The last few years have seen an explosion in the number of probiotic supplements on pharmacy and supermarket shelves, with more than 200 currently available. In addition, there are many foods – especially yoghurt products – spruiking their probiotic benefits, and enthusiastic home fermenters are brewing up their own probiotic-rich foods such as kefir, kombucha, sauerkraut and kimchi.

In this article we look at the sorts of benefits probiotics have been shown to provide in clinical situations, and the evidence behind some of the claims on consumer probiotic products – including claims related to COVID-19.

Healthy gut bacteria

Some of the most commonly found genus of gut bacteria in adults are Bifidobacterium, Lactobacillus, Bacteroides, Clostridium, Escherichia, Streptococcus and Ruminococcus. There are also yeasts and other microbes. While any one individual may have several hundreds of different species, human populations as a whole have thousands.

Collectively called the microbiome, these organisms play an essential role in digestion, including the production of vitamins and fatty acids, and are critical for normal immune system development. They also keep pathogenic (bad) bacteria in check.

However, there may be situations where additional help is needed – bacteria get out of balance due to poor diet, illness or a course of antibiotics. This is called dysbiosis.

Studies in humans and other animals have found that certain strains of bacteria can have positive effects on conditions related to gut bacteria, and manufacturers have come to the party with microbial concoctions promising all sorts of health benefits.

Probiotics and prebiotics: What’s the difference?

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These are live microorganisms – such as bacteria, yeasts and fungi – which in adequate amounts may have health benefits.Ìý

Studies have shown they can improve digestion, help protect against disease and enhance immune function. Strains of lactobacillus and bifidobacterium bacteria are the most commonly used probiotics as they can survive the passage to the gut.Ìý

Probiotics are most widely available as dietary supplements in tablet, capsule and powder forms or as a component in yoghurts and fermented dairy drinks.

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These are non-digestible food ingredients that can increase the activity of select “good” bacteria.Ìý

Prebiotics naturally occur in bananas, asparagus, leeks, onions, garlic, chicory and wholegrains like wheat, rye, barley and oats.Ìý

Savvy marketers spruik their benefits in foods including breads and infant formulas.

What about synbiotics?Ìý

These are products that contain both prebiotics and probiotics.

Do probiotics work?

While individual studies and anecdotal evidence suggest a wide range of uses, well-studied and accepted uses for probiotics are much fewer.Ìý

Some of the main claims you’ll find on probiotic products are fairly general and relate to digestive and immune system support, although some are more specific, mentioning preventing colds, eczema and relief from the symptoms of irritable bowel syndrome.

What conditions do probiotics help with?

Some of the conditions that might be helped by taking probiotics include:Ìý

Antibiotic associated diarrhoea

that taking widely available types of probiotics alongside a course of antibiotics may help reduce the risk of getting diarrhoea.Ìý

They may also reduce the likelihood of getting a Clostridium difficile infection, which can have long-term serious consequences.Ìý

Successful strains include Lactobacillus rhamnosus GG, L. acidophilus (found in yoghurt), L. caseii and Saccharomyces boulardii (a yeast).

Infectious diarrhoea

Probiotics can also reduce the severity and duration of infectious diarrhoea (caused by rotavirus, for example) .

Irritable bowel syndrome (IBS)

While there are studies that show some benefit from probiotics in reducing symptoms of IBS, there’s no consensus on which strains or dose.Ìý

The symptoms of IBS vary from person to person, so it’s considered unlikely that there’s a one size fits all treatment. That said, they could be worth a try – discuss the options with your doctor.

Inflammatory bowel disease

Probiotics may be useful for treating pouchitis, a side effect of bowel surgery for people with ulcerative colitis.Ìý

However, the evidence for treatment of ulcerative colitis itself is inconclusive, with some studies suggesting a modest effect. Your doctor may be able to recommend products that could help.Ìý

There’s no evidence probiotics are useful for Crohn’s disease.

Eczema and other allergies

There’s some research showing that women taking probiotics in pregnancy and while breastfeeding can prevent eczema in their baby’s early life, although, as yet there’s not enough known about the best species or dose to provide recommendations.Ìý

There are also some studies looking at other allergies, such as hay fever, but there’s not enough evidence to draw any conclusions.

Coughs and colds

Probiotics are popularly thought to reduce the risk of upper respiratory tract infections (including colds, sinusitis and pharyngitis) via their effects on the immune system.Ìý

While some studies have found this to be the case, a large systematic review of the studies considered the overall quality of evidence low, with criticisms about the way the research was conducted, inconsistent results, or for being funded by probiotic companies, and therefore at risk of bias.

Helicobacter pylori (H. pylori) infection

This is a bacteria found in around half the population, and under certain circumstances can lead to stomach and duodenal ulcers and cancers in the gastric system.Ìý

Probiotics from the Lactobacillus genus can be as an addition to standard antibiotic therapy, boosting their effectiveness and reducing some of the side effects of antibiotics. The optimal species and dose are yet to be determined.Ìý

‘Immunity’

Many products make general claims about “supporting” the immune system, or “boosting immunity” – presumably meaning you get sick less often.Ìý

There are various mechanisms by which probiotics may activate certain aspects of the immune system, but it’s difficult to prove that taking them makes you healthier overall.Ìý

An overactive immune system could leave you susceptible to allergies or autoimmune diseases. Meanwhile, people who are immune-compromised should not take probiotics.

Traveller’s diarrhoea

It’s estimated about travelling to certain countries in Asia, the Middle East, Mexico, Central and South America and Africa will suffer from traveller’s diarrhoea (TD), usually caused by (bad) bacteria.

Some studies have found taking probiotics – especially lactobacillus species – while travelling (and some time before and after) can reduce the risk of TD, but other studies have found no effect. The best type of probiotic likely depends on where you’re travelling, and it’s possible that high temperatures and humidity may affect the probiotics. More studies are needed to determine which, if any, will help.

Will probiotics help against COVID-19?

You may have seen claims that probiotics can help protect against COVID-19, though they generally stop short of directly stating the supplements will treat COVID-19.

One argument is based on tenuous links with (inconclusive and poor quality) research on probiotics and colds and flus, suggesting if they’re good for some respiratory infections, they may also be good for COVID-19. It’s also been suggested that they may be helpful for treating diarrhoea that some coronavirus patients get. Most commonly they’re recommended to support or boost immunity, so if COVID-19 comes along you can fight it more effectively.Ìý

It’s early days yet, with much still to be learnt about the virus and no good clinical evidence to support any of these claims.

Health benefits of probiotics

There are numerous challenges in determining whether probiotics can help in a particular condition, and much of the uncertainty about whether over-the-counter products do anything lies in the difference between products tested in clinical trials and those on the market.

Firstly, there are many different species of probiotic, and within each species there may be a number of different strains. These different strains – each typically patented by their developer – may have different effects, regardless of species.

What’s tested in clinical trials may be a single strain or a combination of two, three or more. Strains may enhance or negate the effects of each other. That means the findings in a given trial are pretty much restricted to that exact formulation, and can’t necessarily be generalised to similar strains or species, and certainly not ‘probiotics’ in general (although in some situations, effects may be more widely applicable to more than one specific strain). Nor can you take a few different strains that each seem to do something and combine them for a mega-probiotic cure-all.

Running clinical trials is expensive and time-consuming, so those that are conducted tend to be small and short-term, most strains only have a single clinical trial, and trials that are funded by the manufacturer of a product may be biased.

So you can see, because the action and effectiveness are strain-specific – and specific to a particular combination of strains if there is more than one – for consumers to be confident a product will act as claimed, evidence must be provided for each probiotic product individually, preferably using products identical to those sold to consumers, in large, high-quality, long-term, multi-centre, independently funded trials.

Should a healthy person take probiotics?

If probiotics can help in situations of dysbiosis, can they help make healthy people healthier? The short answer seems to be no. have found that giving healthy people probiotic supplements doesn’t change their microbiome, and they don’t provide any health benefit.

But while they’re likely harmless, they may have unexpected effects. found that rats given probiotics suffered impairment in one aspect of memory. Authors acknowledged the finding was in rats, rather than humans, but this unexpected effect points to a need to exercise caution when recommending people take probiotics.

Israeli researchers also reported an unexpected effect, where the gut bacteria of people taking probiotics for antibiotic-associated diarrhoea took six months to return to normal.Ìý

A found that melanoma patients were less likely to respond to cancer immunotherapy if they were also taking probiotic supplements, although the study was too small to be conclusive.

The bottom line is that there’s not enough known about probiotic supplements to assume they’re unequivocally safe.

Which foods are rich in probiotics?

Fermented foods, such as yoghurt, kefir, sauerkraut and kimchi, contain live bacteria and have been linked with numerous health benefits, although the science is still lacking for many claims.Ìý

However, there’s a good argument for getting your probiotics from yoghurt (and other fermented foods) rather than a pill, as they contain other valuable nutrients.

Certain brands of yoghurt and cultured drinks (for example, Yakult) have been studied in clinical trials, and found helpful for treating diarrhoea and various other conditions. A 2015 Australian study, for example, found that Vaalia yoghurt reduced the incidence of diarrhoea in children taking antibiotics.Ìý

However, results obtained from one brand of yoghurt can’t be applied to all – as with pills, it depends on the strains of bacteria and dose. There’s also some concern that many trials are sponsored by the manufacturers, with the possibility of bias.

Then there are prebiotics – non-digestible food ingredients that can increase the activity of select ‘good’ bacteria. A high-fibre diet is naturally rich in prebiotics, with foods like bananas, asparagus, leeks, onions, garlic, chicory, and wholegrains like wheat, rye, barley and oats particularly beneficial.

Probiotic tips

• Different probiotic strains have different effects. Any product you use for a particular condition needs to be matched to the strain and dose found to work in clinical trials.Ìý
• The effects of probiotics, even when proven in clinical trials, are modest at best. They should supplement, rather than replace, conventional treatments.
• People respond differently to probiotics – for some people they’re accepted in the gut, while for others taking the same probiotics for the same condition, the probiotics pass straight through.
• Generally speaking, you need at least 10 billion colony-forming units (CFU) to have an effect, but the dose depends on the particular probiotic.
• Probiotics don’tÌý hang around in your gut for long. Therefore you have to take them every day to receive benefits. That may be okay for a defined event, like taking probiotics while on antibiotics. But for more nebulous claims, such as “boosted immunity”, that’s every day, always.
• The most common side effects of probiotics are gas and bloating, but they don’t last long.
• People who are critically ill or have compromised immunity shouldn’t take probiotics, unless approved by their doctor.
• A diet rich in vegetables, fruit and wholegrains, along with other healthy lifestyle measures such as regular exercise, avoidance of smoking or excessive drinking, and stress management will help provide ideal conditions for a healthy microbiome.

Labelling and regulation

In Australia, probiotic products are considered either functional foods and regulated by Food Standards Australia New Zealand (FSANZ), or complementary medicine and regulated by the Therapeutic Goods Administration (TGA).Ìý

While complementary medicines must show the amount of an active ingredient, foods don’t have to disclose the number of probiotic bacteria in a product, which makes it difficult for consumers to make an informed purchase decision.Ìý

The number of probiotic bacteria should be maintained to the end of a product’s shelf life to be of any health benefit.ÌýBut stability testing isn’t always undertaken by manufacturers and independent testing has shown some products have far fewer probiotics than they claim.

ÌÇÐÄVlog believes that health claims on food or complementary medicines should undergo pre-market assessment by the regulators to prevent manufacturers from making misleading or unsubstantiated claims. All probiotic products should name the probiotic bacteria to strain level and disclose the number of bacteria in the product to help consumers in their purchase decision.

The post What are probiotics? appeared first on ÌÇÐÄVlog.

There are four main groups targeted by protein supplement marketing. We weigh up the usefulness of supplements for each of these groups so you can decide whether they might be helpful, or just a waste of money:

• Athletes who want to build more muscle and recover quickly from exercise.
• People on weight-loss diets looking at protein to help keep hunger at bay, and also make sure they don’t lose muscle as well as fat.
• Older people who may not eat enough protein to prevent losing muscle, and may therefore struggle with day to day activities and ultimately independent living.
• Vegans looking for easy protein.

We’ve also looked at a range of widely available brands for tips on better buys.

Protein for athletes

People who exercise heavily tend to have a greater appetite, and they usually get enough protein from normal food without the need for a special high-protein diet or supplements.

Protein for weight loss

Most Australians get plenty of protein in their diet and don’t need protein supplements to achieve weight loss.

Protein for middle-aged and older people

For some people – especially frail elderly people who have little interest in eating – supplements could be the best option. Your doctor can give you a referral to a dietitian, and you may be eligible for a Medicare rebate.

Do vegans need a protein supplement?

It’s perfectly possible to get enough protein from a well-planned plant-based diet, but some vegans find protein supplements an easy and convenient way to get essential amino acids.

What to buy

We looked at products readily available in supermarkets and pharmacies and came up with product suggestions based on the cost per gram of protein. They range in cost from around 4 cents to 20 cents per gram, which works out at 80 cents to $4 for a 20 gram serve (actual recommended serving sizes vary according to product, but 20 grams is the minimum amount recommended to be effective).

Buying products online may better suit those with niche requirements or a need for larger quantities than a typical user. And, of course, you may need to taste a few different ones to see what you like best.

Low-carb plus artificial sweetener

Many of the widely available protein supplements contain artificial sweeteners, in particular stevia (which isÌýclaimed to be natural) and sucralose. This means you can get lots of sweet, flavoured protein for very little energy.

An example is Vital Strength 100% Premium Whey (4.5–7 cents per gram of protein). It’s sweetened with sucralose, comes in chocolate, vanilla and banana flavour, and can be found at supermarkets and pharmacies.

Unflavoured and unsweetened – a versatile option

You can also buy plain whey or vegan protein, with no flavours or sweeteners. This is a very versatile option, as you can add it to sweet and savoury foods and drinks: smoothies, shakes, soups and baked products. It also means you can choose the type and amount of sweeteners you prefer, whether sugar, honey, fruit or artificial sweeteners.

An economical example is Coles Unflavoured Whey Protein Concentrate (4.9 cents per gram of protein).

Older adults

While older adults could use any of the products above, there are supplements that may be better suited to some people because they contain added nutrients, more energy and don’t need special blending or shaking equipment – simply add milk or water and stir with a spoon. But be sure to discuss your options with your doctor or dietitian to find the most appropriate product – if any – for your needs.

One example is Sustagen Hospital Formula Active, which is available from supermarkets and pharmacies (in larger 840g containers, costing between $26–32).

Correction 28/3/19: An earlier version of this story had incorrect pricing information for Sustagen Hospital Formula Active and Vital Strength 100% Premium Whey which we’ve now updated.

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They may seem like a harmless product, and you might feel that you’re helping out a friend or family member by buying from them.Ìý

Unfortunately, essential oils may be a lot less innocuous than you think.

Is it safe to consume essential oils?

NSW Poisons Information Centre does not recommend consuming essential oils or even using them on your skin without a carrier oil (which dilutes essential oils before they’re applied to the skin).Ìý

“There’s very little information around the safety and efficacy of most essential oils, although we do have good data around the toxicity of a few,” says Genevieve Adamo, the centre’s senior specialist in poisons information and toxicovigilance.

“Eucalyptus oil, clove oil and peppermint oil are particularly nasty – ingesting as little as 2–3ml can cause sedation or drowsiness and 5ml can cause coma.

“We’ve also seen instances where people have picked up the wrong bottle and inadvertently dosed their child or baby with 5ml of an essential oil instead of 5ml of a medicine. That has the potential to cause serious poisoning.”

What are essential oils?

Essential oils are plant-derived volatile oils that have the aroma and other properties of the plant, and can be used in aromatherapy and to make perfumes.

Ingestion of some essential oils can cause:

• seizures
• mucosal irritation
• nausea
• vomiting
• burns
• and chronic exposure can potentially cause organ damage.

“Even with very small exposures there’s a risk that they can be aspirated into the airways which can cause a chemical pneumonitis, which is damaging to the lungs,” says Adamo.

If poisoning occurs from ingesting essential oil, call 000 or the poisons information hotline on 13 11 26.

Can you trust the health claims made by Doterra?

Doterra’s website states that “all [essential oil] application methods are safe when used appropriately including aromatic, topical, and internal methods” and that oils can be used in recipes to replace herbs or spices, added to water, tea, smoothies or other drinks, or taken internally (the company also provides recipes).

“People have a perception that anything natural is safe and that’s not the case,” says Adamo.

In 2017, NSW Poisons fielded 66 calls about exposure to Doterra oils. So far in 2018, there have been 90.

“We’re certainly seeing a much larger number of calls about exposures to these MLM essential oils, which used to be unheard of,” says Adamo.

“We have significant concerns around the fact that we do not know if the people selling essential oils in an MLM situation have any independent qualifications or training, and that the Poisons Centre has never, to its knowledge, been consulted to provide information regarding the safety or toxicity around essential oils for the purpose of using it to train people.”

We reached out to Doterra’s Australian office for comment and received no reply.

Jon Wardle, associate professor of Public Health at Sydney’s University of Technology says it’s important to remember just how concentrated essential oils are, and that companies selling them often promote use that isn’t evidence-based.

“To be fair, even Doterra has put some money into research, but most of the research that does exist [into essential oils] is all relatively limited and inconclusive,” says Wardle.

Case study: Kim’s ongoing health issues

“They made drinks and finger food with essential oils, without our knowledge and consent – and it was actually ingesting the oils that caused my eventual adverse reaction,” she remembers.

“The seller said the oils were ‘organic’, ‘pure’ and ‘CPTG – Certified Pure Therapeutic Grade’. I was told there was an ‘oil for everything’.”

On the seller’s advice and company book, Hungerford started regularly using the oils in a diffuser, via inhalation, topical use and ingestion – and applied certain oils neat to a wound on her knee. Her scar never healed properly and is now permanent.

During 2017 to 2018, prior to medical intervention, Hungerford developed sunburn-like redness and rashes to several areas of her body after using the essential oils, as well as ongoing respiratory issues such as an asthma cough.

“My doctors and I attribute these issues to sensitisation caused by essential oils. I no longer use essential oils, particularly lavender, and can’t have them near me or I suffer reactions,” she says.

“I questioned the Doterra team members about their qualifications but they had none. They’re just sales reps.”

Making claims to sell more products

Both Adamo and Wardle say they have growing concerns about the rise of unregulated, home-based ‘wellness’ distributors who dispense advice to consumers that they’re not qualified to give.

“The main concern is that a lot of MLM sellers are just normal everyday people – no medical training, no health literacy, they’re not qualified professionals able to make judgements,” says Wardle.

“It’s amplified by the MLM model, which encourages selling as much product as you can.”

Be wary when buying from friends

The typical ‘party-plan’ set-up that invariably includes demos, finger food and friendly chit-chat will also come with a not-so-subtle pressure to buy – and it’s hard to resist if you know the seller, says Wardle.

“Research shows that friends and family are by far the most influential in regards to our health, even more than practitioners or doctors – and MLMs are mostly built around networks,” he says.

“So when you hear stories at one of these parties [about how an essential oil worked] it can be a powerful motivator.Ìý

“But my advice would be don’t buy anything you don’t want to. And realise you’re walking into a situation that’s not necessarily a health push, but a sales push.”

How to check health claims

Poisons centres and government health departments often have information about essential oils and the risks, such as Western Australia’s Department of Health’s fact sheet.

A second opinion from a pharmacist, doctor or health expert with a special interest in complementary medicine might also be useful, adds Wardle.

“We don’t want to say that no one should use Doterra ever, but people should definitely be more critical,” he says.

Adamo says consumers need to ask questions, look critically at the evidence and consider the qualifications of the person providing the information.

“Would you consider buying medications from people who aren’t qualified health professionals?” she says.

“And the people who are selling these products need to consider their responsibility and liability in the information that they’re providing to their customers.”

The post Is it safe to use essential oils? appeared first on ÌÇÐÄVlog.

On this page:

• Is creatine expensive?

Not surprisingly, it’s now one of the most popular dietary supplements on the market.

But does the evidence behind the hype stack up?

What is creatine?

Creatine is a naturally occurring compound made from amino acids found in protein, and plays an important role in energy production within our cells. It’s stored mostly in muscles and also in the brain – places where lots of energy is needed.

Our body produces some creatine, mainly in the liver, and it also comes from meat and fish in your diet. But increasingly it’s being taken as a supplement in the form of creatine monohydrate, especially by athletes and bodybuilders – sales in the US alone are estimated at 2500-4000 tonnes per year.

What can creatine supplements do?

Its usefulness in certain sports is well-documented, and creatine supplements have been used this way for several decades. But because of its role in various aspects of human physiology, creatine has been or is currently being investigated for various other uses, most excitingly in areas that could lead to a much improved quality of life for people with certain medical conditions and age-related changes.

No matter what the usage or condition, not everyone benefits to the same degree and some may not benefit at all. It’s not clear why this is, but a creatine supplement seems to be most useful when existing creatine levels are low, which may occur in vegetarians, vegans, and people who don’t eat much meat. The body can only use so much, so if you’ve got enough, having more won’t help – any extra is excreted in urine. However, there have been cases where excessive amounts have been linked with more serious health effects, particularly kidney problems.

Likely effective

There’s good evidence creatine is effective for:

• improving some aspects of sports performance
• improving weightlifting performance
• improving muscle strength and performance for people with muscular dystrophy
• maintaining or building muscle in older adults.

Possibly effective

There’s preliminary evidence, but more research is needed for:

• building or maintaining bone (in older adults)
• improving cognitive performance (memory, reasoning).

Unlikely to be effective

Current evidence shows it’s unlikely to be effective for:

• aerobic exercise
• slowing the progression of Parkinson’s disease
• slowing the progression of Huntington’s disease (especially for women).

Insufficient evidence

More research is needed for:

• Amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease
• stroke prevention.

Is creatine safe?

Creatine appears to be safe when appropriate doses are taken, even over long periods of time. The most common side effect is weight gain, associated with increased water in muscles. In large doses, gastrointestinal effects such as nausea and diarrhoea have been reported, and sometimes more serious problems.

Experts recommend caution for people with kidney problems or who have potential for kidney problems, such as a family history of kidney disease or diabetics, and suggest discussing your need to take creatine with your doctor.

Caution is also recommended for pregnant and breastfeeding women, and children and adolescents under 18, due to a lack of information about side effects in these groups.

Creatine supplements are only loosely regulated in Australia, with no routine independent safety and quality testing. They sometimes contain other ingredients, which aren’t always labelled, that can cause serious health problems in some people – for example stimulants.

Is creatine expensive?

Creatine monohydrate typically comes in a powder form in containers that last a month or more. Depending on the brand and dose, creatine supplements cost around 10–25 cents per day.

Bottom line

There’s some good evidence that creatine can help athletes in certain types of sport, but make sure you use it as directed and don’t expect miracles. As for other applications, especially for medical conditions where it’s not yet proven safe or effective, it’s best to talk to your doctor about whether it may be helpful.

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On this page:

• What does iron do?
• Types of iron
• Iron absorption
• Iron deficiency
• Do I need a supplement?
• Too much iron

What does iron do?

Iron’s most important role in the body is as part of haemoglobin, the red pigment in your blood that carries oxygen to your body’s tissues.Ìý And low oxygen equals low energy. Iron is also an important nutrient for your immune system, builds protein in the body and helps transmit nerve signals.

Types of iron

There are two types of iron in food. And although Popeye was right about needing iron, eating spinach isn’t the best way to increase your intake. Haem iron, found in animal products, is much easier for our bodies to absorb.

Haem iron

• Red meat is a particularly good source.
• Also found in other animal products like chicken and fish.
• Our bodies absorb 20–35% of the haem iron in animal foods.

Non-haem iron

• Found mainly in plant foods such as bread, cereals, fruit and vegetables.
• Much harder to absorb – between 2 and 15% is absorbed from plant foods.

Iron absorption

How much iron our bodies absorb varies between individuals, and partly explains the large percentage range above. Generally speaking, a person with a mixed western diet that includes animal foods will absorb about 18%, and a vegetarian will absorb about 10% of the iron in their diet. Absorption naturally increases if your body is running short on iron or when you need extra, such as during pregnancy.

How much iron you absorb from food also depends on what you eat and drink in combination.

Foods that help

Vitamin C-rich foods and the protein in meat both increase the amount of iron you absorb from fruits, vegetables and cereals.

Tip: Add a glass of OJ to your breakfast and you’ll probably double the amount of iron your body gets from a breakfast cereal.

Foods that hinder

Some compounds in foods, called inhibitors, bind with iron and stop it being absorbed through the walls of the bowel into the bloodstream.

Some inhibitors are hard to avoid, because they’re found in foods which also contain iron, but others you can simply avoid eating or drinking at the same time as you consume your iron. This is particularly important for non-haem iron, which is harder to absorb anyway.

Iron inhibitors include:

• tannins found in tea and coffee
• phytates in beans, peas and lentils and in fibre-rich cereals such as bran
• oxalates in spinach and some other dark green vegetables
• phosvitin in egg yolk
• antacids and aspirin
• calcium and zinc supplements.

How much iron do we need?

The average person needs to absorb just a small amount of iron each day to stay healthy (around 1mg for adult males, 1.5mg for menstruating females). The Australian (RDI) for iron is the amount of dietary iron required to meet the needs of most of the population, and it’s different for different age groups and life stages.

Iron deficiency

If you’re low in iron, you may begin to notice tiredness, irritability and difficulty concentrating.

Eventually, getting too little iron will empty your body’s iron reserves. At this stage blood cell production falls, leading to iron-deficiency anaemia. This is unlikely to be fatal, but it will mean a reduced quality of life. Besides making you more rundown, low iron also increases your risk of infection.

Who’s at risk?

Women of child-bearing age lose more iron because they menstruate. Women need even more iron during pregnancy, as their baby draws down extra iron as it grows.

Baseline data from the (ALSWH) suggest that one in three women have had diagnosed iron deficiency by the age of 45-50 years.

Also at risk of iron deficiency are:

• babies
• vegetarians
• athletes
• regular blood donors.

Men and post-menopausal women generally easily meet their iron needs through a normal diet.

Do I need a supplement?

Look at your diet before popping any pills. You can usually improve your iron intake by eating better.Ìý Don’t take an iron supplement ‘just in case’ — you may be wasting your money. There’s also a small chance you’re seriously overloading your body.

Get a blood test

If you’re feeling tired and run down, talk to your doctor first to see if there may be another problem. A simple blood test can tell you if you’re iron-deficient.

If you are, your doctor will discuss with you how to treat the deficiency. Ideally you should change your diet and eat more iron-rich foods, but if this isn’t doable or still not enough, a supplement may be recommended, particularly if you are pregnant.

Iron-boosting tips

• Include red meat, fish or poultry as a regular part of your diet (unless you’re a vegetarian).
• Have a piece of citrus fruit or glass of juice with your breakfast cereal.
• Choose an iron-fortified breakfast cereal and don’t add unprocessed bran — it’ll inhibit iron absorption.
• If you’re on a weight loss diet, be particularly careful to include enough iron-rich foods.
• Limit tea and coffee to between meals.
• Choose tomato, broccoli, cauliflower, pumpkin and cabbage — the non-haem iron in them is more easily absorbed.
• Choose more iron-rich foods if you donate blood or have heavy periods.
• If you have to take other mineral supplements, such as calcium or zinc, don’t take them with meals.

Too much iron

Most of us are unlikely to get too much iron from food alone. However, about 1 in 200 people of northern European origin has a genetic predisposition for , a genetic abnormality which can cause excessive iron absorption and storage in the body – it’s the most common genetic disorder in Australia.

Unchecked, it can damage the liver, pancreas and heart. As iron slowly accumulates, insidious signs might present the same symptoms as other health issues, like early-onset arthritis or stomach complaints.

The most common symptoms include:

• tiredness
• fatigue
• feeling unwell for a prolonged period of time
• abdominal pains
• swollen liver
• joint pains
• slate grey appearance or bronze complexion
• loss of sex drive.

You should see your GP if you’ve noticed any of these symptoms.

Warning: For a toddler, just a handful of iron pills can be poisonous. If you have small children keep any vitamin and mineral supplements in their original, closed container, out of reach and sight, preferably in a locked cabinet.

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On this page:

• Vitamin lollies and goat milk chews
• Blooms Back, Neck & Shoulders +
• Dick Wicks Magnetic Knee Support
• Bioglan Melatonin
• Combined paracetamol and ibuprofen pills
• Sudafed PE and others
• Eye drop products with benzalkonium chloride
• Fluoride-free toothpaste
• Cough medicine

But scanning the shelves, we found a surprising number of products that couldn’t possibly live up to their claims, others that might do more harm than good and some that don’t offer very good value for money.

Here are 10 you might give a miss.

Vitamin lollies and goat milk chews

These are essentially treats with little nutritional value. Save your money and buy real food and milk (lactose-free or goat) instead.

Blooms Back, Neck & Shoulders +

Even if this turmeric and magnesium supplement works, oral medicine can’t target pain in specific areas of the body.

Dick Wicks Magnetic Knee Support

There’s no good quality evidence to show that magnetic bandages work any better than regular bandages, which are a lot cheaper.

Bioglan Melatonin

Melatonin helps some people with sleep problems, but there’s no evidence homeopathic melatonin such as Bioglan Melatonin works.

Toddler and junior formula

Apart from being more expensive than fresh or powdered milk, some toddler and junior formulas contain less protein and calcium, and filling up on these may discourage healthy eating.

Combined paracetamol and ibuprofen pills

Combination pills offer a convenient, though more expensive, type of painkiller that may be more effective than paracetamol or ibuprofen alone. However, they’re not suitable for all types of pain, and confusion around dosage has raised concerns.

Sudafed PE and others

Studies have found that phenylephrine, or PE, the active ingredient in various decongestant medicines, isn’t effective.

Eye drop products with benzalkonium chloride

These can cause eye irritation in some people, and there are concerns that long-term use can damage the surface of the eye.

Fluoride-free toothpaste

Many so-called “natural” toothpastes don’t contain fluoride which, when used as recommended, is a safe and effective treatment to prevent dental cavities.

Cough medicine

There’s a surprising lack of evidence that cough medicines work.

The post 10 common pharmacy products you don’t need appeared first on ÌÇÐÄVlog.

On this page:

• Rigorous or Lax regulation?
• Consumers in the dark

We’re talking about the listing or registration number from the Australian Register of Therapeutic Goods (ARTG), which is administered by the Therapeutic Goods Administration (TGA). Somewhere on the front of the label you’ll find a number, preceded by AUST L or AUST R. The L stands for listed, and the R stands for registered. The difference is significant.

Rigorous or Lax regulation?

Listed productsÌý(AUST L) are considered low risk by the TGA, and companies must be able to demonstrate safety and quality. They include some over-the-counter medicines, including sunscreen and most complementary medicines and vitamins.

The company must also hold evidence it works, but the TGA doesn’t look at the evidence for every product that is listed on the ARTG. However, it does conduct some random and targeted reviews of a small percentage of products each year.

Reviews of studies on commercially available complementary medicines have found that while some have been well-studied and found to be effective, many have not, and scientific evidence for their effectiveness is often scant, poor quality and/or inconclusive, if there’s any at all.

Similarly, vitamins and minerals are useful for correcting dietary deficiencies, but benefits in doses above and beyond recommended daily intake are few and far between, and in large amounts some can be harmful.

Registered products (AUST R) are considered higher risk than listed products, and the TGA individually assesses each one for safety, quality and evidence that it works as claimed. The level of evidence required is much stronger, usually in the form of clinical trials to prove they’re effective.Ìý

All prescription medicines are registered, as are many over-the-counter medicines, including painkillers, cough and cold medicines, and fungal creams. A small number of complementary medicines are registered.

Consumers in the dark

Given the difference in regulatory requirements for listed and registered products, we were interested to find out how much consumers understood. In a national survey of 1052 peopleÌýÌÇÐÄVlog Consumer Pulse found that 80% had never actually noticed these numbers on the label, and a further 7% weren’t sure.

Among the 142 people who were aware that the label contained these codes, many weren’t really sure what the difference was between AUST R and AUST L. And when it came to evidence they work, almost half (43%) erroneously thought listed products had been evaluated by the TGA to see if they worked, while a further 23% weren’t sure.

Overall, when people were asked if they were concerned that many herbal medicines and dietary supplements hadn’t been tested by the TGA to see if they work, more than three-quarters (77%) said they were at least a little concerned, and only 7% were unconcerned. Eighty-two percent thought that highlighting this would be useful.

Registered medicines aren’t always safe – which is why they’re subject to greater scrutiny by the TGA. Before they can be sold, they often undergo many years of clinical testing on thousands of people, and all known risks are documented. While all medicines – even placebo medicines – have side effects reported, if the risks are considered too great they won’t be permitted on the market.

Even after registered medicines go on the market, safety continues to be monitored and if problems emerge at this point, the product may be withdrawn from the market or perhaps more tightly regulated. On an individual level, a doctor will also check they’re safe for their patients – some medicines can affect some people differently to others, especially if they’re taking more than one medicine.

When it comes to listed products, however, in addition to the questionable efficacy, there are questions about how safe they are. And with patients often neglecting to tell their doctor they’re taking them, doctors may be kept out of the loop.

The TGA doesn’t actually test the products for safety and quality. There is a list of ingredients that the TGA considers safe in medicines, though sometimes only in limited amounts. As long as products only contain these ingredients in the allowed amounts, they are likely to be safe for consumers. Sometimes there are lab tests of products and inspections of manufacturing facilities to ensure good manufacturing practice is upheld.

The problem may lie with ingredients that aren’t listed on the label. For example, Australian researchers found that nine out of ten traditional Chinese medicines (TCMs) were found to be adulterated with toxic substances, pharmaceutical drugs and/or animal DNA not listed in the ingredients.

The group analysed 26 different TCMs purchased in Australia, most being for coughs and colds or general wellness. They found various heavy metals (arsenic, cadmium and lead) exceeding allowable levels, toxic substances (strychnine and brucine), pharmaceutical medicines (antibiotics, pseudoephedrine, warfarin, paracetamol) and banned or restricted herbs considered to be harmful. Ìý

In addition, some herbal ingredients permitted by the TGA in listed products have been found in some studies to be harmful – for example, green tea extract, garcinia combogia and bitter orange.

Finally, there’s also the potential for certain herbal medicines to interact with other medicines you’re taking, changing their effectiveness or resulting in unwanted side effects. If you decide to take alternative medicine, make sure you tell your doctor or pharmacist about all medicines you’re taking.

The post Listed vs registered medicines – what’s the difference? appeared first on ÌÇÐÄVlog.

On this page:

• Rosemary
• Sage
• Spearmint
• ÌýBacopa (brahmi)
• Panax ginseng
• Ginkgo biloba
• Caffeine

Where’s the evidence?

Despite there being plenty of products on the marketÌýclaiming to help with memory, there’s very little evidence for the effectiveness of their ingredients published in science and medicine journals. Companies are unwilling to invest large amounts of money in the clinical trial process, when money spent on marketing and celebrity endorsements gets a much better return.

The best-studied of the memory herbs is ginkgo biloba. A variety of different extracts have been tested – albeit mainly for preventing or treating dementia in older adults, rather than in young adults. The other memory herbs have but a few studies to their names, and the results are inconsistent, making it difficult to determine whether they’re effective or not.

With herbal medicines it’s important to know whether the extract being tested is the same as that being sold in products. The chemical profile of plant components can change according to where it’s grown, seasonal and annual variations, when it’s harvested and how it’s treated during processing. This in turn will affect the product’s actions and effects in the body – not all extracts are equal.Ìý

This is further complicated by the tendency of manufacturers to mix a whole bunch of different ‘memory-boosting’ ingredients together, without testing the final formulation to see if it works. Herbs are known to interfere with each other, and may negate, or indeed enhance, each other’s effects, so it’s important to study this.

With those limitations in mind, let’s see what we’ve got.

Rosemary

Rosemary essential oils raced off the shelves in the UK when parents of students facing their final exams read reports of memory improvements after inhaling the aroma. Long associated with remembrance in folklore, a few small studies have put this theory to the test, with some finding modest benefits. Typically, though, the tests look at short-term memory performance, rather than the longer-term memory needed for exam performance. And more isn’t necessarily better – one study found that a higher dose had a negative effect on memory.

Sage

Will the herb of wisdom make you wiser? Like rosemary, there are very few studies, and those that have been done are small, with very modest results in favour of enhanced memory and mood.

Spearmint

Like rosemary and sage, spearmint is a member of the lamiaceae family, and reputed to have positive effects on memory. Studies with spearmint chewing gum have had mixed results, mostly showing no benefit.

ÌýBacopa (brahmi)

Bacopa monnieri (or monniera), also known as brahmi, has a long history of use in Indian Ayurvedic medicine. While only a handful of small studies have been conducted –Ìýmostly on one product by one research team – there are indications that it can help some aspects of memory when taken at a particular dose (generally a dose of 300mg per day is tested), for a reasonable period of time (typically benefits are found after two to three months, with shorter time frames showing no effect).

However, findings are inconsistent, and some studies found no effect. It’s difficult to say whether effects are down to the different extracts, different doses, different research protocols or just chance.

Bacopa is considered safe, and is regularly given to children in India. Minor side effects include nausea, stomach cramps and diarrhoea. It could be worth a try.

Panax ginseng

If you’ve left it too late to try Bacopa, there’s always Panax ginseng (also known as Asian ginseng, as distinguished from the Siberian or American ginsengs). Reputed as a general pick-me-up, its effects on memory haven’t been studied well enough to draw firm conclusions.Ìý

While some studies found no effect, others report it has beneficial memory effects after a single dose. In some cases it has negative effects on memory and performance. The best dose to take is also unclear – some studies found 400mg gives good results and 200mg negative results, while other studies found the opposite. This may simply reflect chance findings and statistical anomalies, rather than real effects.

The most common side effects are headaches and sleep problems. It’s not recommended for children or pregnant women, and long-term effects are not known.

Ginkgo biloba

One of the most popular herbal supplements for sale around the world, ginkgo biloba has been widely recommended for preventing memory decline in older people, reducing the likelihood or impact of dementia. This was based on many small studies, and was thought to be due to its effects of increasing blood flow in the brain. More recent, large government-funded studies, however, have not found it to have a useful effect. It’s been less well studied for younger people, but it’s unlikely to be of much help.

A product combining ginkgo with ginseng was found to enhance mental alertness and memory in young, healthy people, but most of the research was conducted by one research group and was funded by the manufacturer.

While considered safe, side effects include headache, stomach upset, and allergic skin reactions, and it may interact with blood thinners.

Caffeine

Ubiquitous in everyday life, caffeine is known to help improve memory performance, most likely due to improved attention when learning. It seems to work better in people who don’t usually have caffeine, although that may be due to limitations of the studies conducted. High doses (more than 400mg, or four cups of coffee) may have a negative effect.

Verdict on herbal medicines

Despite some positive effects on memory discovered in testing, conclusive evidence for these herbal treatments is impeded by a lack of good-quality clinical trials. And unfortunately, the product with the most and best clinical trials behind it, ginkgo biloba, seems not to be of any benefit.

Whether you want to try any of them comes down to how you weigh up the known costs and risks vs uncertain potential benefits. While they may cost you up to $30 a month if you use them for a few months leading up to your exams, it may be a price you’re willing to pay. They’re safe when taken at recommended doses, are unlikely to harm your performance and, well, who knows? They may help.

Or, with much larger and more numerous studies behind them, you could also try exercise and sleep.

Exercise

The benefits of exercise for the brain, as well as the body, are well known. Regular exercise has been shown to be a benefit in school children in improving:

• brain volume and blood flow in the brain
• memory and attention
• academic performance andÌýmathematic ability
• intelligence
• perceptual skills and verbal ability.Ìý

Spent all year stuck in class, behind a computer? The good news is that exercise can have short-term memory and attention benefits that last up to 48 hours.

Sleep

Hundreds of tests over the last century have shown the benefits of sleep for consolidating memories. And it’s not just that sleep-deprivation is bad (though it is) – even in rested people, the process of sleep consolidates memories, demonstrated by the improved memory retention of things learnt in the evening (just before sleep) vs the morning (a long time before sleep). A short nap in the middle of the day (six minutes, reportedly) can have a beneficial effect on remembering the morning’s learnings.

And since it’s not just memory that’s important for exams, getting a good night’s sleep will likely have a better effect on your exam performance than hours spent cramming a few extra facts (which you may or may not even remember) because sleep improves creativity and speeds up problem solving.

The post Herbal memory boosters for exams appeared first on ÌÇÐÄVlog.

On this page:

• What is vitamin D?
• Sources of vitamin D
• Vitamin D supplements
• When to get your sun
• Risk factors for vitamin D deficiency
• Symptoms of vitamin D deficiency
• Health implications for vitamin D deficiencies

While some have rejected this suggestion, it could be explained by a few factors – for example, sunscreens now having higher SPF ratings (30+ is the norm), and people being more likely to spend more time indoors, particularly recreation time.

What is vitamin D?

Vitamin D is primarily known for its role in bone health. It helps with the absorption of calcium and phosphate, reduces calcium loss from bones, and is needed for bone growth and remodelling.Ìý

There are suggestions that it also plays an important role in other aspects of human health, especially immunity and infection control; recent research on tuberculosis bacteria has shed light on the critical role vitamin D plays in the function of T-cells, which are white blood cells that fight infection in the body.Ìý

It’s also linked with fighting flu and other respiratory infections due to its role in the production of infection-fighting amino acids (antimicrobial peptides).

Sources of vitamin D

Apart from supplements, vitamin D occurs in two forms – D3 and D2. Our main source of vitamin D comes from exposure to sunlight, when a steroid in the skin (called 7-dehydrocholesterol (7-DHC)) is converted to vitamin D3 (cholecalciferol) through the action of solar UVB radiation.Ìý

Smaller amounts of vitamin D3 can also be obtained from certain foods such as fatty fish, eggs, meat and fortified foods such as margarine and certain low-fat milks.

Vitamin D2 (ergocalciferol) comes from fungi, and may be used in supplements. However, most adults are unlikely to get more than 5-10% of their vitamin D needs from dietary sources. Also, Vitamin D2 is considered less potent than vitamin D3.Ìý

In addition to getting enough sun, it’s important to eat the recommended dose of calcium as well as undertaking weight-bearing or muscle-strengthening exercises for optimal bone and muscle function.

Vitamin D supplements

If you think you’re at risk of vitamin D deficiency you could consider taking a supplement.

If the ideal amount of sun exposure can’t be reached, is recommended in order to prevent deficiency.

• At least 600 IU (15 µg) per day is recommended for people aged under 70.
• 800 IU (20 µg) per day is recommended for those aged over 70 years.

People in high-risk groups may require higher doses.ÌýThis also depends on where you live, your skin colour, age and other factors.Ìý

For people with a diagnosed deficiency, greater amounts will be needed, possibly in conjunction with calcium – your doctor or other health professional will advise you.

Vitamin D supplements are cheap, and usually come in a dose of 1000IU. Many multi-vitamins contain vitamin D, but not in the amount required for preventing or treating deficiency.

A safe upper maximum for adolescents and adults is 4000IU per day. Long-term amounts over 10,000IU per day have been associated with kidney damage.

Recommended sun exposure times

For most people, sensible sun exposure is the easiest way to increase your vitamin D levels. But how much sun do you need? In order to maintain adequate vitamin D levels it’s recommended that people with moderately fair skin get 6-7 minutes of sun with arms and hands exposed outside the hours of 10am-2pm (11am-3pm daylight savings time).ÌýIn winter, this translates to7-40 minutes (depending on your location) at noon, with as much bare skin exposed as possible. People with dark skin may need 3-6 times as long.

When to get your sun

When you go out for your daily dose of vitamin D, you might like to consider taking a morning stroll, rather than afternoon. A in mice has found that propensity for skin cancer fluctuates according to circadian rhythms. Mice are more likely to get skin cancer when exposed to UV radiation in the morning, thanks to low levels of an enzyme which repairs UV damage.Ìý

Researchers have hypothesised that humans likely have higher levels of the enzyme in the morning (the opposite of mice, which are nocturnal) and may be less susceptible to cancer from UV damage in the morning than the afternoon. But further research needs to be done before any recommendations for humans can be made.

Risk factors for vitamin D deficiency

Some people are at higher risk of deficiency including:

• People who are housebound, or living in a long-term care facility (such as a nursing home), or shift workers who sleep through the day. Studies have found that up to 77% of aged care residents are deficient.
• People with naturally dark skin, whichÌýhas a sun protection factor of up to 15 – so, the equivalent of wearing SPF15 sunscreen. In equatorial regions, where there’s plenty of sun, this isn’t such a problem, but dark-skinned people living further north or south may need supplements.
• People who cover themselvesÌýfor religious or cultural reasons, or due to increased risk of skin cancer or other skin conditions.Ìý
• People who live in southern parts of AustraliaÌýhave a higher risk of deficiency than those in the north, although people in the north may also be at risk due to skin cancer prevention measures.
• Obese peopleÌýVitamin D is readily taken up by fat cells, and it’s believed obese people have vitamin D stored in body fat instead of off doing what it should do, elsewhere in the body.Ìý
• Elderly peopleÌýhave lower concentrations of 7-DHC in the skin, and need larger amounts of sun than younger people. To avoid skin damage, though, supplements are a safer option.
• People with certain diseases or conditionsÌýsuffer from reduced vitamin D absorption and/or synthesis, including Crohn’s disease, coeliac disease, inflammatory bowel disease, cystic fibrosis, chronic pancreatitis, and kidney or liver disease.Ìý
• Certain medicationsÌýalso contribute to vitamin D deficiency, including rifampicin (an antibiotic) and anticonvulsants.

Symptoms of vitamin D deficiency

Vitamin D deficiency is largely symptomless, and may not be suspected unless the individual suffers an unusual fracture, or has one or more risk factors. Deficiency can be determined by measuring the levels of 25(OH)D (the main form of circulating vitamin D), however, testing is only recommended for those with a moderate to high risk of deficiency.

The Ìý is determined according to the 25(OH)D levels in the blood. Levels of 25(OH)D in the blood above 50 nmol/L are considered adequate vitamin D levels. Anything less than 12.5 nmol/L is considered to be a severe vitamin D deficiency.

Health implications for vitamin D deficiencies

While symptoms are more or less non-existent, the result of a vitamin D deficiency can be more serious. The most common results of vitamin D deficiency are:Ìý

• Rickets (softening of the bones during childhood),
• Osteomalacia (softening of the bones in adults which causes pain in the bones, and often joints and muscles), and
• Osteoporosis (porous bones).

These issues can lead to bone fractures, which can mean the end of independent living for an elderly person.

Vitamin D deficiency is also blamed for many other health effects not related to our bones. But whether or not vitamin D is actually the cause of these conditions is still unclear.

People living further from the equator, where there are lower UV radiation levels, are at increased risk of:

• Multiple sclerosis,
• Type 1 diabetes,
• High blood pressure,
• Tuberculosis,
• Schizophrenia, andÌý
• Depression.

All of these conditions have been linked with vitamin D levels in at least one study.ÌýLow levels of vitamin D have also been associated with increased risk of developing colorectal, breast, prostate and other cancers, as well as the metabolic syndrome. In addition, giving vitamin D supplements to people at risk of deficiency has been found to reduce the risk of multiple sclerosis and certain cancers, and prevent falls in the elderly.

But it’s important to note that many of these findings are based on preliminary research, and some authorities have questioned the benefits of vitamin D for reasons other than bone health and fall prevention. A review by the points out that many of the studies are observational, have design limitations, or are contradictory.

A review of over 1000 studies by the reported a general lack of evidence for a causal relationship between vitamin D deficiency and many of the associated disorders mentioned above – that is, it can’t be proven that vitamin D deficiency actually caused the problem. They were also critical of beneficial claims linked to taking supplements, saying there were no health guarantees other than for healthy bones (when taken with calcium).

ÌÇÐÄVlog verdict

It’s definitely a good idea to get enough vitamin D for bone health, whether through exposure to sun or supplements, and this may confer additional preventative health benefits.Ìý

But too much sun poses its own risks, and taking vitamin D supplements other than to avoid deficiency is not going to make you healthier. Talk to your doctor first if you’re worried you might be deficient in vitamin D for any reason.

The post Vitamin D deficiency appeared first on ÌÇÐÄVlog.

On this page:

• Scientific studies
• Research findings
• Is glucosamine safe?
• How much to take
• How much glucosamine?
• ÌÇÐÄVlog verdict
• Other remedies to try
• Alternative treatments

Scientific studies

The main criticism of complementary therapies has always been a lack of scientific evidence or the poor quality of published studies, but this isn’t true of glucosamine – a recent overview of the subject identified 20 high-quality clinical trials.

To test how well glucosamine works, researchers typically compare the pain levels experienced by groups of arthritis sufferers who are given glucosamine, a placebo or a non-steroidal anti-inflammatory drug (NSAID). Research of this nature is controversial, because humans are complex organisms and studies inevitably produce conflicting results. And more often than not, there’s some detail in the way a trial is conducted that lays it open to criticism. Considered alone, individual studies are often only pointers – the way forward comes from systematic evaluation of the evidence as a whole.

In 2006 the evidence for glucosamine’s effectiveness was looking good – but since then, new research findings have seriously muddied the waters.

Research findings

The UK-basedÌýÌýlooked at all published research up to January 2005 and concluded that the evidence is inconclusive because the research findings were inconsistent.

The eight most rigorous clinical trials failed to show any benefits from glucosamine over a placebo, whereas a series of studies using a glucosamine sulphate product from the Italian pharmaceutical company Rottapharm consistently showed clear benefits.

The large government-sponsored Glucosamine/Chondroitin Arthritis Intervention Trial () in the US that tested glucosamine hydrochloride again found that glucosamine gave no better pain relief than a placebo. It came to the same conclusion for chondroitin sulphate. The only clear benefit was from glucosamine and chondroitin in combination, and then only for a small subgroup of people with moderate to severe knee pain.

A smaller European trial concluded that glucosamine (given as glucosamine sulphate) relieved pain better than a placebo but this trial was sponsored by Rottapharm. A more recent European trial, independent of drug company support, found glucosamine sulphate was no better than a placebo for treating hip osteoarthritis. An extension of the GAIT study reported on loss of cartilage in osteoarthritis of the knee. The researchers tested 357 people (with 581 arthritic knees) and measured joint narrowing (using x-rays) before and after two years of treatment with any one of the following:

• Glucosamine hydrochloride (1500mg/day)
• Chondroitin sulphate (1200mg/day)
• A combination of glucosamine hydrochloride (1500mg/day) and chondroitin sulphate (1200mg/day)
• The NSAID celecoxib (200mg/day)
• Placebo.

The study suggested that glucosamine and chondroitin sulphate, together or alone, were no better than placebo in slowing loss of cartilage (though the researchers pointed out that interpretation is complicated because the placebo group fared better than expected based on previous research findings).

Some experts now say glucosamine hydrochloride isn’t effective at all, and question the apparent benefits from glucosamine sulphate as coming from bias caused by industry sponsorship. To complicate matters, clinical trials consistently show a big placebo effect, where people feel less pain despite only taking dummy pills.

But this hasn’t stopped some claims in ads and on labels that the benefits from glucosamine are ‘clinically proven’. In reality, the jury is still out.

Is glucosamine safe?

The one thing that clinical trials have proved with reasonable certainty is that glucosamine and chondroitin are generally safe for most people. However, there are some exceptions:

• If you suffer from an allergy to seafood you should avoid the majority of brands, where the glucosamine has been made from crustacean shells. At least two brands, Pretorius Professional Vegetarian Glucosamine 1500 and Bioorganics Vegetarian Glucosamine, are of vegetable origin.
• If you have diabetes, check with your GP before taking glucosamine. While it appears safe in the short term, there’s some evidence that in the long term glucosamine could make your diabetes worse.
• People taking blood-thinning medicines, such as warfarin, should talk to their doctor before taking chondroitin, as it can increase the risk of bleeding. Chondroitin also occasionally causes stomach upsets.

How much to take

If — despite the shaky scientific evidence — you still want to give glucosamine a try, there’s plenty of choice.

In 2008 we tested 26 glucosamine products and combinations of glucosamine and chondroitin sulphate, all widely available in supermarkets.

There were big differences in price, but of more concern is that some products didn’t give you enough glucosamine or chondroitin sulphate to reach the levels tested in clinical trials — even if you took the maximum recommended dose.

How much glucosamine?

Under government regulations, the amount of active ingredient per tablet or capsule must be not less than 92.5% (and not more than 107.5%) of the amount stated on the label.

We measured the amount of glucosamine per tablet or capsule and found that, while most were within the acceptable range, three of them didn’t contain enough glucosamine to match the dose levels of 1500mg/day of glucosamine hydrochloride or glucosamine sulphate used in clinical trials, even according to their own labels.

How much chondroitin sulphate?

The generally recognised therapeutic dose is 800 to 1000mg per day; in the big US trial, the dose level was 1200mg/day.

Only three products in our 2008 analysis would give you 1200mg/day or more of chondroitin sulphate if you take the maximum recommended dose. A quick check in 2014 easily found two products that would not provide the recommended amount of glucosamine or chondroitin if you followed the directions on the label.

ÌÇÐÄVlog verdict

The scientific evidence for glucosamine or glucosamine/chondroitin makes it seem doubtful that it’s effective at relieving the pain of osteoarthritis. However, plenty of people who suffer from osteoarthritis think it’s worked for them, so it’s still worth giving glucosamine and chondroitin a try, even if the only result is the placebo effect. If you get any effect at all, it’s likely to take four to six weeks. On the other hand, exercise and weight loss are likely to benefit you more.

Avoid any products that give you less than 1500mg/day of glucosamine.

Other remedies to try

Experts say that lifestyle changes are crucial in successfully treating osteoarthritis.

• Regular exercise is one of the most effective treatments, with the bonus that it will improve your health generally. Low-impact exercise, with less weight or force going through your joints, is best. Examples are walking, cycling and swimming.
• A physiotherapist can suggest targeted exercises to reduce pain and improve the function of the affected joints.
• Weight loss from exercise and diet can reduce the severity of symptoms, especially for people with knee osteoarthritis. It reduces the impact load on the joint and can improve joint flexibility and reduce pain.

Alternative treatments

We also checked out some popular alternative treatments. They’re included as an extra in some brands of glucosamine, but none of them has been as thoroughly researched as glucosamine and chondroitin.

Evidence suggests the following products are of little or no benefit:

• Willow bark
• Selenium
• Vitamins A, C, E

Here are some products that might help, but for which the evidence is inconclusive:

• Acupuncture
• Avocado-soybean unsaponifiables
• Capsaicin cream
• New Zealand green-lipped mussels
• Ginger extract

As none of these therapies has been thoroughly tested, it’s not known if they’re safe or unsafe. Always talk to your doctor before trying them.

Complementary medicines need to be treated with the same care and respect as prescription medicines. They can cause side effects and interfere with other medicines, making them less effective.

Case studies

The scientific evidence might be shaky, but plenty of arthritis sufferers feel they’re getting some benefit from glucosamine. We asked members of ÌÇÐÄVlog Online who’d tried glucosamine to tell us whether or not it had helped. About 75% thought it had worked for them.

Paul and his wife Ann take glucosamine with chondroitin. Paul has been able to stop taking Celebrex, and Ann has given upthe Diclofenec she had been taking. He thinks that given the potential risks from the two prescription medications, they’re well in front health-wise.

Judith has osteoarthritis in her knees and ankles, which was treated with the NSAID Vioxx until it was withdrawn. She can’t take regular anti-inflammatories because she also has a hiatus hernia, so about five years ago she started taking one 1500mg glucosamine tablet a day. While this hasn’t completely removed the pain or inflammation, she thinks it has reduced it. She now takes fish oil as well and thinks this has helped too.

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