An Ounce Of Prevention Is Worth A Pound Of Cure!

Chromium What is it?

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BURIED TREASURE MINERALS

BURIED TREASURE ACTIVE 55

NATROL CHROMIUM

 

Chromium: What is it?

Chromium is a mineral that humans require in trace amounts, although its mechanisms of action in the body and the amounts needed for optimal health are not well defined. It is found primarily in two forms: 1) trivalent (chromium 3+), which is biologically active and found in food, and 2) hexavalent (chromium 6+), a toxic form that results from industrial pollution. This fact sheet focuses exclusively on trivalent (3+) chromium.

Chromium is known to enhance the action of insulin [1-3], a hormone critical to the metabolism and storage of carbohydrate, fat, and protein in the body [4]. In 1957, a compound in brewers’ yeast was found to prevent an age-related decline in the ability of rats to maintain normal levels of sugar (glucose) in their blood [3]. Chromium was identified as the active ingredient in this so-called “glucose tolerance factor” in 1959 [5].

Chromium also appears to be directly involved in carbohydrate, fat, and protein metabolism [1-2,6-11], but more research is needed to determine the full range of its roles in the body. The challenges to meeting this goal include:

  • Defining the types of individuals who respond to chromium supplementation;
  • Evaluating the chromium content of foods and its bioavailability;
  • Determining if a clinically relevant chromium-deficiency state exists in humans due to inadequate dietary intakes; and
  • Developing valid and reliable measures of chromium status [9].

What foods provide chromium?

Chromium is widely distributed in the food supply, but most foods provide only small amounts (less than 2 micrograms [mcg] per serving). Meat and whole-grain products, as well as some fruits, vegetables, and spices are relatively good sources [12]. In contrast, foods high in simple sugars (like sucrose and fructose) are low in chromium [13].

Dietary intakes of chromium cannot be reliably determined because the content of the mineral in foods is substantially affected by agricultural and manufacturing processes and perhaps by contamination with chromium when the foods are analyzed [10,12,14]. Therefore, Table 1, and food-composition databases generally, provide approximate values of chromium in foods that should only serve as a guide.

Table 1: Selected food sources of chromium [12,15-16]
Food Chromium (mcg)
Broccoli, ½ cup 11
Grape juice, 1 cup 8
English muffin, whole wheat, 1 4
Potatoes, mashed, 1 cup 3
Garlic, dried, 1 teaspoon 3
Basil, dried, 1 tablespoon 2
Beef cubes, 3 ounces 2
Orange juice, 1 cup 2
Turkey breast, 3 ounces 2
Whole wheat bread, 2 slices 2
Red wine, 5 ounces 1–13
Apple, unpeeled, 1 medium 1
Banana, 1 medium 1
Green beans, ½ cup 1

What are recommended intakes of chromium?

Recommended chromium intakes are provided in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences [14]. Dietary Reference Intakes is the general term for a set of reference values to plan and assess the nutrient intakes of healthy people. These values include the Recommended Dietary Allowance (RDA) and the Adequate Intake (AI). The RDA is the average daily intake that meets a nutrient requirement of nearly all (97 to 98%) healthy individuals [14]. An AI is established when there is insufficient research to establish an RDA; it is generally set at a level that healthy people typically consume.

In 1989, the National Academy of Sciences established an “estimated safe and adequate daily dietary intake” range for chromium. For adults and adolescents that range was 50 to 200 mcg [17]. In 2001, DRIs for chromium were established. The research base was insufficient to establish RDAs, so AIs were developed based on average intakes of chromium from food as found in several studies [14]. Chromium AIs are provided in Table 2.

Table 2: Adequate Intakes (AIs) for chromium [14]
Age Infants and children
(mcg/day)
Males
(mcg/day)
Females
(mcg/day)
Pregnancy
(mcg/day)
Lactation
(mcg/day)
0 to 6 months 0.2
7 to 12 months 5.5
1 to 3 years 11
4 to 8 years 15
9 to 13 years 25 21
14 to 18 years 35 24 29 44
19 to 50 years 35 25 30 45
>50 years 30 20

mcg = micrograms

Adult women in the United States consume about 23 to 29 mcg of chromium per day from food, which meets their AIs unless they’re pregnant or lactating. In contrast, adult men average 39 to 54 mcg per day, which exceeds their AIs [14].

The average amount of chromium in the breast milk of healthy, well-nourished mothers is 0.24 mcg per quart, so infants exclusively fed breast milk obtain about 0.2 mcg (based on an estimated consumption of 0.82 quarts per day) [14]. Infant formula provides about 0.5 mcg of chromium per quart [18]. No studies have compared how well infants absorb and utilize chromium from human milk and formula [10,14].

What affects chromium levels in the body?

Absorption of chromium from the intestinal tract is low, ranging from less than 0.4% to 2.5% of the amount consumed [19-25], and the remainder is excreted in the feces [1,23]. Enhancing the mineral’s absorption are vitamin C (found in fruits and vegetables and their juices) and the B vitamin niacin (found in meats, poultry, fish, and grain products) [26]. Absorbed chromium is stored in the liver, spleen, soft tissue, and bone [27].

The body’s chromium content may be reduced under several conditions. Diets high in simple sugars (comprising more than 35% of calories) can increase chromium excretion in the urine [13]. Infection, acute exercise, pregnancy and lactation, and stressful states (such as physical trauma) increase chromium losses and can lead to deficiency, especially if chromium intakes are already low [28-29].

When can a chromium deficiency occur?

In the 1960s, chromium was found to correct glucose intolerance and insulin resistance in deficient animals, two indicators that the body is failing to properly control blood-sugar levels and which are precursors of type 2 diabetes [1]. However, reports of actual chromium deficiency in humans are rare. Three hospitalized patients who were fed intravenously showed signs of diabetes (including weight loss, neuropathy, and impaired glucose tolerance) until chromium was added to their feeding solution. The chromium, added at doses of 150 to 250 mcg/day for up to two weeks, corrected their diabetes symptoms [7,30-31]. Chromium is now routinely added to intravenous solutions.

Who may need extra chromium?

There are reports of significant age-related decreases in the chromium concentrations of hair, sweat and blood [32], which might suggest that older people are more vulnerable to chromium depletion than younger adults [14]. One cannot be sure, however, as chromium status is difficult to determine [33]. That’s because blood, urine, and hair levels do not necessarily reflect body stores [9,14]. Furthermore, no chromium-specific enzyme or other biochemical marker has been found to reliably assess a person’s chromium status [9,34].

There is considerable interest in the possibility that supplemental chromium may help to treat impaired glucose tolerance and type 2 diabetes, but the research to date is inconclusive. No large, randomized, controlled clinical trials testing this hypothesis have been reported in the United States [14]. Nevertheless, this is an active area of research.

What are some current issues and controversies about chromium?

Chromium has long been of interest for its possible connection to various health conditions. Among the most active areas of chromium research are its use in supplement form to treat diabetes, lower blood lipid levels, promote weight loss, and improve body composition.

Type 2 diabetes and glucose intolerance

In type 2 diabetes, the pancreas is usually producing enough insulin but, for unknown reasons, the body cannot use the insulin effectively. The disease typically occurs, in part, because the cells comprising muscle and other tissues become resistant to insulin’s action, especially among the obese. Insulin permits the entry of glucose into most cells, where this sugar is used for energy, stored in the liver and muscles (as glycogen), and converted to fat when present in excess. Insulin resistance leads to higher than normal levels of glucose in the blood (hyperglycemia).

Chromium deficiency impairs the body’s ability to use glucose to meet its energy needs and raises insulin requirements. It has therefore been suggested that chromium supplements might help to control type 2 diabetes or the glucose and insulin responses in persons at high risk of developing the disease. A review of randomized controlled clinical trials evaluated this hypothesis [35]. This meta-analysis assessed the effects of chromium supplements on three markers of diabetes in the blood: glucose, insulin, and glycated hemoglobin (which provides a measure of long-term glucose levels; also known as hemoglobin A1C). It summarized data from 15 trials on 618 participants, of which 425 were in good health or had impaired glucose tolerance and 193 had type 2 diabetes. Chromium supplementation had no effect on glucose or insulin concentrations in subjects without diabetes nor did it reduce these levels in subjects with diabetes, except in one study. However, that study, conducted in China (in which 155 subjects with diabetes were given either 200 or 1,000 mcg/day of chromium or a placebo) might simply show the benefits of supplementation in a chromium-deficient population.

Overall, the value of chromium supplements for diabetes is inconclusive and controversial [36]. Randomized controlled clinical trials in well-defined, at-risk populations where dietary intakes are known are necessary to determine the effects of chromium on markers of diabetes [35]. The American Diabetes Association states that there is insufficient evidence to support the routine use of chromium to improve glycemic control in people with diabetes [37]. It further notes that there is no clear scientific evidence that vitamin and mineral supplementation benefits people with diabetes who do not have underlying nutritional deficiencies.

Lipid metabolism

The effects of chromium supplementation on blood lipid levels in humans are also inconclusive [1,8,38]. In some studies, 150 to 1,000 mcg/day has decreased total and low-density-lipoprotein (LDL or “bad”) cholesterol and triglyceride levels and increased concentrations of apolipoprotein A (a component of high-density-lipoprotein cholesterol known as HDL or “good” cholesterol) in subjects with atherosclerosis or elevated cholesterol or among those taking a beta-blocker drug [39-41]. These findings are consistent with the results of earlier studies [42-45].

However, chromium supplements have shown no favorable effects on blood lipids in other studies [46-51]. The mixed research findings may be due to difficulties in determining the chromium status of subjects at the start of the trials and the researchers’ failure to control for dietary factors that influence blood lipid levels [9-10].

Body weight and composition

Chromium supplements are sometimes claimed to reduce body fat and increase lean (muscle) mass. Yet a recent review of 24 studies that examined the effects of 200 to 1,000 mcg/day of chromium (in the form of chromium picolinate) on body mass or composition found no significant benefits [11]. Another recent review of randomized, controlled clinical trials did find supplements of chromium picolinate to help with weight loss when compared wtth placebos, but the differences were small and of debatable clinical relevance [52]. In several studies, chromium’s effects on body weight and composition may be called into question because the researchers failed to adequately control for the participants’ food intakes. Furthermore, most studies included only a small number of subjects and were of short duration [36].

For additional information on chromium and body weight, see our health professional fact sheet on Weight Loss.

What are the health risks of too much chromium?

Few serious adverse effects have been linked to high intakes of chromium, so the Institute of Medicine has not established a Tolerable Upper Intake Level (UL) for this mineral [10,14]. A UL is the maximum daily intake of a nutrient that is unlikely to cause adverse health effects. It is one of the values (together with the RDA and AI) that comprise the Dietary Reference Intakes (DRIs) for each nutrient.

Chromium and medication interactions

Certain medications may interact with chromium, especially when taken on a regular basis (see Table 3). Before taking dietary supplements, check with your doctor or other qualified healthcare provider, especially if you take prescription or over-the-counter medications.

Table 3: Interactions between chromium and medications [14,53-55]
Medications Nature of interaction
  • Antacids
  • Corticosteroids
  • H2 blockers (such as cimetidine, famotidine, nizatidine, and rantidine)
  • Proton-pump inhibitors (such as omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole)
These medications alter stomach acidity and may impair chromium absorption or enhance excretion
  • Beta-blockers (such as atenolol or propanolol)
  • Corticosteroids
  • Insulin
  • Nicotinic acid
  • Nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Prostaglandin inhibitors (such as ibuprofen, indomethacin, naproxen, piroxicam, and aspirin)
These medications may have their effects enhanced if taken together with chromium or they may increase chromium absorption

Supplemental sources of chromium

Chromium is a widely used supplement. Estimated sales to consumers were $85 million in 2002, representing 5.6% of the total mineral-supplement market [56]. Chromium is sold as a single-ingredient supplement as well as in combination formulas, particularly those marketed for weight loss and performance enhancement. Supplement doses typically range from 50 to 200 mcg.

The safety and efficacy of chromium supplements need more investigation. Please consult with a doctor or other trained healthcare professional before taking any dietary supplements.

Chromium supplements are available as chromium chloride, chromium nicotinate, chromium picolinate, high-chromium yeast, and chromium citrate. Chromium chloride in particular appears to have poor bioavailability [36]. However, given the limited data on chromium absorption in humans, it is not clear which forms are best to take.

Chromium and Healthful Diets

The federal government’s 2015-2020 Dietary Guidelines for Americans notes that “Nutritional needs should be met primarily from foods. … Foods in nutrient-dense forms contain essential vitamins and minerals and also dietary fiber and other naturally occurring substances that may have positive health effects. In some cases, fortified foods and dietary supplements may be useful in providing one or more nutrients that otherwise may be consumed in less-than-recommended amounts.”

For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture’s MyPlateexternal link disclaimer.

The Dietary Guidelines for Americans describes a healthy eating pattern as one that:

  • Includes a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, and oils.
    Whole grain products and certain fruits and vegetables like broccoli, potatoes, grape juice, and oranges are sources of chromium. Ready-to-eat bran cereals can also be a relatively good source of chromium.
  • Includes a variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products.
    Lean beef, oysters, eggs, and turkey are sources of chromium.
  • Limits saturated and trans fats, added sugars, and sodium.
  • Stays within your daily calorie needs.

References

  1. Mertz W. Chromium occurrence and function in biological systems. Physiol Rev 1969;49:163-239.
  2. Mertz W. Chromium in human nutrition: a review. J Nutr 1993;123:626-33.
  3. Mertz W. Interaction of chromium with insulin: a progress report. Nutr Rev 1998;56:174-7.
  4. Porte Jr. D, Sherwin RS, Baron A (editors). Ellengerg & Rifkin’s Diabetes Mellitus, 6th Edition. McGraw-Hill, New York, 2003.
  5. Schwarz K, Mertz W. Chromium(III) and the glucose tolerance factor. Arch Biochem Biophys 1959;85:292-5.

Magnesium

 

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What is magnesium and what does it do?

Magnesium is a nutrient that the body needs to stay healthy. Magnesium is important for many processes in the body, including regulating muscle and nerve function, blood sugar levels, and blood pressure and making protein, bone, and DNA.

How much magnesium do I need?

The amount of magnesium you need depends on your age and sex. Average daily recommended amounts are listed below in milligrams (mg):

Life Stage Recommended Amount
Birth to 6 months 30 mg
Infants 7–12 months 75 mg
Children 1–3 years 80 mg
Children 4–8 years 130 mg
Children 9–13 years 240 mg
Teen boys 14–18 years 410 mg
Teen girls 14–18 years 360 mg
Men 400–420 mg
Women 310–320 mg
Pregnant teens 400 mg
Pregnant women 350–360 mg
Breastfeeding teens 360 mg
Breastfeeding women 310–320 mg

What foods provide magnesium?

Magnesium is found naturally in many foods and is added to some fortified foods. You can get recommended amounts of magnesium by eating a variety of foods, including the following:

  • Legumes, nuts, seeds, whole grains, and green leafy vegetables (such as spinach)
  • Fortified breakfast cereals and other fortified foods
  • Milk, yogurt, and some other milk products

What kinds of magnesium dietary supplements are available?

Magnesium is available in multivitamin-mineral supplements and other dietary supplements. Forms of magnesium in dietary supplements that are more easily absorbed by the body are magnesium aspartate, magnesium citrate, magnesium lactate, and magnesium chloride.

Magnesium is also included in some laxatives and some products for treating heartburn and indigestion.

Am I getting enough magnesium?

The diets of most people in the United States provide less than the recommended amounts of magnesium. Men older than 70 and teenage girls are most likely to have low intakes of magnesium. When the amount of magnesium people get from food and dietary supplements is combined, however, total intakes of magnesium are generally above recommended amounts.

What happens if I don’t get enough magnesium?

In the short term, getting too little magnesium does not produce obvious symptoms. When healthy people have low intakes, the kidneys help retain magnesium by limiting the amount lost in urine. Low magnesium intakes for a long period of time, however, can lead to magnesium deficiency. In addition, some medical conditions and medications interfere with the body’s ability to absorb magnesium or increase the amount of magnesium that the body excretes, which can also lead to magnesium deficiency. Symptoms of magnesium deficiency include loss of appetite, nausea, vomiting, fatigue, and weakness. Extreme magnesium deficiency can cause numbness, tingling, muscle cramps, seizures, personality changes, and an abnormal heart rhythm.

The following groups of people are more likely than others to get too little magnesium:

  • People with gastrointestinal diseases (such as Crohn’s disease and celiac disease)
  • People with type 2 diabetes
  • People with long-term alcoholism
  • Older people

What are some effects of magnesium on health?

Scientists are studying magnesium to understand how it affects health. Here are some examples of what this research has shown.

High blood pressure and heart disease

High blood pressure is a major risk factor for heart disease and stroke. Magnesium supplements might decrease blood pressure, but only by a small amount. Some studies show that people who have more magnesium in their diets have a lower risk of some types of heart disease and stroke. But in many of these studies, it’s hard to know how much of the effect was due to magnesium as opposed to other nutrients.

Type 2 diabetes

People with higher amounts of magnesium in their diets tend to have a lower risk of developing type 2 diabetes. Magnesium helps the body break down sugars and might help reduce the risk of insulin resistance (a condition that leads to diabetes). Scientists are studying whether magnesium supplements might help people who already have type 2 diabetes control their disease. More research is needed to better understand whether magnesium can help treat diabetes.

Osteoporosis

Magnesium is important for healthy bones. People with higher intakes of magnesium have a higher bone mineral density, which is important in reducing the risk of bone fractures and osteoporosis. Getting more magnesium from foods or dietary supplements might help older women improve their bone mineral density. More research is needed to better understand whether magnesium supplements can help reduce the risk of osteoporosis or treat this condition.

Migraine headaches

People who have migraine headaches sometimes have low levels of magnesium in their blood and other tissues. Several small studies found that magnesium supplements can modestly reduce the frequency of migraines. However, people should only take magnesium for this purpose under the care of a health care provider. More research is needed to determine whether magnesium supplements can help reduce the risk of migraines or ease migraine symptoms.

Can magnesium be harmful?

Magnesium that is naturally present in food is not harmful and does not need to be limited. In healthy people, the kidneys can get rid of any excess in the urine. But magnesium in dietary supplements and medications should not be consumed in amounts above the upper limit, unless recommended by a health care provider.

The upper limits for magnesium from dietary supplements and/or medications are listed below. For many age groups, the upper limit appears to be lower than the recommended amount. This occurs because the recommended amounts include magnesium from all sources—food, dietary supplements and medications. The upper limits include magnesium from only dietary supplements and medications; they do not include magnesium found naturally in food.

Ages Upper Limit for Magnesium
in Dietary Supplements
and Medications
Birth to 12 months Not established
Children 1–3 years 65 mg
Children 4–8 years 110 mg
Children 9–18 years 350 mg
Adults 350 mg

 

High intakes of magnesium from dietary supplements and medications can cause diarrhea, nausea, and abdominal cramping. Extremely high intakes of magnesium can lead to irregular heartbeat and cardiac arrest.

Are there any interactions with magnesium that I should know about?

Yes. Magnesium supplements can interact or interfere with some medicines. Here are several examples:

  • Bisphosphonates, used to treat osteoporosis, are not well absorbed when taken too soon before or after taking dietary supplements or medications with high amounts of magnesium.
  • Antibiotics might not be absorbed if taken too soon before or after taking a dietary supplement that contains magnesium.
  • Diuretics can either increase or decrease the loss of magnesium through urine, depending on the type of diuretic.
  • Prescription drugs used to ease symptoms of acid reflux or treat peptic ulcers can cause low blood levels of magnesium when taken over a long period of time.
  • Very high doses of zinc supplements can interfere with the body’s ability to absorb and regulate magnesium.

Tell your doctor, pharmacist, and other health care providers about any dietary supplements and prescription or over-the-counter medicines you take. They can tell you if the dietary supplements might interact with your medicines or if the medicines might interfere with how your body absorbs, uses, or breaks down nutrients.

Magnesium and healthful eating

People should get most of their nutrients from food, advises the federal government’s Dietary Guidelines for Americans. Foods contain vitamins, minerals, dietary fiber and other substances that benefit health. In some cases, fortified foods and dietary supplements may provide nutrients that otherwise may be consumed in less-than-recommended amounts. For more information about building a healthy diet, refer to the Dietary Guidelines for Americansexternal link disclaimer and the U.S. Department of Agriculture’s MyPlateexternal link disclaimer.

Where can I find out more about magnesium?

Disclaimer

This fact sheet by the Office of Dietary Supplements provides information that should not take the place of medical advice. We encourage you to talk to your healthcare providers (doctor, registered dietitian, pharmacist, etc.) about your interest in, questions about, or use of dietary supplements and what may be best for your overall health. Any mention in this publication of a specific brand name is not an endorsement of the product.

Updated: February 17, 2016

Chondroitin sulfate benefits

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What is it?

Chondroitin sulfate is a chemical that is normally found in cartilage around joints in the body. Chondroitin sulfate is usually manufactured from animal sources, such as shark and cow cartilage.

Chondroitin sulfate is used for osteoarthritis. It is often used in combination with other ingredients, including manganese ascorbate, glucosamine sulfate, glucosamine hydrochloride, or N-acetyl glucosamine.

Chondroitin sulfate is also taken by mouth for HIV/AIDS, heart disease, heart attack, weak bones (osteoporosis), joint pain caused by drugs used to treat breast cancer, acid reflux, high cholesterol, muscle soreness after exercise, a bladder condition called interstitial cystitis, a bone disease called Kashin-Beck disease, and itchy and scaly skin (psoriasis). Chondroitin sulfate is also used in a complex with iron for treating iron-deficiency anemia.

Chondroitin sulfate is available as an eye drop for dry eyes. In addition, it is used during cataract surgery, and as a solution for preserving corneas used for transplants. It is approved by the FDA for these uses.

Some people with osteoarthritis use ointments or skin creams for pain that contain chondroitin sulfate, in combination with glucosamine sulfate, shark cartilage, and camphor.

Some people also inject chondroitin sulfate into the muscles for osteoarthritis.

Some people insert chondroitin sulfate into the bladder for urinary tract infections (UTIs), bladder conditions, or loss of control of the bladder.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CHONDROITIN SULFATE are as follows:

Possibly effective for…

  • Cataracts. Research shows that injecting a solution that contains chondroitin sulfate and sodium hyaluronate into the eye protects the eye during cataract surgery. Many different products containing chondroitin sulfate and sodium hyaluronate have been reviewed by the U.S. Food and Drug Administration (FDA) for use during cataract surgery. However, it’s not clear if adding chondroitin sulfate to sodium hyaluronate solutions helps reduce pressure within the eye after cataract surgery compared to other similar treatments. Some early studies suggest that a specific eye solution containing chondroitin sulfate and hyaluronate (Viscoat, Alcon Laboratories) can decrease pressure in the eye and improve overall eye health after a cataract is removed. However, the drops do not appear to be better than drops containing hyaluronate alone or another chemical called hydroxypropylmethyl-cellulose. The effect of solutions containing only chondroitin sulfate on cataract surgery is not known.
  • Osteoarthritis. Clinical research on the effectiveness of chondroitin sulfate taken by mouth for osteoarthritis is inconsistent. The reason for contradictory findings is unclear, but could be due to differences in people studied, different products used, or other differences in study design. Overall, the evidence shows that some people with osteoarthritis of the knee or hand may experience pain relief after taking chondroitin sulfate for 3-6 months. But pain relief is likely to be small at best. Other evidence shows that taking chondroitin sulfate for about 2 years might prevent osteoarthritis from becoming worse.
    Some research has evaluated the effects of chondroitin sulfate when taken by mouth in combination with glucosamine sulfate or glucosamine hydrochloride. Most research shows that taking these combination products for about 3-4 months reduces pain and improves joint function in patients with knee osteoarthritis. But some conflicting evidence exists.
    Some skin creams containing chondroitin sulfate are promoted for reducing osteoarthritis pain. There is some evidence that a skin cream containing chondroitin sulfate in combination with glucosamine sulfate, shark cartilage, and camphor seems to reduce arthritis symptoms. However, any symptom relief is most likely due to the camphor and not the other ingredients. There is no research showing that chondroitin is absorbed through the skin.
  • Urinary tract infections (UTIs). Early research suggests that administering a specific chondroitin sulfate and hyaluronic acid solution (iAluRil, IBSA Farmaceutici) through a catheter weekly for 4 weeks and then monthly for about 5 months reduces UTIs in women with a history of UTIs.

Insufficient evidence to rate effectiveness for…

  • Joint pain caused by breast cancer drugs. Early research suggests that taking a combination of glucosamine sulfate and chondroitin sulfate in two or three divided doses daily for 24 weeks improves joint pain and symptoms caused by drugs used to treat breast cancer.
  • Dry eyes. Research on the effectiveness of chondroitin sulfate on dry eyes is mixed. Early research suggests that using chondroitin sulfate eye drops decreases dry eyes. However, other evidence suggests that eye drops containing chondroitin sulfate are less effective than tear-replacement drops (Gel-Larmes). Other research shows that using a specific eye drop containing chondroitin sulfate together with xanthan gum (PRO-148, Laboratorios Sophia, SA de CV, Guadalajara, Mexico) four times daily for 60 days does not improve tears, but might improve the severity of dry eye symptoms.
  • Muscle soreness after exercise. Early research suggests that taking chondroitin sulfate daily does not reduce muscle soreness after exercise in men.
  • Acid reflux. When taken along with conventional treatments such as antacids, a syrup containing hyaluronic acid and chondroitin sulfate appears to reduce the intensity of acid reflux symptoms.
  • Bladder inflammation (interstitial cystitis). Several low-quality studies suggest that administering chondroitin sulfate solution into the bladder with or without hyaluronic acid can improve symptoms of bladder inflammation. Also, other early research suggests that taking a combination product containing chondroitin sulfate (CystoProtek) by mouth can improve bladder inflammation. However, some higher-quality research shows that inserting chondroitin sulfate into the bladder does not improve symptoms.
  • Bone and joint disease (Kashin-Beck disease). Early research suggests that chondroitin sulfate, with or without glucosamine hydrochloride, can reduce pain in people with Kashin-Beck disease. Also, taking chondroitin sulfate with glucosamine sulfate can slow joint space narrowing in people with this bone disease. However, it is unclear if taking chondroitin sulfate alone slows joint space narrowing.
  • Heart attack. Some early research shows that taking chondroitin sulfate by mouth might lower the risk of having a first or recurrent heart attack.
  • Skin redness and irritation (psoriasis). Early research suggests that taking chondroitin sulfate for 2-3 months decreases pain and improves skin conditions in people with psoriasis. But other research suggests that taking chondroitin sulfate (Condrosan, CS Bio-Active, Bioiberica S.A., Barcelona, Spain) daily for 3 months does not reduce psoriasis severity in people with psoriasis and knee osteoarthritis.
  • Overactive bladder. Early research suggests that inserting sodium chondroitin sulfate into the bladder through a urinary catheter improves quality of life in people with overactive bladder.
  • Heart disease.
  • Weak bones (osteoporosis).
  • High cholesterol.
  • Other conditions.

More evidence is needed to rate chondroitin sulfate for these uses.

How does it work?

In osteoarthritis, the cartilage in the joints breaks down. Taking chondroitin sulfate, one of the building blocks of cartilage, might slow this breakdown.

Are there safety concerns?

Chondroitin sulfate is LIKELY SAFE when taken by mouth or used as an eye solution during cataract surgery. Chondroitin sulfate has been taken by mouth safely in research for up to 6 years. Also, chondroitin sulfate has been given premarket approval by the US Food and Drug Administration (FDA) to be used as an eye solution during cataract surgery.

But there is some concern about the safety of chondroitin sulfate because it comes from animal sources. Some people are worried that unsafe manufacturing practices might lead to contamination of chondroitin products with diseased animal tissues, including those that might transmit bovine spongiform encephalopathy (mad cow disease). So far, there are no reports of chondroitin causing disease in humans, and the risk is thought to be low. It can cause some mild stomach pain and nausea. Other side effects that have been reported are bloating, diarrhea, constipation, headache, swollen eyelids, leg swelling, hair loss, skin rash, and irregular heartbeat.

Some chondroitin products contain excess amounts of manganese. Ask your healthcare professional about reliable brands.

Chondroitin sulfate is POSSIBLY SAFE when injected into the muscle short-term, when applied to the skin short-term, when used as an eye drop short-term, and when inserted into the bladder with a catheter by a physician.

Special precautions & warnings:

Pregnancy and breast-feeding: There is not enough reliable information about the safety of taking chondroitin sulfate if you are pregnant or breast feeding. Stay on the safe side and avoid use.

Asthma: There is some concern that chondroitin sulfate might make asthma worse. If you have asthma, use chondroitin sulfate cautiously.

Blood clotting disorders: In theory, administering chondroitin sulfate might increase the risk of bleeding in people with blood clotting disorders.

Prostate cancer: Early research suggests that chondroitin might cause the spread or recurrence of prostate cancer. This effect has not been shown with chondroitin sulfate supplements. However, until more is known, do not take chondroitin sulfate if you have prostate cancer or are at high risk for developing it (you have a brother or father with prostate cancer).

Are there interactions with medications?

Moderate
Be cautious with this combination.
Warfarin (Coumadin)
Warfarin (Coumadin) is used to slow blood clotting. There are several reports showing that taking chondroitin with glucosamine increases the effect of warfarin (Coumadin) on blood clotting. This can cause bruising and bleeding that can be serious. Don’t take chondroitin if you are taking warfarin (Coumadin).

Are there interactions with herbs and supplements?

There are no known interactions with herbs and supplements.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The following doses have been studied in scientific research:

BY MOUTH:

  • For osteoarthritis: the typical dose of chondroitin sulfate is 800-2000 mg taken as a single dose or in two or three divided doses daily for up to 3 years.

APPLIED TO THE SKIN:

  • For osteoarthritis: a cream containing 50 mg/gram of chondroitin sulfate, 30 mg/gram of glucosamine sulfate, 140 mg/gram of shark cartilage, and 32 mg/gram of camphor has been used as needed for sore joints for up to 8 weeks.

INJECTED INTO THE MUSCLE:

  • For osteoarthritis: chondroitin sulfate (Matrix) has been injected into the muscle daily or twice weekly for 6 months.

INSERTED INTO THE BLADDER:

  • For urinary tract infections (UTIs): 50 mL of a specific solution containing chondroitin sulfate and hyaluronic acid (iAluRil, IBSA Farmaceutici), has been inserted into the bladder once weekly for 4 weeks, and then once or twice monthly for up to 5 months.

APPLIED TO THE EYE:

  • For cataracts: Several different eye drops containing sodium hyaluronate and chondroitin sulfate (DisCoVisc, Alcon Laboratories; Viscoat, Alcon Laboratories; DuoVisc, Alcon Laboratories; Viscoat, Alcon Laboratories; Provisc, Alcon Laboratories) have been used during cataract surgery.

Other names

Calcium Chondroitin Sulfate, CDS, Chondroitin, Chondroitin Polysulfate, Chondroitin Polysulphate, Chondroitin Sulfate A, Chondroitin Sulfates, Chondroitin Sulfate B, Chondroitin Sulfate C, Chondroitin Sulphates, Chondroitin Sulphate A Sodium, Chondroïtine, Chondroïtine Sulfate A, Chondroïtine Sulfate B, Chondroïtine Sulfate C, Chondroïtine 4-Sulfate, Chondroïtine 4- et 6- Sulfate, Condroitin,

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Volpi N. Quality of different chondroitin sulfate preparations in relation to their therapeutic activity. J Pharm Pharmacol 2009;61:1271-80. View abstract.
  2. Lauder RM. Chondroitin sulphate: a complex molecule with potential impacts on a wide range of biological systems. Complement Ther Med 2009;17:56-62. View abstract.
  3. Barnhill JG, Fye CL, Williams DW, Reda DJ, Harris CL, Clegg DO. Chondroitin product selection for the glucosamine/chondroitin arthritis intervention trial. J Am Pharm Assoc 2006;46:14-24. View abstract.
  4. Zegels B, Crozes P, Uebelhart D, Bruyère O, Reginster JY. Equivalence of a single dose (1200 mg) compared to a three-time a day dose (400 mg) of chondroitin 4&6 sulfate in patients with knee osteoarthritis. Results of a randomized double blind placebo controlled study. Osteoarthritis Cartilage 2013;21:22-7. View abstract.

 

Gelatin- What Is It?

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Gelatin is a protein made from animal products.

Gelatin is used for weight loss and for treating osteoarthritis, rheumatoid arthritis, and brittle bones (osteoporosis). Some people also use it for strengthening bones, joints, and fingernails. Gelatin is also used for improving hair quality and to shorten recovery after exercise and sports-related injury.

In manufacturing, gelatin is used for preparation of foods, cosmetics, and medicines.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for GELATIN are as follows:

Insufficient evidence to rate effectiveness for…

  • A kind of arthritis called osteoarthritis. There is some clinical evidence that gelatin might relieve pain and improve joint function in patients with osteoarthritis.
  • Brittle bones (osteoporosis).
  • Strengthening bones and joints.
  • Strengthening fingernails.
  • Improving hair quality.
  • Weight loss.
  • Shortening recovery after exercise and sports-related injury.
  • Other conditions.

More evidence is needed to rate the effectiveness of gelatin for these uses.

How does it work?

Gelatin contains collagen, which is one of the materials that make up cartilage and bone. This is why some people think gelatin might help for arthritis and other joint conditions.

Are there safety concerns?

Gelatin is LIKELY SAFE for most people in food amounts and POSSIBLY SAFE in the larger amounts used as medicine. There’s some evidence that gelatin in doses up to 10 grams daily can be safely used for up to 6 months.

Gelatin can cause an unpleasant taste, sensation of heaviness in the stomach, bloating, heartburn, and belching. Gelatin can cause allergic reactions in some people.

There is some concern about the safety of gelatin because it comes from animal sources. Some people are worried that unsafe manufacturing practices might lead to contamination of gelatin products with diseased animal tissues including those that might transmit mad cow disease (bovine spongiform encephalopathy). Although this risk seems to be low, many experts advise against using animal-derived supplements like gelatin.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of gelatin in medicinal amounts during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Are there interactions with medications?

It is not known if this product interacts with any medicines.

Before taking this product, talk with your health professional if you take any medications.

Are there interactions with herbs and supplements?

There are no known interactions with herbs and supplements.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The appropriate dose of gelatin depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for gelatin. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Miller, L. G. Observations on the distribution and ecology of Clostridium botulinum type E in Alaska. Canadian Journal of Microbiology 1982;21:926.
  2. Kawahara H, Tanaka K Iikura Y Akasawa A Saito H. The incidence of gelatin allergy among atopic children in Japan. J Allergy Clin.Immunol. 1998;103:321-325.
  3. Morganti, P and Fanrizi, G. Effects of gelatin-glycine on oxidative stress. Cosmetics and Toiletries (USA) 2000;115:47-56.Gelatin

What is it? Guarana

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Guarana is a plant named for the Guarani tribe in the Amazon, who used the seeds to brew a drink. Today, guarana seeds are still used as medicine.

Guarana is used for weight loss, to enhance athletic performance, as a stimulant, and to reduce mental and physical fatigue. It is a frequent addition to energy and weight loss products.

Some people also use guarana to treat low blood pressure and chronic fatigue syndrome (CFS), and to prevent malaria and dysentery. It is also used to enhance sexual desire, to increase urine flow, and as an astringent.

Other uses include treatment of ongoing diarrhea, fever, heart problems, headache, joint pain, backache, and heat stress.

In food manufacturing, guarana has been used as a flavoring ingredient in beverages and candy.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for GUARANA are as follows:

Insufficient evidence to rate effectiveness for…

  • Anxiety. Early research suggests that taking two tablets of a specific product (Euphytose) containing hawthorn, black horehound, passionflower, valerian, cola nut, and guarana three times daily for 28 days can reduce anxiety in some people. However, it is not clear if guarana alone is beneficial.
  • Mental performance. Early research in healthy people suggests that taking a single dose of guarana dry extract can improve thinking speed. However, other research suggests that taking guarana daily does not improve mental function in adults or older people.
  • Weight loss. Guarana might promote weight loss when used in combination with mate and damiana. There is also developing evidence that a specific combination product containing guarana, ephedra, and 17 other vitamins, minerals, and supplements (Metabolife-356) might help reduce weight by approximately 2.7 kg over eight weeks when used with a low-fat diet and exercise. However, more evidence is needed to rate guarana for this use.
  • Malaria.
  • Diarrhea.
  • Fever.
  • Headaches.
  • Heart problems.
  • Improvement of exercise endurance.
  • Improvement of short-term, high-intensity performance and power.
  • Increasing blood pressure in people who have low blood pressure.
  • Chronic fatigue syndrome (CFS).
  • Joint pain.
  • Fluid retention.
  • Other conditions.

More evidence is needed to rate guarana for these uses.

How does it work?

Guarana contains caffeine. Caffeine works by stimulating the central nervous system (CNS), heart, and muscles. Guarana also contains theophylline and theobromine, which are chemicals similar to caffeine.

Are there safety concerns?

Guarana is LIKELY SAFE for most adults when consumed in amounts commonly found in foods.

Guarana is POSSIBLY SAFE when taken my mouth in medicinal amounts for a short time.

Guarana is POSSIBLY UNSAFE when taking by mouth in high doses for a long time. Doses greater than 250-300 mg daily have been linked to side effects. Side effects depend on the dose. At typical doses, the caffeine in guarana can cause insomnia, nervousness and restlessness, stomach irritation, nausea, vomiting, increased heart rate and blood pressure, rapid breathing, tremors, delirium, diuresis, and other side effects. Large guarana doses might cause headache, anxiety, agitation, ringing in the ears, pain when urinating, stomach cramps, and irregular heartbeats. People who take guarana regularly may experience caffeine withdrawal symptoms if they reduce their usual amount.

Guarana is LIKELY UNSAFE and even deadly, due to its caffeine content, when taken by mouth or injected in very high doses. The fatal dose of caffeine is estimated to be 10-14 grams (150-200 mg per kilogram; the “typical” man weighs about 70 kilograms, so a lethal dose of caffeine for this man would be 10,500-14,000 mg). This is quite a high dose. Consider that one cup of brewed coffee provides from 95-200 mg of caffeine. However, serious poisoning can occur at doses lower than 150-200 mg per kilogram depending on an individual’s caffeine sensitivity or smoking behavior, age, and prior caffeine use.

Special precautions & warnings:

Pregnancy and breast-feeding: Guarana is POSSIBLY SAFE for pregnant and breast feeding women when taken in amounts commonly found in foods. If you are pregnant or breast-feeding, guarana should be taken with caution due to the caffeine content. Small amounts are probably not harmful. However, taking guarana in high doses by mouth is POSSIBLY UNSAFE. Consuming more than 200 mg has been linked to an increased risk of miscarriage and other negative effects.

Anxiety: The caffeine in guarana might make feelings of anxiety worse.

Bleeding disorders: There is some evidence suggesting that the caffeine in guarana might make bleeding disorders worse, although this has not been reported in people. If you have a bleeding disorder, check with your healthcare provider before starting guarana.

Diabetes: Some research suggests that the caffeine in guarana may affect the way people with diabetes process sugar (glucose) and may complicate blood sugar control. There is also some interesting research that suggests caffeine may enhance the warning symptoms of low blood sugar in patients with type 1 diabetes. Some studies show that the symptoms of low blood sugar are more intense when they start in the absence of caffeine, but as low blood sugar continues, symptoms are greater with caffeine. This might increase the ability of diabetic patients to detect and treat low blood sugar. However, the downside is that caffeine might actually increase the number of low-sugar episodes. If you have diabetes, talk with your healthcare provider before starting guarana.

Diarrhea. Guarana contains caffeine. The caffeine in guarana, especially when taken in large amounts, can worsen diarrhea.

Irritable bowel syndrome (IBS): Guarana contains caffeine. The caffeine in guarana, especially when taken in large amounts, can worsen diarrhea and might worsen symptoms of IBS.

Heart disease: The caffeine in guarana might cause irregular heartbeat in certain people. Use with caution.

High blood pressure: Taking guarana might raise blood pressure in people with high blood pressure due to its caffeine content. However, this effect might be less in people who are regular coffee-drinkers or otherwise use caffeine on a regular basis.

Glaucoma: The caffeine in guarana increases the pressure inside the eye. The increase occurs within 30 minutes and lasts for at least 90 minutes after drinking caffeinated beverages.

Osteoporosis: The caffeine in guarana can flush calcium out of the body through the kidneys. This calcium loss might help to weaken bones. To minimize this problem, don’t use more than 300 mg of caffeine per day. Taking calcium supplements may also help to offset these calcium losses. Postmenopausal women who have a genetic problem that affects how vitamin D is used by the body should use caffeine with caution.

Are there interactions with medications?

Major
Do not take this combination.
Amphetamines
Stimulant drugs such as amphetamines speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and increase your heart rate. The caffeine in guarana might also speed up the nervous system. Taking guarana along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with caffeine.
Cocaine
Stimulant drugs such as cocaine speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and increase your heart rate. The caffeine in guarana might also speed up the nervous system. Taking guarana along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with caffeine.
Ephedrine
Stimulant drugs speed up the nervous system. Caffeine (contained in guarana) and ephedrine are both stimulant drugs. Taking guarana along with ephedrine might cause too much stimulation and sometimes serious side effects and heart problems. Do not take caffeine-containing products and ephedrine at the same time.
Moderate
Be cautious with this combination.
Adenosine (Adenocard)
Guarana contains caffeine. The caffeine in guarana might block the affects of adenosine (Adenocard). Adenosine (Adenocard) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop consuming guarana or other caffeine-containing products at least 24 hours before a cardiac stress test.
Antibiotics (Quinolone antibiotics)
The body breaks down caffeine to get rid of it. Some antibiotics might decrease how quickly the body breaks down caffeine. Taking these antibiotics along with guarana can increase the risk of side effects including jitteriness, headache, increased heart rate, and other side effects.

Some antibiotics that decrease how quickly the body breaks down caffeine include ciprofloxacin (Cipro), enoxacin (Penetrex), norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagam), trovafloxacin (Trovan), and grepafloxacin (Raxar).

Cimetidine (Tagamet)
Guarana contains caffeine. The body breaks down caffeine to get rid of it. Cimetidine (Tagamet) can decrease how quickly your body breaks down caffeine. Taking cimetidine (Tagamet) along with guarana might increase the chance of caffeine side effects including jitteriness, headache, fast heartbeat, and others.
Clozapine (Clozaril)
The body breaks down clozapine (Clozaril) to get rid of it. The caffeine in guarana seems to decrease how quickly the body breaks down clozapine (Clozaril). Taking guarana along with clozapine (Clozaril) can increase the effects and side effects of clozapine (Clozaril).
Dipyridamole (Persantine)
Guarana contains caffeine. The caffeine in guarana might block the effects of dipyridamole (Persantine). Dipyridamole (Persantine) is often used by doctors to do a test on the heart. This test is called a cardiac stress test. Stop consuming guarana or other caffeine-containing products at least 24 hours before a cardiac stress test.
Disulfiram (Antabuse)
The body breaks down caffeine to get rid of it. Disulfiram (Antabuse) can decrease how quickly the body gets rid of caffeine. Taking guarana (which contains caffeine) along with disulfiram (Antabuse) might increase the effects and side effects of caffeine including jitteriness, hyperactivity, irritability, and others.
Estrogens
The body breaks down the caffeine in guarana to get rid of it. Estrogens can decrease how quickly the body breaks down caffeine. Taking guarana along with estrogens can cause jitteriness, headache, fast heartbeat, and other side effects. If you take estrogens, limit your caffeine intake.

Some estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.

Fluvoxamine (Luvox)
The body breaks down the caffeine in guarana to get rid of it. Fluvoxamine (Luvox) can decrease how quickly the body breaks down caffeine. Taking guarana along with fluvoxamine (Luvox) might cause too much caffeine in the body, and increase the effects and side effects of caffeine.
Lithium
You body naturally gets rid of lithium. The caffeine in guarana can increase how quickly your body gets rid of lithium. If you take products that contain caffeine and you take lithium, stop taking caffeine products slowly. Stopping caffeine too quickly can increase the side effects of lithium.
Medications for asthma (Beta-adrenergic agonists)
Guarana contains caffeine. Caffeine can stimulate the heart. Some medications for asthma can also stimulate the heart. Taking caffeine with some medications for asthma might cause too much stimulation and cause heart problems.

Some medications for asthma include albuterol (Proventil, Ventolin, Volmax), metaproterenol (Alupent), terbutaline (Bricanyl, Brethine), and isoproterenol (Isuprel).

Medications for depression (MAOIs)
Guarana contains caffeine. Caffeine can stimulate the body. Some medications used for depression can also stimulate the body. Taking guarana with these medications used for depression might cause serious side effects including fast heartbeat, high blood pressure, nervousness, and others.

Some of these medications used for depression include phenelzine (Nardil), tranylcypromine (Parnate), and others.

Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Guarana contains caffeine. Caffeine might slow blood clotting. Taking guarana along with medications that also slow clotting might increase the chances of bruising and bleeding.

Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, others), ibuprofen (Advil, Motrin, others), naproxen (Anaprox, Naprosyn, others), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin), and others.

Nicotine
Stimulant drugs such as nicotine speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and increase your heart rate. The caffeine in guarana might also speed up the nervous system. Taking guarana along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with caffeine.
Pentobarbital (Nembutal)
The stimulant effects of the caffeine in guarana can block the sleep-producing effects of pentobarbital.
Phenylpropanolamine
The caffeine in guarana can stimulate the body. Phenylpropanolamine can also stimulate the body. Taking guarana along with phenylpropanolamine might cause too much stimulation and increase heartbeat, blood pressure and cause nervousness.
Riluzole (Rilutek)
The body breaks down riluzole (Rilutek) to get rid of it. Taking guarana can decrease how fast the body breaks down riluzole (Rilutek) and increase the effects and side effects of riluzole.
Stimulant drugs
Stimulant drugs speed up the nervous system. By speeding up the nervous system, stimulant medications can make you feel jittery and speed up your heartbeat. Guarana contains caffeine, which can also speed up the nervous system. Taking guarana along with stimulant drugs might cause serious problems including increased heart rate and high blood pressure. Avoid taking stimulant drugs along with guarana.

Some stimulant drugs include nicotine, cocaine, sympathomimetic amines, and amphetamines.

Theophylline
Guarana contains caffeine. Caffeine works similarly to theophylline. Caffeine can also decrease how quickly the body gets rid of theophylline. Taking guarana along with theophylline might increase the effects and side effects of theophylline.
Verapamil (Calan, Covera, Isoptin, Verelan)
The body breaks down the caffeine in guarana to get rid of it. Verapamil (Calan, Covera, Isoptin, Verelan) can decrease how quickly the body gets rid of caffeine. Taking guarana along with verapamil (Calan, Covera, Isoptin, Verelan) can increase the risk of caffeine side effects including jitteriness, headache, and an increased heartbeat.
Minor
Be watchful with this combination.
Alcohol
The body breaks down the caffeine in guarana to get rid of it. Alcohol can decrease how quickly the body breaks down caffeine. Taking guarana along with alcohol might cause too much caffeine in the bloodstream and caffeine side effects including jitteriness, headache, and fast heartbeat.
Birth control pills (Contraceptive drugs)
The body breaks down the caffeine in guarana to get rid of it. Birth control pills can decrease how quickly the body breaks down caffeine. Taking guarana along with birth control pills can cause jitteriness, headache, fast heartbeat, and other side effects.

Some birth control pills include ethinyl estradiol and levonorgestrel (Triphasil), ethinyl estradiol and norethindrone (Ortho-Novum 1/35, Ortho-Novum 7/7/7), and others.

Fluconazole (Diflucan)
Guarana contains caffeine. The body breaks down caffeine to get rid of it. Fluconazole (Diflucan) might decrease how quickly the body gets rid of caffeine Taking guarana along with fluconazole (Diflucan) might increase the risk of caffeine side effects such as nervousness, anxiety, and insomnia.
Medications for diabetes (Antidiabetes drugs)
Guarana might increase blood sugar. Diabetes medications are used to lower blood sugar. By increasing blood sugar, guarana might decrease the effectiveness of diabetes medications. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

Mexiletine (Mexitil)
Guarana contains caffeine. The body breaks down caffeine to get rid of it. Mexiletine (Mexitil) can decrease how quickly the body breaks down caffeine. Taking mexiletine (Mexitil) along with guarana might increase the caffeine effects and side effects of guarana.
Terbinafine (Lamisil)
The body breaks down caffeine (contained in guarana) to get rid of it. Terbinafine (Lamisil) can decrease how fast the body gets rid of caffeine and increase the risk of side effects including jitteriness, headache, increased heartbeat, and other effects.

Are there interactions with herbs and supplements?

Bitter orange
Guarana contains caffeine. Taking bitter orange along with herbs that contain caffeine, such guarana, can increase blood pressure and heart rate in people who otherwise have normal blood pressure. This might increase the chance of developing problems with the heart and blood vessels.
Caffeine-containing herbs and supplements
Guarana contains caffeine. Taking it with other herbs and supplements that also contain caffeine can increase both the harmful and helpful effects of caffeine. Other natural products that contain caffeine include coffee, black tea, green tea, oolong tea, pu-erh tea, mate, and cola.
Calcium
High caffeine intake from foods, beverages, and herbs including guarana increases urinary calcium excretion.
Creatine
There is some concern that combining caffeine, ephedra, and creatine might increase the risk of serious side effects. There is a report of stroke in an athlete who took 6 grams of creatine monohydrate, 400-600 mg of caffeine, 40-60 mg of ephedra, and a variety of other supplements daily for 6 weeks. Caffeine might also decrease creatine’s possible beneficial effects on athletic performance.
Ephedra (Ma huang)
Ephedra is a stimulant. Guarana is a stimulant, due to it’s caffeine content. Using ephedra along with guarana can cause too much stimulation in the body. One unpublished report linked jitteriness, high blood pressure, seizures, temporary loss of consciousness, and hospitalization requiring life support with the use of a combination ephedra and guarana (caffeine) product. Don’t take guarana with ephedra or other stimulants.
Herbs and supplements that slow blood clotting (Anticoagulant/Antiplatelet herbs and supplements
Guarana seems to be able to slow blood clotting. Using it along with other herbs and supplements that also slow blood clotting might increase the risk of bleeding in some people. Some of these herbs include angelica, clove, danshen, garlic, ginger, ginkgo, and Panax ginseng.
Magnesium
High caffeine intake from foods, beverages, and herbs including guarana increases urinary magnesium excretion.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The appropriate dose of guarana depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for guarana. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Brice C and Smith A. The effects of caffeine on simulated driving, subjective alertness and sustained attention. Hum Psychopharmacol Clin Exp 2001;16:523-531.
  2. Neims AH, Bailey J, and Aldridge A. Disposition of caffeine during and after pregnancy. Clin Res 1979;27:236A.
  3. Johnsen O, Eliasson R, and Abdel-Kadar MM. Effects of caffeine on the motility and metabolism of human spermatozoa. Andrologia 1974;6:53-58.

Healthy Origins Coq10 - 400 Mg - 60 Softgels

Overview

Questions and Answers About Coenzyme Q10 (CoQ10)

  1. What is CoQ10?

    CoQ10 is a compound that is made naturally in the body. The Q and the 10 in coenzyme Q10 refer to the groups of chemicals that make up the coenzyme. CoQ10 is also known by these other names:

    • Q10.
    • Vitamin Q10.
    • Ubiquinone.
    • Ubidecarenone.

    A coenzyme helps an enzyme do its job. An enzyme is a protein that speeds up the rate at which natural chemical reactions take place in cells of the body. The body’s cells use CoQ10 to make energy needed for the cells to grow and stay healthy. The body also uses CoQ10 as an antioxidant. An antioxidant is a substance that protects cells from chemicals called free radicals. Free radicals can damage DNA (deoxyribonucleic acid). Genes, which are pieces of DNA, tell the cells how to work in the body and when to grow and divide. Damage to DNA has been linked to some kinds of cancer. By protecting cells against free radicals, antioxidants help protect the body against cancer.

    CoQ10 is found in most body tissues. The highest amounts are found in the heart, liver, kidneys, and pancreas. The lowest amounts are found in the lungs. The amount of CoQ10 in tissues decreases as people get older.

  2. What is the history of the discovery and use of CoQ10 as a complementary or alternative treatment for cancer?

    CoQ10 was first identified in 1957. Its chemical structure was determined in 1958. Interest in CoQ10 as a possible treatment for cancer began in 1961, when it was found that some cancer patients had a lower than normal amount of it in their blood. Low blood levels of CoQ10 have been found in patients with myeloma, lymphoma, and cancers of the breast, lung, prostate, pancreas, colon, kidney, and head and neck.

    Research about how CoQ10 plays a key role in the way cells make energy was awarded the Nobel Prize in Chemistry in 1978.

    Studies suggest that CoQ10 may help the immune system work better. Partly because of this, CoQ10 is used as adjuvant therapy for cancer. Adjuvant therapy is treatment given following the primary treatment to lower the risk that the cancer will come back.

  3. What is the theory behind the claim that CoQ10 is useful in treating cancer?

    CoQ10 may be useful in treating cancer because it boosts the immune system. Also, studies suggest that CoQ10 analogs (drugs that are similar to CoQ10) may prevent the growth of cancer cells directly. As an antioxidant, CoQ10 may help prevent cancer from developing.

    Refer to the PDQ health professional summary on Coenzyme Q10 for more information on the theory behind the study of CoQ10 in the treatment of cancer.

  4. How is CoQ10 administered?

    CoQ10 is usually taken by mouth as a pill (tablet or capsule). It may also be given by injection into a vein (IV). In animal studies, CoQ10 is given by injection.

  5. Have any preclinical (laboratory or animal) studies been conducted using CoQ10?

    A number of preclinical studies have been done with CoQ10. Research in a laboratory or using animals is done to find out if a drug, procedure, or treatment is likely to be useful in humans. These preclinical studies are done before any testing in humans is begun. Most laboratory studies of CoQ10 have looked at its chemical structure and how it works in the body. The following has been reported from preclinical studies of CoQ10 and cancer:

    • Animal studies found that CoQ10 boosts the immune system and helps the body fight certain infections and types of cancer.
    • CoQ10 helped to protect the hearts of study animals that were given the anticancer drug doxorubicin, an anthracycline that can cause damage to the heart muscle.
    • Laboratory and animal studies have shown that analogs (drugs that are similar to CoQ10) may stop cancer cells from growing.
  6. Have any clinical trials (research studies with humans) of CoQ10 been conducted?

    There have been no well-designed clinical trials involving large numbers of patients to study the use of CoQ10 in cancer treatment. There have been some clinical trials with small numbers of people, but the way the studies were done and the amount of information reported made it unclear if benefits were caused by the CoQ10 or by something else. Most of the trials were not randomized or controlled. Randomized controlled trials give the highest level of evidence:

    • In randomized trials, volunteers are assigned randomly (by chance) to one of 2 or more groups that compare different factors related to the treatment.
    • In controlled trials, one group (called the control group) does not receive the new treatment being studied. The control group is then compared to the groups that receive the new treatment, to see if the new treatment makes a difference.

    Some research studies are published in scientific journals. Most scientific journals have experts who review research reports before they are published, to make sure that the evidence and conclusions are sound. This is called peer review. Studies published in peer-reviewed scientific journals are considered better evidence. No randomized clinical trials of CoQ10 as a treatment for cancer have been published in a peer-reviewed scientific journal.

    The following has been reported from studies of CoQ10 in humans:

    Randomized trials of CoQ10 and doxorubicin

    • A randomized trial of 20 children treated for acute lymphoblastic leukemia or non-Hodgkin lymphoma looked at whether CoQ10 would protect the heart from the damage caused by the anthracycline drug doxorubicin. The results of this trial and others have shown that CoQ10 decreases the harmful effects of doxorubicin on the heart.
    • In a larger trial, 236 patients treated for breast cancer were randomized to receive oral supplements of either 300 mg CoQ10 or placebo, each combined with 300 IU vitamin E, for 24 weeks. The study found that levels of fatigue and quality of life were not improved in patients who received CoQ10 plus vitamin E compared to patients who received the placebo.

    Studies of CoQ10 as an adjuvant therapy for breast cancer

    Small studies have been done on the use of CoQ10 after standard treatment in patients with breast cancer:

    • In a study of CoQ10 in 32 breast cancer patients, it was reported that some signs and symptoms of cancer went away in 6 patients. Details were given for only 3 of the 6 patients. The researchers also reported that all the patients in the study used less pain medicine, had improved quality of life, and did not lose weight during treatment.
    • In another study led by the same researchers, 3 breast cancer patients were given high-dose CoQ10 and followed for 3 to 5 years. The study reported that one patient had complete remission of cancer that had spread to the liver, another had remission of cancer that had spread to the chest wall, and the third had no breast cancer found after surgery.

    It is not clear, however, if the benefits reported in these studies were caused by CoQ10 therapy or something else. The studies had the following weaknesses:

    • The studies were not randomized or controlled.
    • The patients used other supplements in addition to CoQ10.
    • The patients received standard treatments before or during the CoQ10 therapy.
    • Details were not reported for all patients in the studies.

    Anecdotal reports of CoQ10

    Anecdotal reports are incomplete descriptions of the medical and treatment history of one or more patients. There have been anecdotal reports that CoQ10 has helped some cancer patients live longer, including patients with cancers of the pancreas, lung, colon, rectum, and prostate. The patients described in these reports, however, also received treatments other than CoQ10, including chemotherapy, radiation therapy, and surgery.

    In a follow-up study, two patients who had breast cancer remaining after surgery were treated with CoQ10 for 3 to 4 months. It was reported that after treatment with CoQ10, the cancer was completely gone in both patients.

  7. Have any side effects or risks been reported from CoQ10?

    No serious side effects have been reported from the use of CoQ10. The most common side effects include the following:

    • Insomnia (being unable to fall sleep or stay asleep).
    • Higher than normal levels of liver enzymes.
    • Rashes.
    • Nausea.
    • Pain in the upper part of the abdomen.
    • Dizziness.
    • Feeling sensitive to light.
    • Feeling irritable.
    • Headache.
    • Heartburn.
    • Feeling very tired.

    It is important to check with health care providers to find out if CoQ10 can be safely used along with other drugs. Certain drugs, such as those that are used to lower cholesterol, blood pressure, or blood sugar levels, may decrease the effects of CoQ10. CoQ10 may change way the body uses warfarin (a drug that prevents the blood from clotting) and insulin.

    As noted in Question 1, the body uses CoQ10 as an antioxidant. Antioxidants protect cells from free radicals. Some conventional cancer therapies, such as anticancer drugs and radiation treatment, kill cancer cells in part by causing free radicals to form. Researchers are studying whether using CoQ10 along with conventional therapies has any effect, good or bad, on the way these conventional therapies work in the body.

  8. Is CoQ10 approved by the US Food and Drug Administration (FDA) for use as a cancer treatment in the United States?

    CoQ10 is sold as a dietary supplement and is not approved by the FDA for use as a cancer treatment. Dietary supplements are products meant to be added to the diet. They are not drugs and are not meant to treat, prevent, or cure diseases. The manufacturer is responsible for ensuring that the product is safe and that the label claims are truthful and not misleading. The FDA does not approve dietary supplements as safe or effective before they are sold. Also, the way companies make CoQ10 is not regulated. Different batches and brands of CoQ10 supplements may be different from each other.

Current Clinical Trials

Check the list of NCI-supported cancer clinical trials for cancer CAM clinical trials on coenzyme Q10 that are actively enrolling patients.

General information about clinical trials is available from the NCI website.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the use of coenzyme Q10 in the treatment of people with cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Date Last Modified”) is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI’s website. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).

Disclaimer

The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.

Cascara

Nature's Way Cascara Sagrada Aged Bark - 100 Vcaps

What is it?

Cascara is a shrub. The dried bark is used to make medicine.

Cascara used to be approved by the federal Food and Drug Administration (FDA) as an over-the-counter (OTC) drug for constipation. However, over the years, concerns were raised about cascara’s safety and effectiveness. The FDA gave manufacturers the chance to submit safety and effectiveness information to answer these concerns. But the companies decided the cost of conducting safety and effectiveness studies would likely be more than the profit they could expect from sales of cascara. So they didn’t comply with the request. As a result, the FDA notified manufacturers to remove or reformulate all OTC laxative products containing cascara from the U.S. market by November 5, 2002. Today, you can buy cascara as a “dietary supplement,” but not as a drug. “Dietary supplements” don’t have to meet the standards that the FDA applies to OTC or prescription drugs.

Cascara is used as a laxative for constipation, as well as a treatment for gallstones, liver ailments, and cancer. Some people use it as a “bitter tonic.”

In foods and beverages, a bitterless extract of cascara is sometimes used as a flavoring agent.

In manufacturing, cascara is used in the processing of some sunscreens.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for CASCARA are as follows:

Possibly effective for…

  • Constipation. Cascara has laxative effects and may help relieve constipation in some people.

Possibly ineffective for…

  • Bowel preparation before colonoscopy. Most research shows that taking cascara along with magnesium sulfate or milk of magnesia does not improve bowel cleansing in people who are undergoing a colonoscopy.

Insufficient evidence to rate effectiveness for…

  • Gallstones.
  • Liver disease.
  • Cancer.
  • Other conditions.

More evidence is needed to rate the effectiveness of cascara for these uses.

How does it work?

Cascara contains chemicals that stimulate the bowel and have a laxative effect.

Are there safety concerns?

Cascara is POSSIBLY SAFE for most adults when taken by mouth for less than one week. Side effects include stomach discomfort and cramps.

Cascara is POSSIBLY UNSAFE when used long-term. Don’t use cascara for longer than one or two weeks. Long-term use can cause more serious side effects including dehydration; low levels of potassium, sodium, chloride, and other “electrolytes” in the blood; heart problems; muscle weakness; and others.

Special precautions & warnings:

Pregnancy and breast-feeding: Not enough is known about the use of cascara during pregnancy. Stay on the safe side and avoid use if you are pregnant. Cascara is POSSIBLY UNSAFE when taken by mouth while breast-feeding. Cascara can cross into breast milk and might cause diarrhea in a nursing infant.

Children: Cascara is POSSIBLY UNSAFE in children when taken by mouth. Don’t give cascara to children. They are more likely than adults to become dehydrated and also harmed by the loss of electrolytes, especially potassium.

Gastrointestinal (GI) disorders such as intestinal obstruction, Crohn’s disease, ulcerative colitis, appendicitis, stomach ulcers, or unexplained stomach pain: People with any of these conditions should not use cascara.

Are there interactions with medications?

Moderate
Be cautious with this combination.
Digoxin (Lanoxin)
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives can decrease potassium levels in the body. Low potassium levels can increase the risk of side effects of digoxin (Lanoxin).
Medications for inflammation (Corticosteroids)
Some medications for inflammation can decrease potassium in the body. Cascara is a type of laxative that might also decrease potassium in the body. Taking cascara along with some medications for inflammation might decrease potassium in the body too much.

Some medications for inflammation include dexamethasone (Decadron), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisone (Deltasone), and others.

Medications taken by mouth (Oral drugs)
Cascara is a laxative. Laxatives can decrease how much medicine your body absorbs. Decreasing how much medicine your body absorbs can decrease the effectiveness of your medication.
Stimulant laxatives
Cascara is a type of laxative called a stimulant laxative. Stimulant laxatives speed up the bowels. Taking cascara along with other stimulant laxatives could speed up the bowels too much and cause dehydration and low minerals in the body.

Some stimulant laxatives include bisacodyl (Correctol, Dulcolax), castor oil (Purge), senna (Senokot), and others.

Warfarin (Coumadin)
Cascara can work as a laxative. In some people cascara can cause diarrhea. Diarrhea can increase the effects of warfarin and increase the risk of bleeding. If you take warfarin, do not take excessive amounts of cascara.
Water pills (Diuretic drugs)
Cascara is a laxative. Some laxatives can decrease potassium in the body. “Water pills” can also decrease potassium in the body. Taking cascara along with “water pills” might decrease potassium in the body too much.

Some “water pills” that can decrease potassium include chlorothiazide (Diuril), chlorthalidone (Thalitone), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Microzide), and others.

Are there interactions with herbs and supplements?

Chromium-containing herbs and supplements
Cascara contains chromium and could increase the risk of chromium poisoning when taken with chromium supplements or chromium-containing herbs such as bilberry, brewer’s yeast, or horsetail.
Herbs that contain cardiac-glycosides
Cardiac glycosides are chemicals that are similar to the prescription drug digoxin. Cardiac glycosides can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

Using cascara along with an herb that contains cardiac glycosides can cause the body to lose too much potassium, and this can cause heart damage. Herbs that contain cardiac glycosides include black hellebore, Canadian hemp roots, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, oleander leaf, pheasant’s eye plant, pleurisy root, squill bulb leaf scales, star of Bethlehem, strophanthus seeds, and uzara. Avoid using cascara with any of these.

Horsetail
Horsetail increases the production of urine (acts as a diuretic) and this can cause the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using horsetail with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with horsetail.

Licorice
Licorice causes the body to lose potassium.

Cascara can also cause the body to lose potassium because it is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

If potassium levels drop too low, the heart may be damaged. There is a concern that using licorice with cascara increases the risk of losing too much potassium and increases the risk of heart damage. Avoid using cascara with licorice.

Stimulant laxative herbs
Cascara is a stimulant laxative. Stimulant laxatives speed up the bowels. As a result, food may not remain in the intestine long enough for the body to absorb minerals such as potassium. This can lead to lower than ideal potassium levels.

There is a concern that taking cascara along with other stimulant laxatives herbs can make potassium levels drop too low, and this can harm the heart. Other stimulant laxative herbs are aloe, alder buckthorn, black root, blue flag, butternut bark, colocynth, European buckthorn, fo ti, gamboge, gossypol, greater bindweed, jalap, manna, Mexican scammony root, rhubarb, senna, and yellow dock. Avoid using cascara with any of these.

Are there interactions with foods?

There are no known interactions with foods.

What dose is used?

The following doses have been studied in scientific research:

BY MOUTH:

  • As a laxative for constipation: 20-30 mg per day of the active ingredient (hydroxyanthracene derivatives). A typical dose is 1 cup of tea, which is made by steeping 2 grams of finely chopped bark in 150 mL of boiling water for 5-10 minutes, and then straining. The cascara liquid extract is taken in a dose of 2-5 mL three times daily. The appropriate amount of cascara is the smallest dose that is needed to maintain soft stools.

Methodology

To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.

References

  1. Chang, L. C., Sheu, H. M., Huang, Y. S., Tsai, T. R., and Kuo, K. W. A novel function of emodin: enhancement of the nucleotide excision repair of UV- and cisplatin-induced DNA damage in human cells. Biochem Pharmacol 1999;58:49-57.
  2. Chang, C. J., Ashendel, C. L., Geahlen, R. L., McLaughlin, J. L., and Waters, D. J. Oncogene signal transduction inhibitors from medicinal plants. In Vivo 1996;10:185-190.
  3. Chen, H. C., Hsieh, W. T., Chang, W. C., and Chung, J. G. Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells. Food Chem Toxicol 2004;42:1251-1257.

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