This results in a
depending on their body mass index
of C-reactive protein (CRP)—a safer and purer product than the
(BMI), while another group received
marker of systemic inflammation— standard fish oils on the market”
3 g/day of fish oil and a fourth group
were given either 300 mg/day of krill (http://neptunekrilloil.com/
received a placebo.
oil or a placebo for 30 days. By day 7, en/faq.aspx).
At the lowest dosage, krill oil
krill oil had significantly reduced Ultimately, more research is
significantly lowered total and LDL
CRP (by 19 per cent) compared with needed to settle the krill oil/fish oil
(‘bad’) cholesterol, and raised HDL
placebo (increased by 15.7 per cent). debate. But the evidence so far, not
(‘good’) cholesterol compared with
By day 30, krill oil had further to mention many happy customers,
the starting-out (baseline) levels as
reduced CRP by 30 per cent. The suggests that this may be one of the
well as vs the fish-oil and placebo
researchers also reported reduced few hyped supplements that actually
groups. At 2 g/day, krill oil also
arthritic symptoms in the krill-oil delivers.
significantly lowered triglyceride
group, including less pain, stiffness Joanna Evans
levels in addition to cholesterol, but

WDDTY Supplements under the microscope 7

Chlorella
What’s the evidence to support the
health claims made for this tiny
simple one-celled plant?
hlorella, a single-celled green
C algae from the Far East, is a
popular food supplement with
a host of purported benefits. The
most common claim is that it can rid
the body of toxic heavy metals, but it’s
also said to boost immunity, fix high
blood pressure and even fight cancer.
So, is there any science behind this so-
called wonder supplement?
Cancer claims
Although there are studies to suggest
that Chlorella may be a powerful
anticancer agent, most of them have
been in animals or test-tubes. Still, the
findings so far are promising.
In one study, Chlorella vulgaris
(CV)—one species commonly used in
supplements—was found to kill liver
cancer cells in rats. The higher the
dose, the stronger the effect, showing
that Chlorella had a “definite chemo-
preventive effect”.
The researchers reported that the
algae worked by inducing apoptosis, or
programmed cell death, which removes
damaged or ‘bad cells’ from the system.
“The results of the study could
justify the role of CV in the treatment
of thousands of liver cancer patients,
thereby opening a new door for future
research,” the study concluded (J
8 WDDTY Supplements under the microscope
Zhejiang Univ Sci B, 2009; 10: 14–21).
These results have recently been
replicated in a test-tube study of human
liver cancer cells, demonstrating that
this was not just a one-off finding (Clinics
[Sao Paulo], 2010; 65: 1371–7).
In addition to liver cancer, Chlorella
might also be useful for cancer of the
colon. A study by the Korea Institute of
Science and Technology found that
extracts of two types of the algae—C.
vulgaris and C. ellipsoidea—inhibited
the growth of human cancer cells in the
lab. Again, the higher the dose, the
greater the effect.
The scientists attributed the effects
to the “bioactive xanthophylls”—yellow
pigments belonging to the carotenoid
family—found in Chlorella that, they
concluded, “might be useful functional
ingredients in the prevention of human
cancers” (J Agric Food Chem, 2008; 56:
10521–6).
Although these studies suggest a
potential role for Chlorella in cancer
treatment and/or prevention, the
findings have yet to be replicated in
clinical trials. This means that we just
don’t know if the results would be the
same in people.
However, there is one human trial
that looked at the effects of Chlorella
supplementation in brain-cancer
patients. In this study, C. pyrenoidosa
(in the form of 20-g Sun Chlorella
tablets and 150 mL of Wakasa Gold, a
liquid Chlorella extract, both taken
daily) was added to the diet of 21
glioma patients as an adjunct to what-
ever other treatments they might have
been receiving for their brain tumours.
Although it did not significantly
increase survival time, it did appear to
boost their immune systems, increasing
levels of natural-killer cells and
lymphocytes.
“These variables were less adversely
affected by chemotherapy and the
immunosuppressive effects of
medications and protein secretions of
the tumours than would have been
expected in these patients,” the
researchers said. However, they
nevertheless highlighted the need for
controlled clinical studies to confirm
their findings (Phytother Res, 1990; 4:
220–31).
Other benefits?
A handful of other clinical trials suggest
that Chlorella may be beneficial for a
number of chronic conditions besides
cancer. The researchers responsible for
the brain cancer trial also tested the
two C. pyrenoidosa-derived products on
patients with fibromyalgia (a chronic
pain condition), hypertension (high
blood pressure) and ulcerative colitis
(an inflammatory bowel disease)—all
with encouraging results.
In the fibromyalgia study, which was
a double-blind placebo-controlled trial,
37 patients were given either a placebo
or Chlorella supplements (10 g as
tablets and 100 mL as the liquid
extract) daily for three months. After
this time, the patients were switched to
the other treatment group, and then
treated for an additional three months.
The results showed significant
improvements in symptoms when
participants used Chlorella compared
with a placebo (Altern Ther Health Med, 2001;
7: 79–91).
In the hypertension trial, 24 people
with mild-to-moderate hypertension
took a placebo for four weeks, and then
switched to the Chlorella supplements
(again, 10 g/day as tablets and 100
mL/day as liquid extract). After two
months of taking the algae, more than
a third of patients (38 per cent) showed
some improvement in their
hypertension, and one-fourth had an
excellent response, achieving their
sitting diastolic blood pressure goal of
less than 90 mmHg. Moreover, the
researchers found a significant
decrease in blood cholesterol levels (J
Med Food, 2002; 5: 141–52).
The same dosages of Chlorella
tablets and extract were trialled for a
third time in nine ulcerative colitis
patients for two months. In every single
patient, the Disease Activity Index
(DAI)—calculated from their
symptoms and a physician’s
assessment—declined over the two
months of algae supplementation. On
average, the patients’ DAIs fell from 7.2
to 2.8—a 61-per-cent drop that was
highly significant. Scores for the
emotional aspects of the disease were
also significantly improved. However,
this was not a controlled study, so we
don’t know how much the placebo
effect might have come into play (Altern
Ther Health Med, 2001; 7: 79–91).
These studies are promising, but
much more research is needed before it
can be claimed that Chlorella is
beneficial for these or any other health
conditions. It should also be pointed
out that the studies were funded by the
Sun Chlorella Corporation, the
company that makes the products used
in the trials. Nevertheless, lead
trial researcher Dr Randall Merchant,
a professor at the Virginia
Commonwealth University’s Dep-
artment of Anatomy and Neurobiology,
maintains that the company does not
influence his research or its outcomes,
and that he rigorously follows the
principles of experimental design and
analysis (Altern Complement Ther, 2001; 7:
161–5).
Detoxification
Of all the health claims for Chlorella,
the most popular one is that it can help
rid the body of environmental toxins
such as heavy metals—and there’s
convincing scientific evidence to
support this.
The unique cell-wall structure of
these algae contains compounds that
bind to and remove heavy metals such
as cadmium, lead and mercury from the
body, as well as accelerate the removal
of dangerous chlorinated hydrocarbon-
based insecticides (Townsend Lett, 2007;
287: 58–63).
In one of the earliest studies, feeding
C. protothecoides to chlordecone-
poisoned rats was found to significantly
speed up the detox process, decreasing
the half-life of the carcinogenic
insecticide from 40 to 19 days (Drug
Chem Toxicol, 1984; 7: 57–71).
In another study, researchers in
Japan fed rats highly toxic dioxins
(industrial chemicals that we’re all
widely exposed to) as part of either a
control diet or a 10-per-cent Chlorella
diet, then measured the amount of
dioxins excreted by the rats. Those fed
the algae excreted significantly more
dioxins than the controls, leading the
researchers to conclude that Chlorella
might prevent the gastrointestinal
uptake of these chemicals while
promoting the excretion of dioxins
already absorbed in the tissues (J Nutr,
1999; 129: 1731–6).
As for heavy metals, studies in mice
show that Chlorella can boost the
removal of cadmium (Nutr Res Pract, 2009;
3: 15–22), lead (Toxicol Ind Health, 2009; 25:
551–6) and mercury (J Toxicol Sci, 2010; 35:
101–5).
As the results of these animal
studies, however, do not necessarily
apply to humans, once again, clinical
trials are needed. But there is one
published study—involving 35 pregnant
women in Japan—which showed that
those who took C. pyrenoidosa
What’s in Chlorella?
According to the website www.sunchlorella.co.uk, 100 g of Sun Chlorella A
(Chlorella pyrenoidosa tablets) will provide the following nutrients (see the website
for a complete list of the ingredients).
u Chlorophyll 2700 mg
u Carotene 20,300 mcg
u Vitamin B1 1.82 mg
u Vitamin B2 4.52 mg
u Vitamin C 7 mg
u Vitamin D 479 mcg
u Vitamin E 5 mg
u Vitamin K1 1280 mcg
u Niacin 54.7 mg
u Calcium 340 mg
u Iron 120 mg
u Magnesium 330 mg
u Potassium 950 mg
u Phosphorus 1500 mg.
WDDTY Supplements under the microscope 9
supplements had significantly lower
dioxin levels in their breast milk
compared with controls.
“These results suggest that Chlorella
supplementation by the mother may
reduce transfer of dioxins to the child
through breast milk,” the researchers
reported (J Med Food, 2007; 10: 134–42).
The bottom line
In our increasingly toxic world,
Chlorella is potentially a highly useful
supplement, helping us to eliminate
harmful contaminants from our bodies.
However, the published evidence is still
limited and more research is needed
before definitive health claims can be
made.
If you do wish to try Chlorella, be
sure to choose a high-quality
supplement (such as Sun Chorella, the
brand used in the Virginia trials; see
www.sunchlorella. com), as there have
been concerns that the algae can be
contaminated by heavy metals from the
water in which it grows.
Chlorella itself appears to be non-
toxic, although minor side-effects have
been reported, including diarrhoea,
stomach cramps and nausea. There’s
also the possibility of an allergic
reaction, which can manifest as
breathing difficulties, chest pain or
hives. People taking blood-thinners
such as warfarin are advised to avoid
Chlorella, as the vitamin K in the algae
has the opposite effect of warfarin.
Joanna Evans
Spirulina
Spirulina has a host of
reported benefits, but does
it actually work?
he blue-green algae of the genus
T Arthrospira, found in the
saltwater lakes of Mexico and
Central America, is popular with
nutritionists and the health-conscious
everywhere. Often labelled ‘the world’s
healthiest food’, it’s been said to boost
immunity, promote heart health,
combat fatigue, encourage weight loss,
eliminate allergies and even protect
against cancer. Is there any truth to
these claims? WDDTY separates the
fact from the fiction.
The facts
u Nasal allergies. In a controlled
clinical trial, allergic rhinitis
patients fed spirulina had signifi-
cantly less sneezing, itching, nasal
discharge and congestion, compar-
ed with the placebo group (Eur Arch
Otorhinolaryngol, 2008; 265: 1219–23).
u High cholesterol. When the effects
of spirulina on cholesterol were
studied over 20 years ago in 30
healthy men, it was found that
4.2 g/day markedly reduced levels of
LDL (‘bad’) cholesterol after eight
weeks (Nutr Rep Int, 1988; 37: 1329–37).
Other clinical trials have reported
similar results and, in one, spirulina
not only reduced LDL cholesterol,
but also increased HDL (‘good’)
cholesterol, too (Evid Based Comple-
ment Altern Med, 2008 Sep 14; Epub ahead
of print).
u Hypertension. In 36 Mexican men
and women, taking 4.5 g/day of
spirulina for six weeks dramatically
reduced both systolic and diastolic
blood pressure, with the largest
decreases seen in the youngest
(aged 18–38 years) (Lipids Health Dis,
2007; 6: 33).
u Arsenic poisoning. This is a
common problem in developing
countries where arsenic levels in
drinking water are high. When 41
patients with this condition were
given either a placebo or spirulina
extract (250 g) plus zinc (2 g), twice
daily for 16 weeks, urine and hair
analyses found that the spirulina–
10 WDDTY Supplements under the microscope
zinc combo removed significant
quantities of arsenic from the body
(Clin Toxicol [Phila], 2006; 44: 135–41).
u Obesity. In the only trial of spirulina
for weight loss, there was a small
reduction in weight in obese people
taking 2.8 g of spirulina three times
a day. However, further studies are
needed to confirm this, and it is also
not known whether the supplement
will have the same effects in those
who aren’t so overweight (Nutr Rep
Int, 1986; 33: 565–74).
u Cancer. In one clinical trial,
researchers found that 20 out of 44
patients showed complete regress- protect the liver, especially in people
ion of leukoplakia (mouth cancer) with chronic hepatitis. However, a trial
after taking spirulina for one year of 24 patients with chronic viral
vs only 3 out of 43 taking a placebo hepatitis found that one month of
(Nutr Cancer, 1995; 24: 197–202). spirulina treatment had no significant
However, this was an “unblinded, results (Rom J Intern Med, 2002; 40: 89–94).
non-randomized trial and as such It’s also worth noting that, despite
cannot be regarded as evidence of a the widespread publicity, there’s no
positive effect” (Evid Based Complement evidence that spirulina can help in
Altern Med, 2008 Sep 14; Epub ahead of attention-deficit disorder.
print).
The bottom line
The fiction Although the spirulina studies are
Other studies show that spirulina promising, it’s still too early to say
doesn’t work for certain conditions. whether or not it can prevent or treat
Although it’s often claimed to fight any specific health problem. What’s
fatigue and boost energy, a random- more, the dosages used in most of the
ized placebo-controlled trial suggests studies were relatively high, so even if
otherwise. When four patients with it does work, you’d need to take a lot
chronic fatigue were given spirulina of it to see any benefits. Still, as
(3 g/day) for a month, it proved no dietary supplements go, spirulina is a
better than a placebo (Phytother Res, 2007; particularly rich source of proteins,
21: 570–3). However, as these results may vitamins, amino acids, minerals and
have been biased by the design of the other nutrients. This means that,
study, until more clinical studies are providing you choose a good-quality
conducted, we just don’t know. supplement, you can’t go far wrong.
Another claim is that spirulina can Joanna Evans
Is spirulina safe?
Spirulina itself appears to be non-toxic, although blue-green algae may be
naturally contaminated by highly toxic substances called ‘microcystins’,
which could make their way into health supplements. Nevertheless, a
survey by Health Canada—which tested a broad sample of blue-green
algae products available on the Canadian market—found that all spirulina
products were microcystin-free (for details, go to www.hc-sc.gc.ca/ewh-
semt/pubs/water-eau/ cyanobacter-eng.php#blue).
A genuine concern, however, is that spirulina can absorb any heavy
metals present in the water in which it grows (Nutr Rep Int, 1989; 40: 1165–72),
so make sure that you buy spirulina from a reputable manufacturer.
Emu oil
With a laundry list of claimed benefits, is there any
evidence that emu oil isn’t just snake oil?
mu oil has been called a
E “proven natural wonder” and
“one of the most exciting
alternative remedies available
today”. Rendered from the fat of
the emu—the second-largest flight-
less bird in the world, and a native
of Australia—this product is
claimed to be a powerful anti-
inflammatory, with benefits that
include easing arthritis, healing
skin wounds, lowering cholesterol
and even reversing hair loss.
But is there any science behind
this ‘miracle’ product, or is it just
snake oil?
Scientific studies
Although emu oil is purported to
benefit a long list of conditions,
there’s surprisingly little published
research on this popular natural
remedy to support such claims. The
Australian aborigines have
reportedly been using emu oil for
centuries to heal wounds, reduce
pain and relieve various muscle
disorders. However, only recently
have scientists started to take an
interest in the oil, and most of the
studies so far have been in animals.
A couple of rather cruel studies
conducted by a team of researchers
from Southern Medical University’s
Nanfang Hospital Department of
Burns in Guangzhou, China, both
found that emu oil applied topically
can promote wound healing in
scalded rats. In the first study, 30
Wistar rats with second-degree
scalding were randomly assign-ed
to receive either emu oil, povidone
iodine or liquid paraffin. The latter
two agents are commonly used in
the treatment of skin wounds.
The results showed that,
compared with povidone iodine and
liquid paraf-fin, emu oil had a faster
painkilling effect (measured by
timing how long it took the rats to
stop writhing from the pain), and
increased the rate of wound
healing.
“Emu oil can alleviate
inflammation in the scald wound
and promote wound healing in
rats,” concluded the researchers ( Di
Yi Jun Yi Da Xue Xue Bao, 2004; 24:
1255–6).
In the second study, nearly five
times as many scalded rats were
used, and emu oil was pitted
against povidone iodine and a
saline solution. Here again, emu oil
came out on top. The rats treated
with emu oil had significantly
shorter wound-healing times, which
the researchers attrib-uted to the
oil’s anti-inflammatory action.
Also, the really good news was that
emu oil was not associated with any
adverse effects (Di Yi Jun Yi Da Xue
Xue Bao, 2005; 25: 407–10).
Other research shows that
topically applied emu oil can speed
the healing of chemical burns
caused by croton oil applied to the
ears of mice. In a study by
scientists from the University of
Prince Edward Island in
Charlottetown, Canada, mice
treated with emu oil had
significantly less ear-tissue swelling
after six and 12 hours compared
with mice treated with a placebo
(porcine oil) or no treatment at all.
The biggest reduction in swelling
was seen in mice treated with the
highest dose (5 µL) of emu oil.
These mice also had less swelling
than the mice treated with an equal
dose of porcine oil. After 24 hours,
however, swelling was the same in
all three groups (emu oil, porcine
oil and no treatment), suggesting
that the oil needs to reapplied
regularly to be effective (Am J Vet
Res, 1999; 60: 1558–61).
Besides promoting wound-
healing, emu oil also appears to be
useful for arthritis—again,
probably because of its anti-
inflammatory effects. In this case,
Australian researchers tested five
different topically applied emu-oil
preparations on rats with
WDDTY Supplements under the microscope 11
experimental polyarthritis (arth-
ritis involving five or more joints
simultaneously), and found that
four out of the five formulations
were effective for reducing arthritic
severity. The effect was comparable
to that of the anti-inflammatory
drug ibuprofen (Inflammopharmacology,
1997; 5: 127–32).
A follow-up study revealed that
emu oil is more effective against
arthritis than a number of other
oils claiming to have therapeutic
value for inflammatory disorders,
including rhea, fish, flaxseed and
evening primrose oils. It also
demonstrated that emu oil derived
from intestinal fat appears to have
more activity than oil derived from
rump fat (Inflammo-pharmacology, 1998;
6: 1–8).
Other animal studies have
looked at the effects of emu oil
administered orally. Most recently,
researchers at the University of
Adelaide, in Australia, investigated
whether emu oil would have any
impact on mucositis, the painful
inflammation and ulceration of the
mucous membranes lining the
digestive tract usually seen as a
side-effect of cancer treatment.
Using agouti rats with chemo-
therapy-induced mucositis, they
discovered that emu oil
significantly reduced inflammation
in the intes-tine and improved the
“mucosal architecture” of the gut.
The study concluded that
“[F]urther studies investigating
the potential benefits of emu oil as
a nutritional supplement for the
treatment of intestinal disorders
are indicated” (Br J Nutr, 2010; 104:
513–9).
Yet another study compared the
effects of oral emu oil, olive oil and
coconut oil in hamsters with high
cholesterol, a risk factor for athero-
sclerosis (the buildup of plaque in
the arteries). The results showed
that hamsters fed on diets
supplemented with either emu or
olive oil had significantly lower
concentrations of total and low-
density lipoprotein (LDL, or ‘bad’)
cholesterol compared with animals
supplemented with coconut oil.
Moreover, neither emu nor olive oil
had any effect on levels of high-
density lipoprotein (HDL, or
‘good’) cholesterol, known to
protect against heart disease ( Nutr
Res, 2004; 6: 395–406).
Human studies
Although the research so far is
promising—suggesting that emu
oil may be useful for a number of
inflammator y conditions—the
results of animal studies do not
necessarily apply to humans. For
this reason, clinical trials are
needed to confirm these
preliminary findings.
Thus far, there appears to be
only one published clinical trial of
emu oil to date: a pilot double-
blind trial of the oil’s moisturizing
and cosmetic properties. This
preliminary study involved 11 men
and women, with healthy skin (no
acne or eczema), who were asked to
compare two different oils—emu
oil and mineral oil—after two
weeks of topical use of each.
Using data compiled from
questionnaires, which assessed skin
penetration and permeability,
moisturizing properties, texture
and any side-effects (such as
comedogenicity or blackhead
development, odour or irritation),
12 WDDTY Supplements under the microscope
What’s in emu oil?
Emu oil is made up of several
different types of fatty acids, but
mainly monounsaturated fatty
acids. Oleic acid—an omega-9 fatty
acid—is the major
monounsaturated fatty acid in emu
oil, comprising over 40 per cent of
its total fatty acids. The oil also
contains polyunsaturated fatty
acids, including linoleic acid (an
omega-6 fat) and linolenic acid (an
omega-3 fat), as well
as the saturated fatty acids palmitic
acid and stearic acid (www.aea-
emu.org/ resources/research/fatty-
acid-analysis-emu-oil).
the researchers reported that emu
oil scored better than mineral oil
overall. Moreover, all 11
participants said they preferred the
emu oil to the mineral oil (Australas
J Dermatol, 1996; 37: 159–61).
As for specific conditions, there
is one study—a randomized double-
blind placebo-controlled trial, the
gold-standard type of clinical
trial—that investigated the effects
of emu oil in 120 men and women
with osteoarthritis of the hand. The
study participants were randomly
allocated to one of six groups: 1)
emu oil applied topically twice a
day; 2) placebo (canola) oil applied
topically twice a day; 3) emu oil
taken by mouth twice a day (5 mL);
4) placebo oil taken by mouth twice
a day; 5) emu oil applied topically
and ingested; and 6) placebo oil
applied topically and ingested.
At the end of the eight-week
study, pain scores were found to be
signifi-cantly lower in the emu oil
users compared with the placebo
oil users. However, curiously,
topical applica-tion and ingestion
of emu oil each had a more
significant effect on pain reduction
on their own than when used in
combination.
Although this study has not been
published in a peer-reviewed
journal, it can be found on the
website of Emu Spirit, the
Australian company that supplied
the emu oil used in the study and
assisted with its funding (see
w w w. e m u s p i r i t . c o m / w h y - e m u -
spirit/osteoarthritichandpain.htm)
.
The bottom line
Clearly, considerably more research
is needed on the effects of emu oil
in humans and, in particular, inde-
pendent studies. Many websites
claim that the oil is beneficial for a
laundry list of health problems, but
there is simply not enough
evidence at this time to support
such claims.
Nevertheless, it’s unlikely that
using emu oil will do you any harm,
at least when applied topically, so
you may wish to give it a try for
yourself.
Joanna Evans
Cetylated fatty acids
Cetylated fatty acids are
among the latest natural
remedies for joint health,
and are said to be even
better than glucosamine.
But what does the science
say about these fats?
etylated fatty acids (CFAs) are
C a group of naturally occurring
fats that are widely marketed
as a treat-ment for osteoarthritis.
These fats are thought to help
lubricate joints and muscles, soften
tissues, reduce inflammation and
increase flexibility. The question is,
do they really work?
CFA studies so far
Several studies used a proprietary
blend of CFAs called Celadrin (70-
per-cent CFAs and 30-per-cent olive
oil) which comes as an oral supple-
ment or topical cream. In one study
using the capsules, 64 patients with
chronic knee osteoarthritis (OA)
were given either Celadrin (350 mg,
plus 50 mg of soy lecithin and 75 mg
of fish oil, taken six times daily) or a
placebo (vegetable oil) for 68 days.
At the end of the study, those in
the Celadrin group saw a significant
improvement in their knee range of
motion (flexibility) and overall joint
functioning compared with those in
the placebo group.
“CFA may be an alternative to the
use of non-steroidal anti-inflam-
matory drugs for the treatment of
OA”, the researchers concluded (J
Rheumatol, 2002; 29: 1708–12).
The topical version of Celadrin has
also been tested in three separate
studies by a team of researchers at
the University of Connecticut.
Again, the product was trialled in
patients with OA of the knee.
In the first of this series of studies,
40 older patients (mean age: 65
years) were randomly assigned to one
of two treatment groups—Celadrin
cream or a placebo—and were
evaluated before application, 30
minutes after application and 30
days after treatment. Assessments
included how long it took the
patients to get up and go from a
chair, go up and down stairs, balance
and move their knees.
Celadrin was superior to placebo
and had fast-acting effects. Climbing
ability, for example, improved just 30
minutes after initial treatment (J
Rheumatol, 2004; 31: 767–74).
The other two studies of this series
also found Celadrin to be effective for
relieving the pain of OA. One found
that it improved postural stability
and weight distribution across the
soles of the feet during quiet
standing (J Strength Cond Res, 2005; 19:
115–21), while the other reported that
it significantly reduced pain and
improved functional performance in
individuals with OA of the knee,
elbow and wrist (J Strength Cond Res,
2005; 19: 475–80).
Beyond arthritis
Some websites claim that CFAs can
be used to treat a range of condi-
tions other than OA, such as skin
problems, gum disease, gout and
lupus. However, there’s little
research to support these claims.
One small-scale, preliminary study
suggested that Celadrin cream might
be helpful for people with psoriasis, a
chronic autoimmune skin disorder.
WDDTY Supplements under the microscope 13
However, although it was a double-
blind, placebo-controlled study, the
results have yet to be published in a
peer-reviewed journal, but are
available at the following website:
http://celadrininfo.com/studies/
SafetyHumans.pdf.
Another small study found that
Celadrin together with glucosamine
might benefit the heart and blood-
circulation status by reducing
platelet aggregation (blood-clot
formation). The researchers, who
tested the combination on 24
healthy people, reported that it had
aspirin-like effects (Clin Lab Sci, 2010;
23: 32–6).
Nevertheless, more research is
needed to confirm these results.
Consider this
CFAs appear to be a promising
treatment for OA, but the research is
far from conclusive, and some claims
go far beyond the current evidence.
Indeed, while some claim that these
fatty acids are more effective than
glucosamine and chondroitin—two
popular natural treatments for
arthritis—no comparative studies
have been conducted.
Another point to bear in mind is
that the studies have been carried
out with a specific brand of CFAs
(Celadrin), so we don’t know if other
preparations will have the same
results.
As for safety, no adverse effects
have been reported with the use of
CFAs—but then, no one appears to
be looking. This suggests that, in
particular, there need to be studies
to determine the effects of their
long-term use.
Joanna Evans
14 WDDTY Supplements under the microscope
Other supplements for osteoarthritis
u Glucosamine. Numerous studies have shown that this is a safe and
effective way to reduce symptoms of OA (Arthroscopy, 2009; 25: 86–94).
The results of a three-year, double-blind trial suggest that the nutrient
(1500 mg/day in one dose) may even slow the progression of the
disease (Lancet, 2001; 357: 251–6).
u Chondroitin. A recent review concluded that oral chondroitin sulphate
“is a valuable and safe symptomatic treatment for OA disease”.
Interestingly, 800 mg/day had nearly the same effects as 1200 mg/day
in one study (Osteoarthritis Cartilage, 2008; 16 Suppl 3: S19–21). It’s often
recommended that chondroitin be taken in combination with
glucosamine.
u S-adenosylmethionine (SAMe). Double-blind trials show that SAMe
(1200 mg/day) reduces pain, stiffness and swelling better than a
placebo, and as well as painkilling drugs such as ibuprofen and
naproxen in OA sufferers (Am J Med, 1987; 83: 81–3; Am J Med, 1987; 83:
66–71).
u Pycnogenol (pine bark extract). This supplement (150 mg/day) was
tested against a placebo on 100 patients with mild-to-moderate OA of
the knee. After eight weeks, the Pycnogenol group reported a
significant reduction in pain, and the benefits were still evident three
months later. They also had less stiffness in the joints, and were able
to carry out more day-to-day activities and reduce their use of
painkillers; in contrast, 10 per cent in the placebo group had to
increase their dose of analgesics (Phytother Res, 2008; 22: 1087–92).
u Bromelain. Mounting evidence suggests that this extract, derived from
pineapple, may be a useful treatment for OA. The research so far
shows that it has powerful anti-inflammatory and painkilling properties,
although more studies are needed to determine the optimal dosage
(Evid Based Complement Alternat Med, 2004; 1: 251–7).
Serrapeptase
An enzyme found in
silkworms is touted as a
natural alternative to non-
steroidal anti-inflammatory
drugs (NSAIDs). But what
does the science say?
errapeptase, or
(Pharmatherapeutica, 1984; 3: 526–30).
Yet another study showed that
serrapeptase is better than the
traditional post-surgery advice:
bed rest, elevation and the
application of ice. In patients
undergoing surgery of the ankle,
those treated with serrapeptase
had 50-per-cent less postopera-
serra- tive swelling compared with those

S tiopeptidase, is a proteolytic
(protein-digesting) enzyme
with a long history of use in
Germany and Japan. Now known
worldwide for its anti-inflammatory
effects, it’s purported to treat
everything from arthritis to heart
disease and infections. But what
does the science say about
serrapeptase?
What the studies say
Serrapeptase has been the subject
of intense study in recent decades
and, although much of the research
has been in humans, larger-scale
higher-quality trials are needed.
Nevertheless, so far, the evidence
suggests that the enzyme may be
useful for a range of conditions.
u Postoperative pain and
swelling. In a study of 24 healthy
subjects undergoing tooth
extraction, all were given a
treatment combination of either
serrapeptase (5 mg) or placebo
tablets and paracetamol
(acetaminophen) tablets (1000
mg) at the time of the operation.
Those taking serrapeptase
reported significantly less pain
and swelling after surgery
compared with the placebo-
control group (Int J Oral Maxillofac
Surg, 2008; 37: 264–8).
In a much larger study, this
time in patients with chronic
empyema (where pus collects
around the lungs and in the
chest wall) undergoing surgery,
the patients were given either
serrapeptase or a placebo both
before and after their operation.
Here again, the degree of post-
operative swelling was signifi-
cantly less with serrapeptase
than with the placebo
who followed the traditional
advice. The serrapeptase group
also became pain-free sooner
than the control group did
(Fortschr Med, 1989; 107: 67–8, 71–2).
u ENT disorders. An Italian study
of 193 patients suffering from
ear, nose and throat disorders
(acute or chronic) found that
serrapeptase treatment led to a
significant reduction in symp-
toms compared with a placebo. In
addition, not only did the enzyme
act rapidly on localized inflamma-
tion, but it also led to less water
retention, while boosting clot-
busting effects (fibrinolysis), thus
speeding up healing (J Int Med Res,
1990; 18: 379–88).
u Chronic obstructive pulmonary
disease (COPD). A small study
carried out in Japan investigated
the effects of serrapeptase in
patients with COPD, such as
emphysema and bronchitis.
Compared with no treatment,
30 mg/day of the enzyme for four
weeks reduced both the amount
of phlegm (sputum) produced
and the frequency of coughing
(Respirology, 2003; 8: 316–20).
u Carpal tunnel syndrome (CTS).
Twenty CTS patients were
enrolled in a clinical study to
investigate whether serrapeptase
could help in the treatment of
their symptoms. Following a short
course of the non-steroidal anti-
inflammatory drug (NSAID)
nimesulide, the patients were
given 10 mg of serrapeptase twice
a day for six weeks. At the end of
the study, 65 per cent reported
significant improvements in their
symptoms, with no serious side-
effects (J Assoc Physicians India, 1999;
47: 1170–2). Larger, higher-quality
trials are now needed to confirm
these findings.
u Breast disease. Serrapeptase may
be beneficial for breast engorge-
ment, the painful overfilling of
the breasts with milk. When 70
women with the condition were
given either Danzen, a Japanese
serrapeptase preparation, or a
placebo for three days, Danzen
proved to be superior to placebo
for improving breast pain, breast
swelling and induration (harden-
ing). Indeed, while 86 per cent of
the Danzen patients achieved
“moderate to marked” improve-
ments, only 60 per cent of the
patients taking the placebo saw
similar improvements. Also, a
“marked” improvement was seen
in 23 per cent of the treatment
group vs just 3 per cent with the
placebo (Singapore Med J, 1989; 30:
48–54).
u Infections. Serrapeptase was
effective for eradicating infection
caused by Staphylococcus epider-
midis bacteria—at least in rats,
so this may not apply to humans.
Nevertheless, these findings led
the researchers to conclude that
the enzyme might be able to

WDDTY Supplements under the microscope 15

 “enhance antibiotic efficacy in
the treatment of staphylococcal
infections” (J Bone Joint Surg Am,
2006; 88: 1208–14).
Heart disease and beyond
The potent anti-inflammatory
effects of the enzyme make it a good
candidate for treating a variety of
other disorders, including arthritis,
fibromyalgia, migraine, irritable
bowel syndrome and even heart
disease. Indeed, the late German
physician Dr Hans Nieper reported
that serrapeptase is an invaluable
agent for the safe removal of fibrous
clots from coronary arteries and, in
particular, from the carotid arteries
in the neck, which supply blood to
the brain (www.serrapeptase.info/content.
asp?page=Dr-H-A-Nieper).
However, more clinical studies
are needed to ascertain whether or
not serrapeptase is, in fact, effective
for any of these conditions.
Serrapeptase safety
In general, no significant side-
effects have been reported with the
16 WDDTY Supplements under the microscope
What is serrapeptase?
Serrapeptase is an enzyme produced by the Serratia bacteria that live in
the intestines of silkworms. Once the silkworm has completed its
transformation into a moth, it uses this substance to ‘melt’ a hole in its
confining cocoon, allowing it to escape. Unlike other biological enzymes,
serrapeptase affects only non-living tissue, such as the silk cocoon. In
humans, it breaks down the protein debris resulting from toxins and
inflammation while sparing healthy tissues and cells.
Serrapeptase is taken orally typically at a dosage of 10–30 mg/day. To
ensure maximum absorption in the small intestine and to stop stomach
acid from destroying the enzyme, it usually comes in enteric-coated
tablets.
Currently, research is underway to develop topical preparations of
serrapeptase in the form of ointments and gels (Indian J Pharm Sci, 2010; 72:
65–71).
use of this enzyme, although there Other potential adverse effects
have been a few case reports of include diarrhoea and gastro-
eosinophilic pneumonia (usually intestinal problems. However, these
triggered by an allergic reaction, effects are usually mild, especially in
often to a medication) in response comparison to the often severe side-
to serrapeptase (Nihon Kokyuki Gakkai effects of NSAIDs. Yet, until we know
Zasshi, 2009; 47: 254–8; 2000; 38: 540–4). more, it’s up to users to monitor
Although the reaction is unusual, their own health when using this
it nevertheless highlights the fact product.
that natural is not always harmless. Joanna Evans
Natural slimming supplements
Here, we take a look at
some of the so-called
slimming supplements on
the market, and what they
will and won’t do for you
o doubt plenty of us have
N been tempted by a slimming
supplement at some point in
our lives. Indeed, an American
survey published in 2008 found
that more than a third of adults
who made a weight-loss attempt
had used a dietary supplement to
do so (J Obes, 2011; pii: 297315).
With many products claiming to
tone you up and trim you down
with minimal effort and no risk,
it’s little wonder they’re so
popular. But do any of them
actually work? And are they really
safe?
Here are some of the most
popular natural slimming
supplements and the science—or
lack of it—behind them.
CLA
u The pill: Conjugated
linoleic acid (CLA) is a
fatty acid found in the
meat and milk of
grazing animals. The
US Food and Drug
Administration (FDA)
recently approved
CLA for its ‘generally
recognized as safe’
categor y, which
means that it can now
be used in various
foods and drinks. It’s
also found in
numerous supplements aimed at
slimmers and bodybuilders.
u The promise: CLA is said to
reduce body fat storage and to
increase lean muscle mass while
boosting fat breakdown.
u The proof: Studies in mice show
that those given CLA lose
significant amounts of body fat
and show an increase in lean
body mass (Am J Clin Nutr, 2007; 85:
1203–11; Lipids, 1997; 32: 853–8 ).
However, results in human trials
have been mixed.
In one, 60 overweight or
obese men and women were
given either 9 g of olive oil
(placebo) or one of four doses of
CLA (1.7 g/day, 3.4 g/day, 5.1
g/day or 6.8 g/day) for 12
weeks. Compared with the
controls, all of those taking
CLA—regardless of dose—
reduced body fat, although the
results were most significant in
those taking 3.4 g/day or more
( J Nutr, 2000; 130: 2943–8 ). In
another trial, taking CLA (5
g/day) during resistance
training resulted in small,
but statistically significant,
increases in lean body mass and
greater losses of fat mass after
seven weeks compared with a
placebo (Med Sci Sports Exerc, 2006;
38: 339–48).
Other studies, however, have
failed to find any significant
benefit with CLA (Lipids, 2000; 35:
777–82; J Strength Cond Res,
2002; 16: 325–34).
Fortunately, US res-
earchers have attempted to
make sense of the
conflicting research by
conducting a pooled
analysis of all high-quality
clinical trials (they
were randomized, double-
blind and placebo-
controlled) on CLA. They
concluded that CLA has a
‘modest’ effect on human
body composition, with a
dose of around 3 g/day
resulting in a fat loss of
around 0.09 kg/week ( Am J
Clin Nutr, 2007; 85: 1203–11 ). So, it’s
hardly a quick-fix solution. Also,
CLA doesn’t appear to have
much effect on either body
weight or body mass index (BMI)
(J Obes, 2011; pii: 297315).
u Precautions: CLA appears to be
safe, with the most common
side-effects being gastro-
intestinal. However, there are
some concerns that the use of
such supplements by overweight
people could cause or aggravate
WDDTY Supplements under the microscope 17
insulin resistance, which might
then increase the risk of
developing diabetes ( Am J Clin
Nutr, 2007; 85: 1203–11; Circulation,
2002; 106: 1925–9). Other research
suggests that CLA might lower
levels of ‘good’ (HDL)
cholesterol while contributing
to inflammation and oxidative
stress (Crit Rev Food Sci Nutr, 2006;
46: 479–88).
Green-tea extract
u The pill: Green-tea extract (GTE)
contains catechins, active
compounds present in the
unfermented dried leaves of
Camellia sinensis. It’s credited with
a range of benefits, including weight
loss, and is the fourth most popular
dietary supplement in the US.
u The promise: GTE supposedly
increases calorie and fat metabolism
while decreasing appetite. It’s
thought to act mainly on the
sympathetic nervous system, which
deter-mines calorie expenditure.
u The proof: In a double-blind,
controlled Japanese study, 35
healthy men were divided by BMI
and waist size. One group drank
oolong tea with 690 mg of catechins
from GTE; the other drank oolong
tea with only 22 mg of GTE
catechins. After 12 weeks, BMI,
weight, waist size and body fat were
all significantly lower in those
taking the higher dose of catechins
(Am J Clin Nutr, 2005; 81: 122–9).
Another study found that a GTE
rich in catechins taken at breakfast,
lunch and dinner increased the
number of fat calories burned per
day. The scientists concluded that
green tea has thermogenic
properties—in other words, it’s a
metabolism booster. They also
 noted that it caused no increase in
heart rate, a side-effect typically
seen with stimulant-based slimming
products (Am J Clin Nutr, 1999; 70:
1040–5).
More recently, a meta-analysis
concluded that GTE catechins are
effective for reducing BMI, body
weight and waist size, but the effects
are modest at best. Moreover, it
revealed that the catechins only
work if the caffeine has not been
removed, suggesting that this may
be contribu-ting to the weight loss
(Am J Clin Nutr, 2010; 91: 73–81).
u Precautions: Excess green-tea
consumption (more than eight cups
a day) can cause minor side-effects,
including upset stomach, nausea
and heartburn. But more worrying
is the link between green-tea prod-
ucts and liver damage. However, a
review by the US Pharmacopeia
stated that GTE products appear to
be safe as long as they are used and
formulated appropriately (Drug Saf,
2008; 31: 469–84). If you wish to try
GTE, make sure you go for a
reputable brand and take it as
directed. Also, avoid taking the
supplement on an empty stomach.
Hoodia
u The pill: Hoodia
gordonii was once a
little-known plant
native to the
Kalahari desert in
South Africa. Now,
the herb is found in
slimming products
worldwide, ranging
from capsules and
tablets to tinctures and syrups.
u The promise: Hoodia is claimed to
encourage weight loss by
suppressing the appetite. According
to one website promoting the
supplement, with Hoodia, you “can
make cravings vanish, reduce your
calorie intake substantially, and lose
body fat”.
u The proof: Despite being one of the
most widely used slimming
supplements today, there’s actually
little scientific evidence to show
that the herb helps weight loss.
Researchers began studying
Hoodia in the early 1960s and, some
20 years later, isolated an extract
they dubbed ‘P57’, which was
18 WDDTY Supplements under the microscope
believed to stimulate feelings of
satiety in the brain. Yet, so far, there
are still no published clinical trials
of the extract.
Websites selling Hoodia often
cite a trial showing that, after two
weeks, volunteers taking the herb
ate 1000 fewer calories a day than
those taking a placebo. However, the
study involved only 18 people, was
never peer-reviewed or published,
and was sponsored by Phytopharm, a
British biopharmaceutical company
licensed to develop P57 on a large
scale (Harv Womens Health Watch, 2008;
15: 8). The results, therefore, need to
be viewed with caution.
On the upside, there’s published
evidence in animals that Hoodia
may work. South African
researchers tested the plant extract
against appetite-suppressing fen-
fluramine (now banned due to heart
risks) in rats—so the findings may
not necessarily apply to humans—
and found that Hoodia reduced food
intake and also led to weight loss.
Fenfluramine, on the other hand,
reduced food intake only slightly
and led to weight gain (Phytochemistry,
2007; 68: 2545–53).
In another rat study, US
scientists injected P57 directly into
the brain. Food intake was reduced
by 40–60 per cent over 24 hours,
and levels of ATP (adenosine
triphosphate) in the hypo-
thalamus—which controls hunger—
were increased. This ATP
upregulation may lie behind the
herb’s apparent appetite-
suppressing effects (Brain Res, 2004;
1020: 1–11).
Nevertheless, although this is all
highly promising, until more
reliable human trials are published,
we won’t know whether Hoodia—
and, specifically, Hoodia in pill
form—will work in overweight
people as it does in rats.
u Precautions: As clinical trials are
lacking, we’re completely in the
dark about the herb’s safety.
Another concern is that the
products currently available aren’t
regulated, so it’s unclear how much
of the herb—if any—they contain.
Experts argue that there simply
aren't enough Hoodia plants in the
world to account for all the alleged
Hoodia products now on the
market. And not only may they
contain little or no H. gordonii, they
may also include the wrong parts of
the plant or use questionable plant
sources (Harv Womens Health Watch,
2008; 15: 8). In fact, independent
laboratory tests by Alkemists
Pharmaceuticals in California have
revealed that around two-thirds of
the supplements on the US
marketplace contained no
identifiable H. gordonii whatsoever
(www.naturalnews.com/011425.html).
Chromium
u The pill: Chromium is a naturally
occurring mineral that plays an
essential role in the metabolism of
carbohydrates and fats, and in the
action of insulin. It has a range of
purported benefits, but one of its
most common uses—usually in a
form called chromium picolinate—
is as a weight-loss aid.
u The promise: Often touted as a
‘miracle mineral’, chromium is
claimed to curb the appetite,
increase metabolism and, thus, melt
body fat while increasing lean body
mass.
u The proof: The evidence is mixed as
to whether or not chromium really
can help with weight loss and
improve body composition. In one
crossover study, 20 overweight
women, who were following a mild
regimen of diet and exercise, were
given either a placebo or 600
mcg/day of niacin-bound chromium
for two months, then switched over
to the other treatment for a further
two months. The results showed
that those who took the chromium

after the placebo
lost significantly
more fat and less
muscle compared
with the chromium-
first group (Diabetes
Obes Metab, 1999; 1:
331–7). Also, no
adverse effects were
seen with the niacin-
bound chromium
supplements.
A n o t h e r
placebo-controlled
study reported that chromium
picolinate—at a dose of 1000 mg for
eight weeks—reduced food intake,
hunger levels and fat cravings in a
group of healthy overweight adult
women. It was also associated with a
small reduction in body weight
(Diabetes Technol Ther, 2008; 10: 405–12).
However, other studies have
reported that chromium
supplementation—using a range of
doses—had no effect on either
weight loss or body composition
(Nutrition, 2007; 23: 187–95; Biol Trace Elem
Res, 2006; 113: 53–66; J Altern Complement
Med, 2010; 16: 291–9).
According to a meta-analysis
(pooled analysis) of 10 randomized
controlled trials, chromium
picolinate may help with weight
loss, but not much. Overall,
participants lost around 0.08–0.2 kg
per week compared with a
placebo—a relatively small
reduction in overall weight (Am J Clin
Nutr, 2004; 79: 529–36).
u Precautions: A 1995 study sparked
some concern after it reported that
chromium picolinate at very high
concentrations in a test-tube could
damage the chromosomal material
of hamster cells (FASEB J, 1995; 9:
1643–8).
However, the latest evidence
shows that such genotoxic effects
are highly unlikely in humans or
animals taking chromium at the
moderate, recommended levels (Crit
Rev Toxicol, 2008; 38: 173–90).
Indeed, in supplemental
amounts—typically, 50–300
mcg/day—chromium has not been
found to cause toxicity in humans.
However, little is known of the long-
term safety of supplementing with
chromium.
L-Carnitine
u The pill: L-Carnitine is an amino-
acid-like compound that helps the
body turn fat into energy. For this
reason, it’s become a popular
ingredient in dietary supple-
ments—and especially those for
weight loss—as well as some sports-
nutrition products.
u The promise: Carnitine is said to
aid weight loss mainly by boosting
fat metabolism. According to one
website, “With carnitine’s help, fat
levels decrease in the blood and
weight loss is easier”.
u The proof: Although some studies
suggest that dietary carnitine
(found in red meat and dairy
products) has the potential to
stimulate fat metabolism (Nutrition,
2004; 20: 709–15), there’s little
evidence to show that carnitine
supple-ments are effective for
weight loss. In fact, one Australian
study found that eight weeks of L-
carnitine supplementation
combined with aerobic training
failed to promote weight loss in
moderately obese women (Int J Sport
Nutr Exerc Metab, 2000; 10: 199–207).
Similarly, a review of several popular
weight-loss supplements reported
that “no trials demonstrate that L-
carnitine is effective for weight
loss” (Am Fam Physician, 2004; 70:
1731–8).
u Precautions: L-Carnitine appears to
be safe, although the Australian
study mentioned above reported
nausea and diarrhoea in some of the
people taking the supplement that
was sufficient to cause them to drop
out of the study.
WDDTY Supplements under the microscope 19
Hydroxycitric acid
u The pill: Hydroxycitric acid (HCA),
found in the Malabar tamarind
fruit (Garcinia cambogia), has
been used for centuries in
Southeast Asia to make meals feel
more filling. Today, it’s marketed
as a weight-loss supplement either
alone or in combination with
other ingredients.
u The promise: HCA purportedly
aids weight loss by suppressing the
appetite and reducing the
conversion of carbohydrates into
stored fat.
u The proof: The good news is that
some placebo-controlled studies
have found that HCA can increase
weight loss, reduce appetite (Int J
Obes, 1997; 21 [Suppl 2]: S61; Diabetes
Obes Metab, 2004; 6: 171–80) and cut
calorie intake (Int J Obes Relat Metab
Disord, 2002; 26: 870–2), and increase
fat-burning in athletes (J Nutr Sci
Vitaminol [Tokyo], 2002; 48: 128–33).
Moreover, one study reported
increased weight loss after
treatment with HCA plus
chromium (Am J Bariatr Med, 1993;
Summer: 17–9).
However, several other studies
have not confirmed these
proposed effects. In one of the
largest and most rigorous trials,
researchers found no significant
differences in weight loss or body
fat mass between those taking
HCA and those taking a placebo
(JAMA, 1998; 280: 1596–600).
There is, nevertheless, some
 evidence to suggest that HCA
effectiveness may depend on the
dose and type of HCA formulation
used. For example, in rat studies,
Dutch scientists found that the
HCA-based products Citrin K and
Regulator were significantly more
effective than Super CitriMax
HCA-600-SXS at reducing food
intake, despite using the same
dosages (150 and 300 mg/kg)
(Nutr Metab [Lond], 2005; 2: 23). But
these results may not apply to
humans.
u Precautions: Side-effects ass-
ociated with HCA include
headache, nausea and gastro-
intestinal symptoms. However, in
most of the trials, there were no
significant differences in adverse
events between HCA and a placebo
(J Obes, 2011; doi: 10.1155/2011/509038).
Pyruvate
u The pill: Pyruvate is a three-carbon
compound made in our bodies as a
result of glucose metabolism. It’s
also found naturally in foods (such
as apples), as well as in slimming
and sports supplements.
u The promise: Pyruvate can
supposedly reduce body fat and
20 WDDTY Supplements under the microscope
enhance the body’s days a week.
ability to use The results showed a
energy efficiently. significant reduction in body
u The proof: It’s weight and body fat in the
been suggested pyruvate group (Nutrition, 1999; 15:
that pyruvate 337–40).
might be useful According to a recent review
for weight loss published in the Journal of
and for improving Obesity, the evidence so far
body comp- suggests that pyruvate “may be
osition. In one beneficial for weight loss”, and
randomized appears to work via fat-modifying
controlled trial, mechanisms. However, the
h i g h - d o s e researchers point out that the
p y r u v a t e trials conducted so far have used
supplements only small numbers of people and
(22–44 g/day) enhanced lasted for only short periods of
weight loss and led to a greater time (J Obes, 2011; 2011: pii: 297315;
reduction of body fat in overweight Epub 2010 Aug 10).
adults consuming a low-fat diet (Am u Precautions: Studies suggest that
J Clin Nutr, 1994; 59: 423–7). pyruvate is generally well
In another study, a much lower tolerated, with gastrointestinal
dose of pyruvate appeared to have upset (such as wind, bloating and
similar effects. A group of diarrhoea) being the most
overweight men and women were common side-effect. One
randomly assigned to receive either preliminary study involving
6 g/day of pyruvate or a placebo for women who exercised found that
six weeks. In addition, all 10 g/day of pyruvate reduced
participants took part in an blood levels of ‘good’ HDL
exercise programme that consisted cholesterol after one month
of a 45- to 60-minute (Med Sci Sports Exerc, 1998; 30: S155).
aerobic/anaerobic routine three Joanna Evans
Conjugated linoleic acid
Is this natural supplement
a genuine quick-fix for fat
loss?
onjugated linoleic acid
C (CLA) has become a
popular supplement among
both athletes and slimmers alike.
Found naturally in the meat and
milk of grazing animals, this fatty
acid supposedly reduces body fat
and increases lean muscle mass in
humans.
But is it really possible to fight
fat with fat? Let’s take a look at
the evidence so far.
CLA science
Numerous studies have established
that CLA is an effective fat-fighter,
at least in animals. Experimental
mice, pigs and hamsters that were
fed a diet supplemented with CLA
all lost significant amounts of body
fat compared with their matched
controls. Mice appear to be the
most responsive to CLA, with
treated animals losing 60 per cent
of their body fat overall (Am J Clin
Nutr, 2007; 85: 1203–11).
CLA also appears to increase
lean body mass, which refers to all
body tissues (mostly muscle)
minus the fat. In one study, mice
given CLA not only lost body fat,
but also showed a statistically
significant increase in lean body
mass—up to 14 per cent—
compared with the control animals
(Lipids, 1997; 32: 853–8).
But would such benefits be seen
in people, too? More than 30
clinical trials have attempted to
answer this question, but the
results have been mixed.
In one randomized, double-blind
study, researchers in Norway
studied 60 overweight or obese
men and women who were given
either olive oil (placebo) or one of
four doses of CLA (1.7 g/day, 3.4
g/day, 5.1 g/day or 6.8 g/day) for
12 weeks. Compared with the
controls, all of those taking CLA—
regardless of dosage—showed a
reduction in body fat, although the
results were most significant for
the subjects taking 3.4 g/day or
more (J Nutr, 2000; 130: 2943–8).
More recently, supplementation
with CLA was tested against
safflower oil in a group of obese
postmenopausal women with type
2 diabetes. With no other changes
to either their diet or exercise
habits, the women taking the CLA
were able to achieve significant
reductions in their total body fat
as well as their body mass index
(BMI) scores, thus suggesting that
CLA may be a useful supplement
for encouraging weight loss (Am J
Clin Nutr, 2009; 90: 468–76).
CLA has also been tested in
athletes and regular exercisers—
and showed promising results. In a
study of 20 normal-weight adults
who exercised for 90 minutes three
times a week, those taking CLA
(1.8 g/day) lost significantly more
body fat (but not body weight) than
those taking a placebo (J Int Med Res,
2001; 29: 392–6).
In yet another trial, Canadian
researchers reported that CLA
supplementation (5 g/day) during
resistance training resulted in
small, but statistically significant,
increases in lean body mass and
greater losses of fat mass after
seven weeks compared with those
taking a placebo (Med Sci Sports Exerc,
2006; 38: 339–48).
Nevertheless, despite these
positive reports, other studies have
failed to demonstrate any signifi-
cant benefit with CLA supplemen-
tation. One US study reported no
changes in either body fat or lean
body mass in women who had taken
3 g/day of CLA for two months
( Lipids, 2000; 35: 777–82 ). Another
concluded that CLA had no effect
on body mass composition when
taken by experienced resistance-
trained athletes (J Strength Cond Res,
2002; 16: 325–34).
Only modest effects
This lack of consistency across
studies has been blamed on study
design differences, such as the
dosages used, the duration of the
studies, and the age and gender of
WDDTY Supplements under the microscope 21
the participants (Nutr Rev, 2008; 66:
415–21). However, when a recent
meta-analysis pooled the results of
18 validated, ‘gold-standard’, CLA
studies—in other words, they were
randomized, double-blind and
placebo-controlled—to address
these confounding variables, the
researchers came to the conclusion
that CLA does appear to have a
beneficial effect on human body
composition, with a dose of around
3 g/day resulting in fat loss of
about 0.09 kg/week.
Although such an effect seems
“modest”, it can be important
when it accumulates over time,
especially in the West where
continual and gradual weight gain
is the norm (Am J Clin Nutr, 2007; 85:
1203–11).
Nevertheless, whether CLA
works or not, there are some
concerns that the use of such
supplements by overweight people
could cause or aggravate insulin
resistance, which might then
increase the risk of developing
diabetes ( Am J Clin Nutr, 2007; 85:
1203–11; Circulation, 2002; 106: 1925–9).
Other research suggests that CLA
might lower levels of ‘good’ (HDL)
cholesterol, while contributing to
inflammation and oxidative stress
(Crit Rev Food Sci Nutr, 2006; 46: 479–88).
However, as with the efficacy
studies, the evidence is similarly
conflicting. There’s no doubt that
more research is needed to
determine whether CLA supple-
mentation is safe, particularly over
the long term.
Be that as it may, the US Food
and Drug Administration (FDA) has
recently approved CLA for its
‘Generally Recognized as Safe’
category, which means that it can
now be used in various foods and
beverages (Eur J Nutr, 2009; 48: 409–18).
The bottom line
Although CLA appears to have
some impact on body fat, it doesn’t
appear to pack much of a punch. In
addition, considering the cost of
supplements—and the questions
that still surround their long-term
safety—we’re all probably better off
finding another way to fight fat.
Joanna Evans
22 WDDTY Supplements under the microscope
Other CLA effects
Scientists are currently researching a number of other possible benefits of
CLA and, so far, the evidence—from animal studies, so it does not
necessarily apply to humans—suggests that it may be useful for the
following conditions.
u Cancer. Animal and test-tube studies suggest that CLA has anticancer
properties ( Anticancer Res, 2006; 26: 27–34 ). Specifically, CLA
supplementation appears to hinder the growth of breast, skin, stomach
and colon tumours in mice and rats (Br J Nutr, 2000; 83: 459–65).
u Osteoporosis. CLA significantly increased bone mass in middle-aged
female mice, particularly when combined with exercise (J Bone Miner
Metab, 2008; 26: 436–45).
u Sarcopenia. A recent study concluded that CLA may help to prevent
age-related muscle loss (sarcopenia). Mice fed CLA for six months had
more muscle mass compared with those that were fed corn oil (Biochem
Biophys Res Commun, 2009; 383: 513–8).
u Cellulite. In a study of 60 women, CLA combined with a herbal
anticellulite pill was more effective in improving the appearance of the
skin than the herbal pill on its own (Adv Ther, 2001; 18: 225–9).
Colloidal silver
There’s no evidence
to support the claims of
this alternative
antimicrobial
olloidal silver, a suspension of
C ultrafine silver particles in
liquid, is often claimed
to cure a catalogue of ills, ranging
from AIDS and cancer to diabetes.
But, is there any evidence that it works
and, more important, is it safe?
Silver science
Silver was the antimicrobial of choice
before the introduction of antibiotics
(Surg Infect [Larchmt], 2009; 10: 289–92).
However, when it comes to the
colloidal silver products on the market
today—usually meant to be taken by
mouth—there’s little evidence to
support their efficacy.
Colloidal silver reportedly acts as a
catalyst, disabling the enzyme that all
one-celled bacteria, viruses and fungi
need to metabolize oxygen. This done,
they suffocate—and supposedly with
no harm to human enzymes and other
working parts of the body’s chemistry.
Few conventional drugs can claim to
be so finely targeted.
Some test-tube studies suggest that
colloidal silver is a powerful antimic-
robial agent. In one, colloidal silver
solutions with a silver concentration of
30 ppm (parts per million) or higher
were able to kill the Staphylococcus
aureus bacteria that cause a range of
conditions, from acne to pneumonia
(Med Eng Phys, 2008; 30: 948–52). In
another, researchers in India and the
US tested a liquid silver solution
together with 19 antibiotics against
seven bacterial strains, but excluding
those that were resistant. Out of 96
tests, the combination was effective in
all but two (Curr Sci, 2006; 91: 926–9).
However, a study to test the efficacy
of three colloidal silver preparations—
one available via the Internet (silver
concentration of 22 ppm) and two
that were specially prepared in the lab
(concentrations of 403 and 413
ppm)—reported that none were found
to have any antimicrobial effects (J
Wound Care, 2004; 13: 154–5).
What’s more, there’s little research
in humans. Even if colloidal silver can
kill bacteria and other microbes in a
test tube, that’s no guarantee that the
results will be the same in people.
Also, to our knowledge, there are no
clinical studies showing that colloidal
silver is effective against any specific
health conditions.
Of the published studies that can be
found, most are single-patient reports
of adverse effects as a result of taking
colloidal silver. These reports describe
cases where using colloidal silver led ‘ppm’ does not refer to the number of
to argyria, characterized by a bluish- particles in the solution, but to their
gray discoloration of the skin that is weight. Silver particles can range from
neither treatable nor reversible. 0.005 to 0.015 microns in diameter,
Although the actual dosage necessary and the smaller the diameter, the
to produce this condition is not greater the number of particles (and
known, argyria has been associated weight). This means that a product
with both long-term supplementation with a concentration of 5 ppm with an
(one to two years) (Int J Dermatol, 2003; average particle size of 0.005 microns
42: 549) and extremely high doses (1 L/ will contain more silver particles than
day) (Am J Ind Med, 2009; 52: 246–50). a product of 25 ppm with an average
High doses of colloidal silver have size of 0.015 microns.
also been found to lead to vomiting, So, despite the fact that the US
diarrhoea, seizures, coma and even Environmental Protection Agency has
death (Dermatol Online J, 2005; 11: 12; established a non-lethal oral reference
Neurology, 2004; 62: 1408–10). dose for silver (5 mcg/kg body
weight), it may be difficult to know if
Silver speculation you’re exceeding this level or not.
According to some reports, much of Ultimately, while the manufacturers
the danger surrounding colloidal silver of colloidal silver insist that their
is related to the fact that we don’t products are safe and effective, until
know exactly how much silver is in more research is carried out—or the
the solution or the size of the silver labelling becomes more informative—
particles. Even though the product we just don’t know if this is true.
labelling may seem clear, the term Joanna Evans
Promising silver studies
While there’s little evidence to support the use of oral colloidal silver, a
number of studies suggest that silver compounds applied topically may be
a useful treatment for burns and other wounds. In fact, silver
sulphadiazine—a topical cream combining silver nitrate with a
sulphonamide antibiotic—has been used to manage burns-related
infections for the past 40 years, although recent findings suggest the
cream may also be delaying wound healing and may even have serious
cell-killing actions (Burns, 2007; 33: 139–48).
Lately, silver-impregnated dressings have gained popularity, mainly due
to the increase of antibiotic-resistant bacteria. Silver has proven
antibacterial activity in the lab against a wide range of bacteria, including
antibiotic-resistant strains (Am J Nurs, 2006; 106: 60–8). In human trials, silver-
releasing dressings generally show “positive effects” on chronically
infected wounds. However, high-quality evidence is still lacking (J Clin Nurs,
2008; 17: 1973–85).
WDDTY Supplements under the microscope 23
Glyconutrients
The Internet is awash with
claims that a new breed of
supplements will cure
everything from cancer to
AIDS. The evidence thus
far paints a far more sober
picture of modest benefit
oogle ‘glyconutrients’ and
G some 80,000 websites will pop
up, many of which will claim
that glyconutri-ents are the answer to
a wide range of health problems—
from chronic fatigue to cancer.
Indeed, according to one website,
glyconutrients support the body’s
ability to heal, repair, regenerate,
regulate and protect itself, which
makes them useful for a variety of
medical conditions, including acne,
asthma, diabetes, epilepsy,
fibromyalgia, hepatitis, lupus,
attention-deficit/hyperactivity
disorder (ADHD) and even AIDS. The
site also says that glyconutrients are
essential for overall good health and,
as these nutrients are missing from
the diet, we could all benefit from
supplements (www.glyconutrientsreference.
com).
But what are glyconutrients and,
more important, is there any truth to
these impressive claims? WDDTY
separates the facts from the fiction.
What are glyconutrients?
Recently, there’s been a lot of interest
in glycobiology, the study of the struc-
ture, biosynthesis and biology of sac-
charides—sugar chains or glycans—
which are widely distributed in nature.
From this, an entire industry has
emerged, based on the sale of plant
extracts called ‘glyconutrients’, a
newly invented term that refers to
sugars (‘glyco’) that the body can use
(‘nutrients’). The glyconutrient in-
dustry now has a worldwide sales force
of over half a billion people, and sells
nearly half a billion dollars’ worth of
products each year (Glycobiology, 2008;
18: 652–7).
Perhaps the best known of these
single sugars is glucosamine, which
has growing evidence to support its
use in the treatment of arthritis
24 WDDTY Supplements under the microscope
(Arthroscopy, 2009, 25: 86–94).
Nevertheless, the term ‘glyco-
nutrients’ is now being applied to new
supplements that offer a mix of the
various sugars found in plants.
Of the many companies that are
currently selling glyconutrients,
Mannatech, an international company
based in Texas, is the most successful.
Its flagship product, sold as both a
stand-alone and as a component in
other products, is Ambrotose Com-
plex, a patented blend of plant-
sourced polysaccharides, including
aloe vera extract (inner-leaf gel), ara-
binogalactan (gum from the wood of
Larix spp), ghatti gum (from guar
beans) and tragacanth gum (from
Astragalus legumes). The company
claims that Ambrotose Complex was
the “world's first natural plant
polysaccharide/glyconutritional
product” and, so far, more than 4.5
million units have been sold
worldwide.
Although Mannatech is careful to
point out that its products are not
intended to diagnose, treat, cure or
prevent any disease, the company
does claim that Ambrotose can help
to:
u support cell-to-cell communication
u improve immune-system health
u support digestive function and
promote gastrointestinal health
u enhance cognitive brain function,
including memory, and
u improve mood and decrease
irritability.
Mannatech also states that “no other
combination of vitamins, minerals,
amino acids or herbals can provide the
benefits found in our Ambrotose
Complex”.
Where’s the evidence?
There have been a number of
published scientific studies on
Mannatech’s glyconutrient formula,
including double-blind, placebo-
controlled clinical trials. In one of the
latest studies, researchers in Australia
investigated the effects of saccharide
supplementation (Ambrotose Com-
plex powder) on cognition and well-
being in 109 middle-aged adults. Each
participant took a teaspoonful of
Ambrotose (3.6 g/day) or a placebo
twice a day for 12 weeks. Before and
after this period of supplementation,
they all had filled in a number of
questionnaires assessing their mental
functioning and feelings of well-
being. The results showed significant
improvements in both memory and
wellbeing in the Ambrotose group
(Dev Neuropsychol, 2010; 35: 66–80).
In another study, researchers at
Howard University in Washington, DC,
looked at the impact of Ambrotose
Complex on the brain function of 62
healthy college students. The study
showed that a single, 1-tbsp serving of
Ambrotose significantly improved
their visual discrimination and simple
working-memory skills (Percept Mot
Skills, 2009; 108: 259–70).
Other trials show that Ambrotose
has antioxidant activity as well as
prebiotic effects. One test-tube study
revealed that both Ambrotose
Complex and Advanced Ambrotose
powder exhibited bifidogenic and
lactobacillogenic effects—in other
words, they encouraged the growth
and proliferation of both these
probiotic organisms (Int J Food Microbiol,
2010; 139: 168–76)—while a preliminary
trial involving 21 healthy volunteers
demonstrated that four capsules/day
of the Ambrotose AO supplement
increased blood ‘oxygen radical
absorption capacity’ (ORAC, a way to
measure antioxidant protection) by
36.6 per cent (BMC Complement Altern
Med, 2010; 10: 16).
Further studies suggest that
Mannatech’s glyconutrients may even
be useful for specific medical
conditions. Indeed, a review article
of glyconutrients and the study of
glycobiology by scientists in Galves-
ton, TX, describes how these nutrients
have been tested in patients with
asthma, cystic fibrosis, myasthenia
gravis (an autoimmune neuro-
muscular disease) and other chronic
illnesses—with promising results
(Explore [NY], 2006; 2: 488–94).
One six-week study carried out by
Mannatech itself tested a “glyco-
nutritional product containing sac-
charides” in 17 children with ADHD.
The researchers reported that the
supplement reduced the severity of
ADHD and its associated symptoms
within the first two weeks of the study
(Integr Physiol Behav Sci, 1998; 33: 49–60).
Another study on human cells
suggested that glyconutrients may be
useful for those suffering from chronic
fatigue syndrome (CFS). The
researchers, at the University of
California at Irvine, added a
glyconutrient formula to the blood
cells of patients with CFS and found
that the “glyconutrients improved
abnormal immune parameters” (Integr
Physiol Behav Sci, 1998; 33: 280–7).
More recently, a rat study showed
that both Ambrotose Complex and
Advanced Ambrotose had beneficial
effects on chemically induced colitis,
although these results may not
necessarily apply to humans (Dig Dis
Sci, 2010; 55: 1278–85).
Paid-for research
Although all of this evidence may at
first appear to constitue an impressive
body of research, a closer look reveals
that all of these studies were
supported by Mannatech in some way
(which Mannatech admits on its
website).
Even the review article published in
Explore (Explore [NY], 2006; 2: 488–94) is
supported by Mannatech and written
by researchers who have acted as
Mannatech consultants. Moreover, the
article cites positive studies that were
published in the Proceedings of the
Fisher Institute for Medical Research.
News reports in 2006 revealed that
the directors of the Fisher Institute
for Medical Research were also major
Mannatech shareholders (Glycobiology,
2008; 18: 652–7).
However, in all fairness, it should
be pointed out that all these practices
are standard in the drug industry.
There appear to be no independent
studies on PubMed to support the use
of Mannatech’s flagship product, but
this may also reflect the fact that
supplement companies have no
choice but to pay for their own
research.
Clearly, there’s a distinct lack of
independent research into glyco-
nutrients. Although this doesn’t
necessarily mean that we should
discount all of the company-funded
research, it’s nevertheless been well
documented that company-funded
studies are more likely to report
positive findings than are independent
ones.
Many orthodox scientists take issue
with the supposed medicinal effect of
glyconutrients as supplements. Drs
Ronald Schnaar and Hudson Freeze,
at the Johns Hopkins School of Medi-
cine in Baltimore, MD looked at
Ambrotose’s individual components,
and remain unconvinced of their effi-
cacy as supplements. For example,
although aloe vera gel has long been
reported to have medicinal value for
burns and other skin lesions, taking
aloe gel glucomannan (as found in
Ambrotose) orally is not well studied.
However, one clinical study has found
that oral aloe glucomannan failed to
either enhance immune-system func-
tion or decrease viral load in AIDS
patients (J Acquir Immune Defic Syndr Hum
Retrovirol, 1996; 12: 153–7).
As the components of Ambrotose
Complex—all of which are dietary
fibres—are largely indigestible, say
Schnaar and Freeze, they therefore
question whether these ingredients
could really deliver biologically
meaningful concentrations of indi-
vidual monosaccharides to human
tissues.
“While there are clearly established
health benefits of including indiges-
tible fibre in the diet, the implication
that larch-bark arabinogalactans, aloe
vera gel glucomannan and plant-gum
emulsifiers are a biologically signifi-
cant source of dietary monosac-
charides required for optimal cellular
health appears to the authors to be
unsupported,” the article states.
Besides a relatively high price tag,
perhaps the biggest cause for concern
WDDTY Supplements under the microscope 25
is the organization of Mannatech, as
a decentralized multilevel marketing
company. Any MLM operates with an
army of self-employed entrepreneurs,
all selling the product through
independent networks and free to
make any claims.
Indeed, in 2007, Mannatech and its
‘associates’ (sales force) were accused
by the Attorney General of Texas of
using “. . . false, misleading, or
deceptive acts or practices . . .” to
“sell [glyconutrients] as a way to cure,
mitigate, treat, or prevent diseases,
illnesses or serious conditions, despite
[their] admission that the products
do not cure any disease” (Glycobiology,
2008; 18: 652–7).
In the US, supplement companies
are free to sell their products, but can
run foul of the law if they make any
therapeutic claims.
Mannatech reportedly reached a
settlement for this case, and for a
class-action lawsuit brought against it
in 2005, in 2009.
The bottom line
Ultimately, there’s a lack of inde-
pendent research on glyconutrients,
and certainly no proof that these
supplements can prevent or cure any
particular disease. Furthermore,
other, far cheaper nutrients have been
proven to provide the same kinds of
benefits claimed thus far. Extracts of
the herb Ginkgo biloba, for instance,
have been shown to improve memory
and other mental abilities (J Altern
Complement Med, 2000; 6: 219–29).
Many glycobiologists view the term
‘glyconutrient’ as nothing more than
a marketing gimmick used to sell
products rather than an accepted
medical/scientific term.
There is a legitimate field of
research called ‘glycobiology’, which
is now finding that glycans are key
components in human physiology.
As alternative cancer specialist Dr
Ralph Moss recently wrote: ‘Glyco-
biology is a promising avenue of
research, to be sure. However,
network marketing creates a rah-rah
atmosphere, in which a chemical
becomes a product and a product
then becomes a profit center . . . and
an ideological cause.” That cause—
that glyconutrients are an all-purpose
cure-all—remains pure hype.
Joanna Evans

Aloe vera
This ‘miracle plant’
appears to work in a wide
range of conditions
loe vera has been hailed as a
A miraculous healer for thousands
of years, and is probably the
most popular alternative remedy
today. The sticky gel that comes from
the thick succulent leaves of the
plant—known officially as Aloe barba-
densis, a member of the lily family—
is commonly used both topically and
internally for a whole catalogue of
conditions. However, is there any evi-
dence that it works?
Topical applications
One of the most popular uses of aloe
vera is for healing burns, and there’s
considerable evidence to back up its
effectiveness for such wounds. When
an aloe-based cream was pitted against
the antimicrobial cream silver
sulphadiazine in 30 patients with
second-degree burns, the burns
treated with aloe healed significantly
faster than those treated with the
standard over-the-counter treatment
(Surg Today, 2009; 39: 587–91).
Confirming these results, a 2007
review—which pooled the data from
four different studies—revealed that
the burns patients treated with aloe
vera healed an average of nine days
sooner than those in the control
groups (Burns, 2007; 33: 713–8). Neverthe-
less, and interestingly, aloe vera cream
has no proven efficacy for treating
sunburn, for which it is so often used
(J Med Assoc Thai, 2005; 88 Suppl 4: S173–6).
However, several studies suggest
that aloe vera is effective for certain
skin conditions, including psoriasis,
seborrheic dermatitis (dandruff) and
genital herpes (Indian J Dermatol, 2008; 53:
163–6). Yet, despite its well-known anti-
inflammatory properties, it’s not been
successful in preventing or minimizing
radiation-induced skin reactions, such
as those seen in cancer patients (Clin
Oncol [R Coll Radiol], 2005; 17: 478–84).
Where it has been showing a lot of
promise lately is in treating oral-health
problems. In the laboratory, an aloe
vera tooth gel was found to be more
effective at fighting bacteria than two
26 WDDTY Supplements under the microscope
2006; 60: 1080–6).
Four separate reviews of the scien-
tific literature suggest that oral aloe
vera may be useful for reducing blood
glucose in diabetic patients and for
lowering LDL (bad) cholesterol (Br J
Gen Pract, 1999; 49: 823–8).
The herbal remedy may even be able
to help in the treatment of cancer.
When Italian researchers evaluated the
use of oral aloe vera (A. arborescens
in this case; 10 mL three times a day)
in 240 metastatic cancer patients
receiving chemotherapy, those taking
the aloe fared significantly better in
terms of tumour regression and
survival time compared with those
treated with chemo alone (In Vivo, 2009;
23: 171–5).
Aloe vera products
popular commercial toothpastes (Gen Aloe vera contains a wealth of bio-
Dent, 2009; 57: 238–41), while trials in logically active substances, so it’s no
people have reported the successful wonder that it’s proving to be so useful
treatment of plaque, gum disease and across such a wide range of conditions.
oral lichen planus (an often painful Polysaccharides—the long-chain sugar
inflammatory condition affecting the molecules found in aloe vera gel—may,
tongue and soft tissues of the mouth) for instance, be responsible for its anti-
with aloe vera (J Appl Oral Sci, 2008; 16: inflammatory, antifungal and wound-
293–6; Br J Dermatol, 2008; 158: 573–7). healing effects (Molecules, 2008; 13:
1599–616).
Internal use However, when it comes to the aloe
There’s less evidence to support the products available on the market, do
use of aloe vera taken internally, but they all provide the same benefits?
what studies there are show promise. According to one report, commercial,
Oral aloe vera gel (100 mL taken twice stabilized gel products may not work
daily for four weeks) led to significant as well as the fresh gel, although cold
improvement in patients with ulcera- processing is believed to best retain its
tive colitis—a form of inflammatory beneficial properties (Toxicol Appl Phar-
bowel disease (IBD)—compared with a macol, 2008; 227: 125–35).
placebo (Aliment Pharmacol Ther, 2004; 19: It may also be a good idea to look
739–47). for products that have been certified
However, a study by St George’s by the International Aloe Science
Hospital Medical School in London Council (IASC), which was set up to
found equivocal results with aloe in test the purity of the aloe contained
patients with irritable bowel syndrome in these products (see its website at
(IBS), despite a trend towards symp- www.iasc.org for more information).
tomatic improvement (Int J Clin Pract, Joanna Evans
Aloe safety
The external use of aloe vera appears to be safe, although allergic
reactions have been reported. This may be more likely if it’s used fresh
from the plant, as commercial aloe products tend to be processed to
eliminate its irritant extracts (Contact Dermatitis, 2007; 57: 278–9).
Also, when taken internally, some of the constituents of aloe—namely,
anthraquinones, found in the juice (latex), but not the gel of the plant—can
cause stomach cramps and diarrhoea due to its potent laxative effects
(Indian J Dermatol, 2008; 53: 163–6).
Bee propolis
Mounting research suggests
that this all-natural product
produced by honeybees can
treat dental disorders, skin
problems and even
infertility
ropolis, the sticky substance
P made by honeybees (Apis mel-
lifera) from plant resins, is one
of the few natural remedies that has
remained popular over a long period
of time. It is used in folk medicines
from many different places around
the world, and is claimed to have
beneficial effects on human health.
Nowadays, it’s found in everything
from supplements, sprays and
tinctures to creams, cosmetics and
chewing gum.
But is there any evidence to
support its use, and can it really treat
conditions as varied as tooth decay,
arthritis and cancer?
Propolis research
Research carried out in the
laboratory shows that bee propolis
has a broad range of biological
activities, including antibacterial,
antiviral, anti-inflammatory and even
anti-cancer effects (Biol Pharm Bull,
2009; 32: 1244–50). Indeed, a recent
study of Brown Cuban propolis, the
major type of propolis from bees in
Cuba, found that it significantly
inhibited the growth of human breast
cancer cells (Nat Prod Commun, 2009; 4:
1711–6).
The real test, however, is to
determine whether or not propolis is
effective in proper randomized,
placebo-controlled clinical trials.
Nevertheless, so far, what evidence
there is suggests that propolis may
be useful for the following
conditions.
u Dental disorders
Propolis has proved successful
against a raft of dental problems,
ranging from plaque and cavities
to gum disease and mouth ulcers.
In one study carried out in Brazil,
patients used a water-and-alcohol-
based, propolis-containing mouth-
wash for 45 days after oral surgery.
The researchers concluded that it
not only supported the repair of
surgical wounds, but also had
effective painkilling and anti-
inflammatory effects (J Nihon Univ
Sch Dent, 1994; 36: 102–11).
More recently, propolis gel was
shown to be an effective treatment
for denture stomatitis, a chronic
condition characterized by palatal
oedema and redness, which can
be caused by a fungal infection 73 per cent of those treated with
(in particular, Candida albicans) propolis were able to be rid of
as well as bacterial infection, their plane and common warts,
mechanical irritation and allergy respectively, at the end of the trial
(Phytother Res, 2008; 22: 1544–7). (Int J Dermatol, 2009; 48: 1246–9).
Added to toothpaste, propolis can In yet another study, a propolis
prevent periodontal (gum) disease skin cream demonstrated bene-
and reduce plaque formation, as ficial effects on the healing of
well as have an anti-inflammatory partial-thickness burns wounds. In
effect (Folia Med [Plovdiv], 2001; 43: these patients, the antimicrobial
28–30). activity was similar to that of
u Skin problems standard treatment using silver
Propolis has also been used in an sulphadiazine. However, the
ointment to effectively treat skin wounds treated with propolis
infections such as genital herpes consistently showed less inflam-
(caused by herpes simplex virus mation and more rapid healing
type 2) (Phytomedicine, 2000; 7: 1–6). (scar formation) (J Altern Comple-
More recently, the remedy was ment Med, 2002; 8: 77–83).
tested in a three-month trial of u Infertility
135 patients who had different In a preliminary study of 40
kinds of warts. Compared with women with infertility and mild
those treated with either Echin- endometriosis, supplementation
acea or a placebo, the cure rate in with propolis (500 mg twice a day
the propolis group was signifi- for six months) was associated
cantly better. Altogether, 75 and with a pregnancy rate of 60 per
Allergic reactions to propolis
Despite being a natural product, there have been some reports of allergic reactions
to propolis. These reactions are typically limited to skin rash but, as with other bee
products—such as pollen and royal jelly—more severe allergic reactions are
possible. Indeed, in a surveillance evaluation of propolis-containing products, there
were 18 suspected adverse reactions reported between April 2002 and August
2007, a third of which were serious. “[S]ix patients were admitted to hospital or
visited an emergency department and, in two of these, a life-threatening event was
reported,” the report states. In seven patients, an “allergic predisposition” was
found (Drug Saf, 2008; 31: 419–23).
It is, therefore, recommended that those who have a tendency towards
developing allergic disorders should avoid taking bee propolis unless tested first by
an allergy specialist. Individuals who are allergic to bee pollen, honey and/or conifer
and poplar trees should take particular care.
Furthermore, as the effects of propolis during pregnancy and breast-feeding
have not yet been adequately assessed, women are generally recommended not
to take propolis during such times, unless specifically directed to do so by a
qualified medical practitioner.
WDDTY Supplements under the microscope 27
 cent compared with a rate of 20
per cent in those taking a placebo
(Fertil Steril, 2003; 80 [Suppl 3]: S32).
Although the mechanism of action
remains unknown, the inhibition
of aromatase, an enzyme that is
involved in oestrogen metabolism,
might explain these results
(Townsend Lett, 2004; 249: 30).
u The common cold
In a study carried out in Poland,
50 ear–nose–throat patients who
were treated with propolis had
common-cold symptoms for only
one to three days’ duration
compared with the nearly five days
among those who took a placebo
(Otolaryngol Pol, 1989; 43: 180–4).
In another trial carried out in
Romania, preschool and school-
age children were given a water-
based preparation of propolis
(Nivcrisol) throughout the entire
colds season.
It was found that these children
had fewer cases of acute or
chronic symptoms, as well as a
decrease in the numbers of
disease-causing microorganisms
carried in their upper airways (Rom
J Virol, 1995; 46: 115–33).
28 WDDTY Supplements under the microscope
u Rheumatic disease or not propolis is effective for any
In a placebo-controlled trial of 190 particular health condition.
patients in Hungary, two propolis Furthermore, it’s not possible to
treatments were tested: purified know whether the propolis products
propolis and propolis saturated on offer in shops and online can
with anti-inflammatory trace actually provide the same benefits as
metals, respectively applied locally those seen in clinical trials. As usual,
and by iontophoresis (where the this means that you should always do
affected joints are immersed in a your homework before buying and go
conductive metallic-ion solution with a reputable brand.
that allows the transmission of a Joanna Evans
tiny electrical charge). The results
showed that symptoms such as
pain and inflammation were
significantly improved, especially
with the latter form of propolis
treatment (Orv Hetil, 1996; 137:
1365–70).
The bottom line
It appears that human trials of bee
propolis are promising and, when
considered together with the
hundreds of test-tube and animal
studies using the natural remedy, they
suggest that propolis may well be an
alternative product with a vast
potential for improving human health.
However, well-designed studies are
lacking, and more research is needed
before it can be determined whether
Rhodiola rosea
Is there scientific support
for the stress- and fatigue-
busting claims made for
this adaptogenic plant
he plant R hodiola rosea
T (golden or rose root) is a
popular herb famous for its
‘adaptogenic’ properties. Supp-
osedly, it helps the body adapt to
stress—be it chemical, biological
or physical—and offers benefit for
a range of conditions. But what
does the science tell us?
Rhodiola research
Since the 1960s, Rhodiola has been
extensively studied in Russia and
Scandanavia, although many of the
studies are unavailable. However,
of those that are accessible, the
majority are highly positive,
supporting the idea of R. rosea as
an effective adaptogen.
Indeed, trials suggest that
Rhodiola can improve mental
alertness in people suffering from
sleep deprivation or other stressful
circumstances. When 56 physicians
on night duty were given either a
standardized extract of Rhodiola
(170 mg/day) or a placebo for two
weeks, those taking the herb
performed significantly better on a
number of tests, including mental-
arithmetic and memory challenges
(Phytomedicine, 2000; 7: 365–71 ).
Similarly, in exam-stressed
students and compared with a
placebo group, those taking
Rhodiola saw significant imp-
rovements in physical fitness,
psychomotor function, mental
perfor-mance and general
wellbeing. These findings were
even more surprising, given that
the dose (100 mg/day) was very
low (Phytomedicine, 2000; 7: 85–9).
Also, when Rhodiola was tested
in 161 male militar y cadets
undergoing sleep deprivation and
stress, it proved to be more
effective than a placebo
at fighting the effects of fatigue
(Phytomedicine, 2003; 10: 95–105 ).
More recently, Rhodiola has
been shown to be a powerful
endurance enhancer. When
Chinese scientists fed rats extracts
of R. rosea (125 mg/day) for four
weeks, their swimming per-
formance significantly improved
(Chin J Physiol, 2009; 52: 316–24 ).
Although such animal results
may not apply to people, clinical
studies have been equally
impressive. In one, 200 mg of
Rhodiola taken one hour before
endurance exercise allowed the
volunteers to exercise longer
before getting tired (Int J Sport Nutr
Exerc Metab, 2004; 14: 298–307 ).
Beyond fatigue
Besides alleviating mental and
physical fatigue, the plant may also
be useful for depression.
In one randomized, controlled
trial, 89 patients with mild-to- rosea extract can protect rats
moderate depression were given against cognitive deficits, neuronal
either Rhodiola extract (340 or injur y and oxidative stress
680 mg/day) or a placebo for six . . . and may be used as a potential
weeks. The results showed that the agent in treatment of neurodegen-
herbal treatment significantly erative diseases such as
improved their overall depression Alzheimer’s disease” (Biomed Environ
as well as insomnia and emotional Sci, 2009; 22: 318–26).
instability (Nord J Psychiatry, 2007; 61: Other animal evidence suggests
343–8). that Rhodiola might benefit the
Other findings hint at neuropro- heart and even fight cancer. In rats
tective effects. Rats pretreated with tumours, Rhodiola supp-
with the herb fared better after lementation inhibited tumour
being injected with a brain- growth, reduced metastases to the
damaging drug (streptozotocin). liver and extended survival ( Altern
The authors concluded that “R. Med Rev, 2001; 6: 293–302). However,
More about Rhodiola
Rhodiola rosea contains a number of potentially active compounds, but its
main action is apparently to increase beta-endorphins which, in turn, are
believed to inhibit stress hormones such as adrenaline (epinephrine) (Biull
Eksp Biol Med, 1987; 103: 422–4).
The plant’s key constituents are two glycosides: rosavin and salidroside.
When choosing a product, make sure the extract is at least 2.5-per-cent
rosavin and 1-per-cent salidroside. The usual dose is 50 mg of
standardized extract twice a day but, as with any herbal remedy or
supplement, if you are pregnant, breastfeeding, on medication or have a
medical condition, it may be prudent to consult your healthcare practitioner
before taking it.
Herbalists should be aware that only the roots contain the active
ingredients, and just a few grammes of root in a cup of boiling water
provide a satisfactory daily dose.
WDDTY Supplements under the microscope 29
whether these results also apply to
humans remains to be seen.
A pinch of salt
It’s worth bearing in mind that
most of these studies come from
Russia and China, countries known
to publish unusually high numbers
30 WDDTY Supplements under the microscope
of studies with positive findings
( Control Clin Trials, 1998; 19: 159–66 ).
Also, the studies tend to involve
only small numbers of people, so
larger-scale and longer-term trials
are clearly required before any
definitive conclusions can be
drawn.
Nevertheless, Rhodiola appears
to be safe (at least, in the studies
done so far), so if it’s a pick-me-up
that you’re after, it certainly
appears to be a useful alternative
to the caffeine-laden, potentially
harmful, ‘energy drinks’ currently
on the market.
Joanna Evans

Butterbur
The herb butterbur is
often touted as a natural
remedy for hay fever, but
can it really stop seasonal
sneezing?
utterbur (Petasites hybridus)
B is a shrub-like plant with a
long history of medicinal use.
Dur-ing the Middle Ages, it was used
to treat the plague and fever and, in
the 17th century, it was a common
treatment for cough, asthma and
skin wounds. Today, however,
butterbur is probably best known as
an alternative remedy for hay
fever—with some claiming that it’s
just as effective as antihis-tamines.
Where’s the evidence?
Unlike some of the natural
remedies currently marketed for
hay fever, butterbur has scientific
proof that it works. A number of
studies—most of which were using
a standardized extract of the herb
known as Zeller’s extract (ZE
339)—have found butterbur to be
effective for relieving seasonal
symptoms such as sneezing, itchy
eyes and runny nose.
In one randomized controlled
trial (RCT)—considered the ‘gold-
standard’ for the scientific evalua-
tion of treatments—186 hay-fever
sufferers were given either a high
or low dose of ZE 339, or a placebo,
every day for two weeks.
The results showed that the
butterbur extract was significantly
better at improving symptoms than
the placebo. What’s more, the
higher dose was more effective than
the lower dose. Such ‘dose-
dependency’ is generally taken to
be a sign that the treatment truly
does work (Arch Otolaryngol Head Neck
Surg, 2004; 130: 1381–6).
In another RCT, 330 patients
received either butterbur extract
(one ZE 339 tablet three times a
day), the antihistamine fexofen-
adine or a placebo for their hay
fever. The butterbur preparation
proved to be just as effective as the
antihistamine, and both were better
than the placebo (Phytother Res, 2005;
19: 530–7).
Similarly, when butterbur was
pitted against the antihistamine
cetirizine, they were both equally
effective at improving symptoms.
“Butterbur should be considered
for treating seasonal allergic
rhinitis [the medical term for hay
fever] when the sedative effects of
antihistamines need to be avoided”,
concluded the researchers ( BMJ,
2002; 324: 144–6).
Although one small trial reported
that butterbur had no significant
effects ( Ann Allergy Asthma Immunol,
2004; 93: 56–60), a review of the litera-
ture on all butterbur research thus
far concluded that there is
“encouraging evidence” that the
herb may be an effective hay-fever
treatment. Nevertheless, the study
highlighted the need for more
independent studies, as three large
trials had received financial support
from a butterbur-extract manufac-
turer (Ann Allergy Asthma Immunol, 2007;
99: 483–95).
Other medicinal effects
Butterbur appears to be useful for
a number of other conditions as
well as hay fever. Migraines, in
particular, appear to respond well
to the herb.
In one four-month American
study, 245 patients who suffered
from frequent migraines were
randomly assigned to one of three
groups: the first group took 75 mg
of butterbur root extract twice
daily; the second group took 50 mg
of the extract twice daily; and the
third group took a placebo. Neither
the researchers nor the participants
knew who was taking what (double-
blind).
At the end of the study, the
results showed that only the higher
dose of butterbur was significantly
superior—at one, two and three
months—to the placebo in reducing
the frequency of migraine attacks
(Neurology, 2004; 63: 2240–4).
However, in a study aiming to
assess the effectiveness of butterbur
extract taken as a preventative
(prophylactically), just 50 mg/day
(one 25-mg capsule of butterbur
root extract taken twice a day for 12
weeks) was enough to significantly
WDDTY Supplements under the microscope 31
reduce the frequency of migraines
compared with a placebo—with no
reports of any adverse events (Altern
Med Rev, 2001; 6: 303–10).
There’s also evidence that
butterbur may be useful against
asthma attacks. In one preliminary
trial, 64 adults and 16 children/
adolescents were treated with an
extract of the herb (Petadolex) in
addition to their usual asthma
medication for two to four months.
Not only did the number, duration
and severity of attacks decrease
during the therapy, but the forced
expiratory volume increased (a sign
of better lung function) and all the
other assessed symptoms improved,
too. Moreover, more than 40 per
cent of the patients were able to
reduce their use of asthma
medications by the end of the study
(Altern Med Rev, 2004; 9: 54–62).
Some studies hint that butterbur
might also be beneficial for
gastrointestinal disorders (such as
stomach ulcers) and bladder
problems ( Altern Med Rev, 2001; 6:
207–9). However, the evidence so far
suggests that it’s not effective
against allergic skin reactions such
as eczema (Ann Allergy Asthma Immunol,
2004; 92: 250–4).
Dosage and safety
The usual dosage of butterbur is
50–75 mg twice daily of a stand-
ardized extract of the herb (usually
containing a minimum of 7.5 mg
of petasin and isopetasin, the main
active ingredients). In general, this
is well tolerated, with only mild
gastrointestinal complaints (such
as burping) being the most com-
monly reported side-effects ( Adv
Ther, 2006; 23: 373–84).
However, butterbur is known to
contain toxic compounds called
‘pyrrolizidine alkaloids’. These may
be harmful to the liver and possibly
carcinogenic; happily, alkaloid-free
preparations are available.
At this time—and until further
safety testing has been carried
out—it’s advisable that butterbur
not be used by pregnant or nursing
women, young children, and those
with severe kidney or liver disease.
If in doubt, it’s best to consult a
qualified health practitioner.
Joanna Evans
32 WDDTY Supplements under the microscope
Other herbal helpers
Butterbur is not the only herb that can treat hay fever. The following herbs
have also proved to be effective in clinical trials.
u Nettle (Urtica dioica). Test-tube studies show that nettle extract inhibits
several key inflammatory events that lead to the symptoms of hay fever
(Phytother Res, 2009; 23: 920–6). In one randomized, placebo-controlled trial
of 69 subjects, 58 per cent rated nettle (300 mg, freeze-dried) “effective”
in relieving their symptoms, while 48 per cent found it to be the same as,
or better than, their previous medication (Planta Med, 1990; 56: 44–7).
u Aller-7. This patented blend of seven standardized herbal extracts
(Phyllanthus emblica, Terminalia chebula, T. bellerica, Albizia lebbeck,
Piper nigrum, P. longum and Zingiber officinale) appears to be safe and
effective for hay fever. In a 12-week trial of 545 patients, Aller-7
significantly reduced sneezing, runny nose and nasal congestion (Int J
Clin Pharmacol Res, 2004; 24: 79–94).
u Milk-vetch root (Astragalus membranaceus). A study of 48 adults with
moderate-to-severe hay fever found that a food supplement containing
this herb was “strikingly” better than placebo at improving symptoms
(Phytother Res, 2010; 24: 175–81).
Milk thistle
’Tis the season to overdo
it, but is milk thistle the
best natural cure?
ozens, if not hundreds, of
D hangover remedies have been
proposed over the years, but
one that keeps cropping up time and
again is milk thistle (Silybum
marianum), a herb that comes with a
long history of medicinal use.
Especially at this time of year, the
Internet is awash with articles, adverts
and testimonials claiming that milk
thistle is the answer to the after-effects
of alcohol overindulgence.
The general recommendation is
that you should take a milk-thistle pill
before you start drinking to reduce all
of those negative side-effects the day
after. But is there any truth to this
widely held belief?
What the science says
Surprisingly, there do not appear to
have been any scientific studies to
assess the effectiveness of milk thistle
for either preventing or treating
hangovers. However, a number of
clinical trials have looked at whether
the herb can treat alcohol-related liver
disease. The results of some of these
studies suggest that silymarin—a type
of polyphenol believed to be the major
active constituent of milk thistle—can
be useful in the management of early
or progressive liver damage when taken
for one to six months.
In one such trial, nearly 100
patients with alcoholic liver disease
(ALD) were randomly allocated to
receive either silymarin or a placebo for
four weeks. Alcohol consumption was
strictly prohibited during the trial, and
several indicators of liver damage were
assessed.
The results showed that silymarin
was associated with a highly significant
reduction in levels of alanine
transaminase (ALT) and aspartate
transaminase (AST)—liver enzymes
that are commonly increased in
patients with ALD and so are used as
indicators of liver damage. The
silymarin group was also more likely
to show other signs of improved liver
health compared with the placebo
group, including normalization of
liver tissue changes due to the disease
(Scand J Gastroenterol, 1982; 17: 517–21).
In another trial, 36 patients with
chronic ALD were given either sily-
marin at a dose of 420 mg/day or a
placebo for six months. Here again,
the researchers noted a number of
significant improvements in terms of
liver damage in those taking silymarin,
including normalization of ALT and
AST levels, and improvement in their
liver biopsy examinations.
“These results indicate that sily-
marin exerts hepatoprotective [liver-
protective] activity and is able to
improve liver functions in alcoholic
patients,” the researchers concluded
(Orv Hetil, 1989; 130: 2723–7).
The same dose of silymarin was
tested in a French trial of 116 patients
with alcoholic hepatitis (liver inflam-
mation). In this case, 57 patients were
given silymarin and 59 took a placebo
every day for three months. At the end
of the trial, silymarin was found to
significantly alter the course of the
disease, as determined by biological
and histological (tissue) parameters.
Curiously, however, significant
improvements were seen in both the
silymarin and placebo groups, leading
the authors to conclude that the
dosage of 420 mg/day was “not clin-
ically relevant in the treatment of
moderate alcoholic hepatitis” (Gastro-
enterol Clin Biol, 1989; 13: 120–4).
Nevetheless, yet another study—this
time in Austria—assessed the potential
value of 420 mg/day in 170 patients
with liver cirrhosis, roughly half of
whom had alcoholic cirrhosis. After
an observation period of more than
three years (41 months on average),
the Viennese researchers reported a
58-per-cent survival rate in those
taking silymarin compared with a
39-per-cent rate of survival in those
taking the placebo—a difference that
was statistically significant. Further
analysis of various patient subgroups
revealed that silymarin treatment was
also effective in patients with alcoholic
cirrhosis (J Hepatol, 1989; 9: 105–13).
It’s likely that these studies—along
with evidence from animal studies
showing that silymarin can protect
WDDTY Supplements under the microscope 33
against alcohol-induced liver damage
(Indian J Med Res, 2006; 124: 491–504)—may
have fuelled the belief that milk thistle
can help to prevent the after-effects of
a night of heavy drinking.
However, the fact that these studies
suggest that milk thistle can be of
benefit in the case of alcoholics
doesn’t necessarily mean that healthy
moderate or occasional drinkers will
experience the same effects. Moreover,
even if milk thistle could protect
healthy livers against the harmful
effects of alcohol, this still doesn’t tell
us whether the herb can help with a
hangover.
Nevertheless, a recent extensive
review of silymarin—assessing its basic
pharmacology through to its clinical
applications—can shed some light on
the matter. As the authors, based in
Pondicherry, India, have pointed out,
“Silymarin has no direct effect on
ethanol [alcohol] metabolism and has
no role in reducing ethanol levels or
the rate at which ethanol is removed
from the body” (Indian J Med Res, 2006;
124: 491–504). This suggests that it’s
unlikely that milk thistle would be of
any use for a hangover.
However, a study of a different
herb—Opuntia ficus indica, or prickly
pear—reported that the symptoms of
hangover may be largely due to
inflammation triggered by impurities
in alcoholic beverages and by the
byproducts of alcohol metabolism in
the body. This study found that prickly
pear taken five hours before the
consumption of alcohol significantly
reduced hangover symptoms and their
severity in healthy volunteers
compared with a placebo, and
appeared to work via an anti-
inflammatory effect (Arch Intern Med,
2004; 164: 1334–40). As silymarin is also
known to have anti-inflammatory
properties, this could perhaps result in
similar hangover-reducing effects.
Still, until such a study is conducted
with silymarin itself, we just don’t
know if this is the case.
Is it safe?
The bottom line is that, as yet, there’s
no proof to show that milk thistle can
either prevent or treat a hangover.
However, if you still want to give it a
go, it’s unlikely to do you any harm.
Milk thistle is usually used as a
standardized extract (containing 70-
to 80-per-cent silymarin) in the form
of capsules, with 100–300 mg three
times a day being the typical adult
dose. Human studies have shown that
silymarin is non-toxic and without
side-effects when given to adults in
divided doses up to 900 mg/day. At
higher doses of more than 1500
mg/day, silymarin may produce a
laxative effect, which could be due to
increased bile flow and secretion. Mild
allergic reactions have also been noted
(Indian J Med Res, 2006; 124: 491–504). In
addition, if you’re taking any other
medications or are pregnant, it may
be better to consult a qualified prac-
titioner before trying milk thistle.
Joanna Evans
34 WDDTY Supplements under the microscope
New uses of milk thistle
Although milk thistle has a long history of use for liver diseases, new evidence
suggests that it may also help in a range of other conditions.
u Alzheimer’s disease. A recent study from Japan has found silymarin to be
a promising agent for the prevention of this progressively debilitating brain
formation of fibrils (fine fibres) by amyloid beta-protein—at least in a test
disease. Using a mouse model of Alzheimer’s, silymarin suppressed the
tube. These fibrils are thought to play a key role in the development of the
disease (Biosci Biotechnol Biochem, 2010 November 7; Epub ahead of print).
However, such results may not necessarily be seen in humans.
u Cancer. Laboratory studies have found that silymarin and its main
constituent, silibinin, have powerful anticancer effects (Anticancer Agents
Med Chem, 2010; 10: 186–95). One study involving both test tubes and animals
showed that silibinin can suppress the growth and induce the cell death
(apoptosis) of human advanced colorectal cancer cells (Mol Cancer Ther, 2009;
8: 2366–74).
In addition, a recently published study has examined the efficacy of a
combination of silymarin and selenium in 37 men who had undergone
radical prostatectomy. The results after six months showed that the
silymarin–selenium supplement had significantly reduced two markers of fat
metabolism—low-density lipoproteins (LDLs, the ‘bad’ fats) and total
cholesterol—known to be associated with prostate cancer progression
(Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub, 2010; 154: 239–44).
u Diabetes. In a randomized, double-blind, placebo-controlled trial—the
‘gold standard’ for scientific evaluation—51 patients with type 2 diabetes
were given either silymarin (200 mg three times a day) or a placebo together
with conventional therapy for four months. At the end of the study, the
researchers noted several significant improvements in the silymarin group,
including reduced fasting blood glucose and lower levels of total
cholesterol. “In conclusion, silymarin treatment in type II diabetic patients
for 4 months has a beneficial effect on improving the glycemic profile,” the
researchers said (Phytother Res, 2006; 20: 1036–9).
u Skin disorders. Silymarin also appears to protect the skin against
ultraviolet (UV) radiation-induced damage, which can cause sunburn,
premature skin ageing and skin cancer (Biomed Pap Med Fac Univ Palacky
Olomouc Czech Repub, 2005; 149: 29–41). However, clinical (human) trials are
needed. Nevertheless, the evidence so far shows that silymarin has
powerful antioxidant and anti-inflammatory properties, which would make it
a valuable skin-protecting agent (Int J Oncol, 2010; 36: 1053–60).
u Heart disease. The latest laboratory evidence suggests that milk thistle
may have a role to play in heart health, although the results need to be
confirmed in clinical trials. Researchers at the University of Arkansas
discovered that silymarin significantly protected LDL cholesterol against
oxidation, thought to be a major contributor to atherosclerosis—the build-
up of plaque in the arteries (J Agric Food Chem, 2008; 56: 3966–72).
In another, test-tube study, Chinese scientists reported that silibinin
protected against inflammation, fibrosis and cardiac hypertrophy—
thickening of the heart muscle, a major cause of heart failure (J Cell Biochem,
2010; 110: 1111–22).