Overview of genetic disorders
Related Terms
Autosomal recessive disorder, Cancer Genome Atlas, chromosomal disorder, chromosome, cystic fibrosis, Down's syndrome, gene, gene therapy, genes, genetic counseling, genetic makeup, genetic test, genetic testing, HGP, human genome, Human Genome Project, Huntington's disease, inherited disorder, Mendelian disorder, mitochondria, mitochondrial disorder, monogenic disorder, multifactorial disorders, sickle cell anemia, single-gene disorders, trisomy 21, X-linked dominant disorder, X-linked recessive disorder, Y-linked disorder.
Background
A genetic disorder occurs when a person has one or more abnormal genes, missing genes, extra genes, inactivated genes, or overly active genes that lead to a medical condition.
Genetic conditions can be inherited, or passed down from parents to their children. However, some disorders are caused by random genetic mutations that occur during the development of the egg, sperm, or embryo. If a person randomly develops a genetic disorder, he/she can then pass the condition onto his/her children.
Genes are found inside the cells of all organisms. An individual's genes are present in a large molecule called DNA (deoxyribonucleic acid), which looks like a twisted ladder. This unique shape is called a double helix. The sides of the double helix are made of alternating sugar and phosphate molecules. The "rungs" of the "ladder" are made of smaller molecules that contain nitrogen. These molecules include adenine, thymine, cytosine, and guanine.
All genes are made up of different combinations of these four molecules, which are arranged in different lengths. The sequence of these molecules provides the "code," or instructions, for each of the genes involved in the development, growth, and function of all the cells in the body.
A person's DNA is contained inside chromosomes. Nearly every cell in the body contains a nucleus, which contains two sets of chromosomes. Each parent provides one set (23) to his or her offspring. Therefore, each person has 23 pairs of chromosomes. The X and Y chromosome are called sex-determining chromosomes because they distinguish males from females. Human females have a pair of X chromosomes, while males have one X and one Y chromosome.
A genetic disorder may occur when the amino acid sequences that make up individual genes are incorrectly transcribed, leading to inappropriate deletions, additions, or substitutions that cause the structure to become mutated. When a gene is mutated, the protein it codes for no longer functions properly and a disorder may result.
Sometimes a single copy of a mutated gene (inherited from just one parent) can cause a disease. This is called autosomal dominant inheritance.
In other cases, a person may need to inherit two copies (one from each parent) in order to develop a particular disease. These disorders are called autosomal recessive. In such cases, a person may carry a mutated gene, but does not experience symptoms of the disease or disorder. Such individuals are called carriers.
Certain disorders occur when there are genetic mutations in sex chromosomes. These disorders affect males and females differently.
Other types of genetic disorders may be caused by a combination of environmental factors and mutations in several genes.
There are thousands of known genetic disorders. Most inherited disorders are rare and only affect one person out of several thousand or more. Cystic fibrosis is one of the most common autosomal recessive disorders, with about five percent of Americans carrying at least one copy of the defective gene.
Research
Human genome: The Human Genome Project (HGP), which began in 1990, was an international research program that was designed to map out all of the genes that make up human beings (called the human genome), as well as their respective hereditary characteristic controls. The genome was completed in 2003. However, researchers are still studying it in order to improve the treatments, prevention strategies, and diagnoses of hereditary disorders, such as Down's syndrome and Huntington's disease.
Genetic testing: Genetic tests are used to help diagnose patients who have symptoms of genetic disorders. They are also used to determine whether an individual is a carrier of a mutated gene. While carriers do not express the disease, they may pass the disorder on to their children. The tests can be used to screen embryos for disease before implanting them in a woman's uterus.
If patients test positive for a mutated gene, it does not mean that they will definitely develop the disorder. It means that the patient is more likely than most to develop the disorder. Patients should receive genetic counseling before and after genetic testing is performed. This helps ensure that patients understand the risks and limits of genetic testing.
Currently, genetic tests are available to diagnose more than 1,000 different types of genetic disorders. Research involving genetic disorders is ongoing. As scientists continue to learn more about specific disorders, they hope to develop tests to diagnose diseases and help individuals learn if they are carriers of particular disorders.
Gene therapy: Gene therapy is an experimental technique that may help treat or prevent inherited disorders. There are several different methods of gene therapy that are currently being studied. Gene therapy is being studied as a possible way to either replace or inactivate the mutated gene that is causing the disorder. Other gene therapy studies involve inserting a new gene to help the body fight against a specific disease.
Although gene therapy appears to be a promising treatment, further research is needed to determine its safety and effectiveness. Because the safety of gene therapy remains unknown, it is only being studied for the treatment of diseases that have no cures, such as cancer.
No gene therapy products have been approved for sale in the United States. Currently, gene therapy is only available through research studies. Gene therapy is a growing area of research, and hundreds of trials are ongoing.
Implications
As researchers continue to learn more about genetic disorders, many ethical questions have been raised. For instance, in most cases, health insurance companies do not cover the cost of genetic tests, which may be anywhere from $200-3,000. Those insurance companies that do will have access to the test results. However, in April 2008, the U.S. Senate passed the Genetic Information Nondiscrimination Act (GINA), an amended version of H.R. 493, which passed the House April 25, 2007. The bill prohibits employers and health insurance companies from using the results of predictive genetic tests to discriminate against their workers or members.
Genetic testing has also sparked some debate because these tests only provide a probability for developing a particular disorder. Some people who carry a disease-associated mutation may never develop the disease. As a result, patients who test positive for a specific gene may become excessively worried about developing the disorder and experience a decreased quality of life.
Future research
General: Treatment for many genetic disorders is often limited. Treatment focuses on the symptoms of the disease, rather than the underlying cause. However, researchers are currently studying therapies, such as gene therapy, that may one day cure certain inherited disorders.
Cancer Genome Atlas: A new initiative, called the Cancer Genome Atlas, aims to identify all of the genetic abnormalities that are associated with 50 of the most common types of cancer.
Drug development: Newer, more effective drugs with fewer side effects are likely to be developed in the future for genetic disorders, such as Huntington's disease, cystic fibrosis, and Parkinson's disease. For instance, a new drug, called PTC124, has shown promising results as a treatment for cystic fibrosis and muscular dystrophy. This drug targets a specific type of mutation that can cause very different symptoms, depending on the particular gene that is mutated. Although this drug is still undergoing research to determine its safety and efficacy, researchers hope that it can help treat a wide range of inherited disorders.
Scientists are also researching the effects of genetics on a person's ability to break down, absorb, and excrete drugs, herbs, and supplements. Some individuals are highly susceptible to side effects of certain medications. Research in this area may help individuals choose safer and more effective treatment options for patients with inherited disorders.
Genetic screening: Patients may eventually have their individual genomes analyzed for genes that are associated with specific diseases or disorders. As a result, preventative treatments and programs may be designed based on the patient's specific needs. However, preemptive screening may also lead to new ethical dilemmas. For instance, health insurance companies may not want to insure individuals who have genes that are associated with specific conditions. Therefore, ethical and non-discriminatory laws will need to be established.
Author information
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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Types of genetic disorders
Single-gene disorders: Single-gene disorders, also called Mendelian or monogenic disorders, are caused by mutations in the DNA sequence of one gene. Genes provide instructions for proteins, the molecules that perform most functions necessary for life. When a gene is mutated, the protein it codes for no longer functions properly, and a disorder may result. Currently, there are more than 6,000 known single-gene disorders. Researchers estimate that about one out of every 200 people is born with single-gene disorders. Some examples include cystic fibrosis, sickle cell anemia, Marfan syndrome, and Huntington's disease.
Single-gene disorders are inherited as autosomal dominant, autosomal recessive, X-linked recessive, X-linked dominant, or Y-linked traits.
If a disorder is autosomal dominant, an individual will have the disorder if he/she has one dominant allele. An allele is a genetic variation of a single gene. Each gene has two variations. A person with an autosomal dominant disease has a 50% chance of passing the disease on to each of his/her children.
In order to inherit an autosomal recessive disorder, two alleles (one mutated from each parent) of a single gene must be inherited. Individuals who only have one mutated allele and do not experience symptoms are called carriers. If one parent is a carrier, there is a 50% chance with each birth that a child will also be a carrier and a 0% chance he/she will inherit the disease. If both parents are carriers, there is a 25% chance with each birth that that the child will inherit the disease, and a 50% chance that each of one their children will be a carrier.
If the disorder is X-linked recessive, such as hemophilia, it will affect males almost exclusively. If a male inherits the mutated gene, he will develop the disease because he has only one X chromosome. Females, on the other hand, have two X chromosomes. The female would need to inherit two mutated X chromosomes in order to develop the disease. However, if the female inherits one mutated gene she is a carrier for the disease, and there is a 50% chance she will pass the gene to each of her children.
If the disorder is X-linked dominant, individuals will develop the disorder if they inherit one copy of the mutated X chromosome from either parent. In other words, one parent has to have the disease in order for it to get passed to their children. Fragile X syndrome is an example of an X-linked dominant disorder.
If the disorder is Y-linked, males can only be affected. This is because females do not have a Y chromosome. Because the Y chromosome is so small, Y-linked disorders only cause infertility. Many Y-linked disorders can be treated with fertility drugs
or therapies.
Multifactorial disorders: Multifactorial disorders are caused by a combination of environmental factors and mutations in multiple genes. Having particular genetic mutations simply makes patients more susceptible to developing a disorder. For instance, different genes that influence breast cancer susceptibility have been found on several chromosomes. Some of the most common chronic (long-lasting) disorders are multifactorial disorders. Examples include heart disease, obesity, Alzheimer's disease, high blood pressure, arthritis, diabetes, and cancer.
Chromosomal disorders: Since chromosomes carry an individual's genetic material, abnormalities in their structures may lead to disease. Some chromosomal disorders occur when there are missing chromosomes or extra copies of chromosomes are made, while others occur when chromosomes break and rejoin at the wrong locations. Some types of chromosomal disorders can be detected after a microscopic examination of a person's blood. For instance, Down's syndrome is a common disorder that occurs when a patient has three copies of chromosome 21, instead of just two.
Mitochondrial disorders: Mitochondrial disorders are caused by inherited mutations in the nonchromosomal DNA of mitochondria. Mitochondria are small, rod-shaped organ-like structures inside cells that provide energy to the cells. Each mitochondrion may contain 5-10 pieces of DNA. Some of the most common mitochondrial disorders include Lever's hereditary optic atrophy (eye disease), a type of epilepsy called MERRF (myoclonus epilepsy with ragged red fibers), congenital lactic acidosis, and a type of dementia called MELAS (mitochondrial encephalopathy).
Integrative therapies
Note: Currently, there is a lack of scientific data on the use of integrative therapies for the treatment or prevention of genetic disorders. The integrative therapies listed below should be used only under the supervision of a qualified healthcare provider and should not be used in replacement of other proven therapies or preventive measures.
Strong scientific evidence:
Acupuncture: Acupuncture is commonly used throughout the world. According to Chinese medicine theory, the human body contains a network of energy pathways through which vital energy, called "chi," circulates. These pathways contain specific points that function like gates, allowing chi to flow through the body. Needles are inserted into these points to regulate the flow of chi. There has been substantial research on the effectiveness of acupuncture in the treatment of osteoarthritis. Most studies focus on knee, cervical, and hip osteoarthritis symptoms. In recent years, the evidence has improved and is now considered strong for the use of acupuncture in osteoarthritis of the knee.
Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders, medical conditions of unknown origin, neurological disorders, or if taking anticoagulants. Avoid on areas that have received radiation therapy and during pregnancy. Avoid electroacupuncture with irregular heartbeat or in patients with pacemakers. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with a history of seizures.
Alpha-lipoic acid: Alpha lipoic acid (ALA) is made naturally in the body and may protect against cell damage in a variety of conditions. Food sources rich in ALA include spinach, broccoli, and yeast. Many studies have shown that ALA may improve blood sugar levels among patients with type 2 diabetes. Higher-quality studies are needed to provide more definitive answers in the future. Diabetes is a serious illness and should be treated under the supervision of a qualified healthcare provider.
Avoid if allergic to ALA. Avoid with thiamine deficiency or alcoholism. Use cautiously with diabetes or thyroid diseases. Avoid if pregnant or breastfeeding.
Beta-glucan: Beta-glucan is a fiber that comes from the cell walls of algae, bacteria, fungi, yeasts, and plants. Numerous trials have examined the effects of oral beta-glucan on cholesterol. Small reductions in total and low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) have been reported. Little to no significant changes have been noted to occur on triglyceride levels or high density lipoprotein (HDL) cholesterol ("good" cholesterol) levels.
When taken by mouth, beta-glucan is generally considered safe. Avoid if allergic or hypersensitive to beta-glucan. Avoid using particulate beta-glucan. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid if pregnant or breastfeeding.
Beta-sitosterol: Beta-sitosterol is found in plant-based foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut products. It is also found in bourbon and oils. Many human and animal studies have found that supplementation of beta-sitosterol into the diet decreases total serum cholesterol, as well as low-density lipoprotein (LDL or "bad") cholesterol.
Avoid if allergic or hypersensitive to beta-sitosterol, beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing disorders, diabetes, primary biliary cirrhosis (destruction of the small bile duct in the liver), ileostomy, neurodegenerative disorders (such as Parkinson's disease or Alzheimer's disease), bulging of the colon, short bowel syndrome, celiac disease, or sitosterolemia. Use cautiously with a history of gallstones. Avoid if pregnant or breastfeeding.
Calcium: Calcium is the most abundant mineral in the human body. Calcium chloride may be given intravenously (IV or through a vein) by a qualified healthcare professional in cardiac resuscitation, particularly after open-heart surgery, when epinephrine fails to improve weak or ineffective heart contractions. Calcium chloride helps increase heart contractions. Calcium chloride should not be used for cardiac resuscitation with ventricular fibrillation. CPR with calcium chloride should only be done under supervision of a qualified healthcare professional.
Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, hyperparathyroidism (overgrowth of the parathyroid glands), bone tumors, digitalis toxicity, ventricular fibrillation (rapid, irregular twitching of heart muscle), kidney stones, kidney disease, or sarcoidosis (inflammatory disease). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria or irregular heartbeat. Calcium appears to be safe in pregnant or breastfeeding women. Patients should talk to their healthcare providers to determine appropriate dosing during pregnancy and breastfeeding.
Chondroitin: Multiple clinical trials have examined the use of oral chondroitin in patients with osteoarthritis of the knee and other locations (spine, hips, and finger joints). Most of these studies have reported significant benefits in terms of symptoms (such as pain), function (such as mobility), and reduced medication requirements (such as anti-inflammatories). The weight of scientific evidence points to a beneficial effect when chondroitin is used for 6-24 months. Longer-term effects are unclear. Early studies of topical chondroitin have also been conducted.
Chondroitin is frequently used with glucosamine. Glucosamine has independently been demonstrated to benefit patients with osteoarthritis (particularly of the knee). It remains unclear if there is added benefit of using these two agents together compared to using either alone. Chondroitin is currently manufactured from natural sources (shark/beef cartilage or bovine trachea) or by synthetic means.
Avoid with prostate cancer or an increased risk of prostate cancer. Use cautiously if allergic or hypersensitive to chondroitin sulfate products or with shellfish allergy. Use cautiously with bleeding disorders or if taking blood-thinners. Avoid if pregnant or breastfeeding.
Ephedra: Ephedra contains the chemical ephedrine, which appears to cause weight loss when used in combination with caffeine, based on the available scientific evidence. The results of research on ephedrine alone (without caffeine) are unclear. The amounts of ephedrine in commercially available products have widely varied.
Even though this herb has been shown to help reduce weight, it is unsafe for humans for this indication. Serious reactions, including heart attack, stroke, seizure, and death, have occurred after using ephedra. The U.S. Food and Drug Administration (FDA) has banned sales of ephedra dietary supplements.
Ginkgo:
Ginkgo biloba has been used medicinally for thousands of years.
Overall, the scientific literature suggests that ginkgo benefits people with early stage Alzheimer's disease and multi-infarct dementia. Studies show it may be as helpful as acetylcholinesterase inhibitor drugs, such as donepezil (Aricept?). Well-designed research comparing ginkgo to prescription drug therapies is needed.
Avoid if allergic or hypersensitive to members of the Ginkgoaceaefamily.
If allergic to mango rind, sumac, poison ivy, poison oak, or cashews, then allergy to ginkgo is possible. Skin irritation and itching may also occur due to ginkgo allergies. Avoid with blood-thinners (like aspirin or warfarin (Coumadin?)). Ginkgo should be stopped two weeks before surgical procedures. Ginkgo seeds are dangerous and should be avoided. Avoid supplemental doses if pregnant or breastfeeding.
Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Based on human research, there is good evidence to support the use of glucosamine sulfate in the treatment of mild-to-moderate knee osteoarthritis. Most studies have used glucosamine sulfate supplied by one European manufacturer (Rotta Research Laboratorium), and it is not known if glucosamine preparations made by other manufacturers are equally effective. Although some studies of glucosamine have not found benefits, these have either included patients with severe osteoarthritis or used products other than glucosamine sulfate. The evidence for the effect of glycosaminoglycan polysulphate is conflicting and merits further investigation. More well-designed clinical trials are needed to confirm safety and effectiveness and to test different formulations of glucosamine.
Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
Niacin: Niacin, also known as vitamin B3 or nicotinic acid, is a well-accepted treatment for high cholesterol. Multiple studies show that niacin (not niacinamide) has significant benefits on levels of high-density cholesterol (HDL or "good cholesterol"). Niacin has been shown to produce better results than prescription drugs, such as "statins." There are also benefits on levels of low-density cholesterol (LDL or "bad cholesterol"), although these effects are less dramatic. A combination therapy with niacin and a statin may help decrease low-density lipoproteins levels. Individuals should check with their physicians and/or pharmacists before starting niacin.
Avoid if allergic to niacin or niacinamide. Avoid with a history of liver disease, liver dysfunction, irregular heartbeats (arrhythmia), heart disease, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Multiple human trials report small reductions in blood pressure with intake of omega-3 fatty acid. DHA may have greater benefits than EPA. However, high intake of omega-3 fatty acids per day may be necessary to obtain clinically relevant effects, and at this dose level, there is an increased risk of bleeding. Therefore, a qualified healthcare provider should be consulted before starting treatment with supplements.
There is strong scientific evidence from human trials that omega-3 fatty acids from fish or fish oil supplements (EPA + DHA) significantly reduce blood triglyceride levels. Benefits appear to be dose-dependent. Fish oil supplements also appear to cause small improvements (increases) in high-density lipoprotein ("good cholesterol"). However, increases (worsening) in low-density lipoprotein levels (LDL/"bad cholesterol") are also observed. It is unclear if alpha-linolenic acid significantly affects triglyceride levels, and there is conflicting evidence in this area.
The American Heart Association has published recommendations for EPA + DHA. While omega-3 fatty acids from both plants (ALA) and fish (EPA+DHA) have been shown to reduce C-reactive protein (CRP) in some studies, others have failed to show an effect. There is growing evidence that reducing CRP is beneficial towards favorable cardiovascular outcomes, although additional research is pending in this area.
Strong evidence supports the use of fish oil (EPA plus DHA) in the prevention of secondary heart disease. Several well-conducted randomized controlled trials report that in people with a history of heart attack, regular consumption of oily fish or fish oil/omega-3 supplements reduces the risk of non-fatal heart attack, fatal heart attack, sudden death, and all-cause mortality. Most patients in these studies were also using conventional heart drugs, suggesting that the benefits of fish oils may add to the effects of other therapies.
Patients who are allergic to fish should avoid fish oil or omega-3 fatty acid products derived from fish. People who are allergic to nuts should avoid alpha linolenic acid or omega-3 fatty acid products that are derived from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
Psyllium: Psyllium, also known as ispaghula, comes from the husks of the seeds of
Plantago ovata. Psyllium is well studied as a lipid-lowering agent with generally modest reductions seen in blood levels of total cholesterol and low-density lipoprotein ("bad cholesterol"). Effects have been observed following eight weeks of regular use. Psyllium does not appear to have significant effects on high-density lipoprotein ("good cholesterol") or triglyceride levels. Because only small reductions have been observed, people with high cholesterol should discuss the use of more potent agents with their healthcare providers. Effects have been observed in adults and children, although long-term safety in children is not established.
Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, or previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes or kidney dysfunction. Use cautiously if pregnant or breastfeeding.
Red yeast rice: Red yeast rice (RYR) is the product of yeast (
Monascus purpureus) grown on rice. Since the 1970s, human studies have reported that red yeast lowers blood levels of total cholesterol, low-density lipoprotein/LDL ("bad cholesterol"), and triglyceride levels. Other products containing red yeast rice extract can still be purchased. However, these products may not be standardized and effects are unpredictable. For lowering cholesterol, there is better evidence for using prescription drugs, such as lovastatin.
Avoid if allergic or hypersensitive to red yeast. Avoid with liver disease. Use cautiously with bleeding disorders. Avoid if pregnant or breastfeeding.
Soy: Soy is a subtropical plant, native to southeastern Asia. This member of the pea family (Fabaceae) grows from one to five feet tall and forms clusters of three to five pods, each containing 2-4 beans per pod.
Numerous human studies report that adding soy protein to the diet can moderately decrease blood levels of total cholesterol and low-density lipoprotein ("bad" cholesterol). Small reductions in triglycerides may also occur, while high-density lipoprotein ("good" cholesterol) does not seem to be significantly altered.
Some scientists have proposed that specific components of soybean, such as the isoflavones genistein and daidzein, may be responsible for the cholesterol-lowering properties of soy. However, this has not been clearly demonstrated in research, and it remains controversial. It is unknown if products containing isolated soy isoflavones have the same effects as regular dietary intake of soy protein. Dietary soy protein has not been proven to affect long-term cardiovascular outcomes, such as heart attack or stroke.
Avoid if allergic to soy. Breathing problems and rash may occur in sensitive people. Soy, as a part of the regular diet, is traditionally considered to be safe during pregnancy and breastfeeding, but there is limited scientific data. The effects of high doses of soy or soy isoflavones in humans are not clear, and therefore, are not recommended. There has been a case report of vitamin D deficiency rickets in an infant nursed with soybean milk (not specifically designed for infants). People who experience intestinal irritation (colitis) from cow's milk may experience intestinal damage or diarrhea from soy. It is unknown if soy or soy isoflavones share the same side effects as estrogens, like increased risk of blood clots. The use of soy is often discouraged in patients with hormone-sensitive cancers, such as breast, ovarian or uterine cancer. Other hormone-sensitive conditions such as endometriosis, may also be worsened. Patients taking blood-thinners should check with their doctors and pharmacists before taking soy supplements.
Vitamin A: Vitamin A is a fat-soluble vitamin that is derived from two sources: preformed retinoids and provitamin carotenoids. Retinoids, such as retinal and retinoic acid, are found in animal sources, such as livers, kidneys, eggs, and dairy produce. Carotenoids, such as beta-carotene (which has the highest vitamin A activity), are found in plants, such as dark or yellow vegetables and carrots. The prescription drug All-Trans-Retinoic Acid (ATRA, Vesanoid?) is a vitamin A derivative that is an established treatment for acute promyelocytic leukemia and improves median survival in this disease. Treatment should be under strict medical supervision.
Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity may occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
Willowbark: Willowbark that contains salicin has been used to treat many different kinds of pain. Willow bark is a traditional pain-relieving therapy for osteoarthritis. Several studied have confirmed this finding. Additional study comparing willow bark to conventional medicinal agents for safety and effectiveness is warranted.
Avoid if allergic/hypersensitive to aspirin, willow bark (Salix spp.), or any of its constituents, including salicylates. Avoid operating heavy machinery. Avoid in children with chickenpox and any other viral infections. Avoid with blood disorders or kidney disorders. Avoid if taking other NSAIDs, acetazolamide, or other carbonic anhydrase inhibitors. Avoid with elevated serum cadmium levels. Use cautiously with gastrointestinal problems, hepatic disorders, diabetes, gout, high blood pressure, hyperlipidemia, history of allergy or asthma, or leukemia. Use cautiously if taking protein-bound medications, antihyperlipidemia agents, alcohol, leukemia medications, beta-blockers, diuretics, phenytoin (Dilantin?), probenecid, spironolactone, sulfonylureas, valproic acid, or methotrexate. Use cautiously if predisposed to headaches. Use cautiously with tannin-containing herbs or supplements. Avoid if pregnant or breastfeeding.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several human studies support the use of yoga in the treatment of high blood pressure when practiced for up to one year. It is not clear if yoga is better than other forms of exercise for blood pressure control. Yoga practitioners sometimes recommend that patients with high blood pressure avoid certain positions, such as headstands or shoulder stands (inverted asanas), which may increase blood pressure.
Yoga is generally considered safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine or fragile or atherosclerotic neck arteries. Avoid if at risk for blood clots or with high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung diseases. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided during pregnancy.
Zinc: Zinc formulations have been used since ancient Egyptian times to enhance wound healing. Strong scientific evidence suggests that zinc may help manage or reduce symptoms of sickle cell anemia. Most of these studies reported increased height, weight, immune system function, and testosterone levels and decreased numbers of crises and sickled cells following zinc treatment.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
Good scientific evidence:
5-HTP: 5-HTP is the precursor for serotonin. Serotonin is the brain chemical associated with sleep, mood, movement, feeding, and nervousness. Studies suggest that 5-HTP may reduce eating behaviors, lessen caloric intake, and promote weight loss in obese individuals.
Avoid 5-HTP if allergic or hypersensitive to it. Signs of allergy to 5-HTP may include rash, itching, or shortness of breath. Avoid with eosinophilia syndromes, Down syndrome, or mitochondrial encephalomyopathy. Use cautiously if taking antidepressant medications, 5-HTP receptor agonists, carbidopa, phenobarbital, pindolol, reserpine, tramadol, or zolpidem. Use cautiously with kidney insufficiency, HIV/AIDS (particularly HIV-1 infection), epilepsy, or with a history of mental disorders. Avoid if pregnant or breastfeeding.
Arginine (L-arginine): L-arginine helps maintain the body's fluid balance (urea, creatinine), and aids in wound healing, hair growth, sperm production (spermatogenesis), blood vessel relaxation (vasodilation), and immune function. Early evidence from several studies suggests that arginine taken by mouth or by injection may improve exercise tolerance and blood flow in the arteries of the heart. Benefits have been shown in some patients with coronary artery disease and chest pain (called angina). However, more research is needed to confirm these findings and to develop safe and effective dosages.
Avoid if allergic to arginine. Avoid with a history of stroke or liver or kidney disease. Avoid if pregnant or breastfeeding. Use cautiously if taking blood-thinners, blood pressure drugs, antidiabetic drugs, or herbs or supplements with similar effects. Check blood potassium levels. L-arginine may worsen symptoms of sickle cell disease.
Atkin's diet?: The Atkins Diet? is an eating style that radically departs from the U.S. Food and Drug Administration's (FDA) food pyramid, which positions carbohydrates as the staple of the American diet. The Atkins Diet? advocates an increased consumption of fats as the primary source of energy while simultaneously restricting the intake of carbohydrates. A carbohydrate-restricted diet has been shown to result in weight loss in obese and non-obese individuals. Effects at one year may be less, and drop out rates are high. Human trials examining the effects of the Atkins Diet? are randomized and controlled. Although blinding is difficult with this type of study, the studies were well designed. Overall the studies suggest that the Atkins Diet? does result in long-term weight loss. Long term efficacy and safety studies still need to be conducted.
Avoid with kidney disorders. Avoid if using growth hormone. Use cautiously with mood disorders, such as depression, schizophrenia, or bipolar disorder, or if taking medications for these conditions. Use cautiously in athletes due to the potential for muscle cramps, negative feelings towards exercise, fatigue, and low blood sugar levels. Use cautiously with osteoporosis, gout, diabetes, menstrual disorders, gastrointestinal disorders, celiac disease, skin conditions, epilepsy, or heart disease. Use cautiously in malnourished individuals, vegetarians, or individuals with absorption concerns. Use cautiously if taking diuretics, antilipemics, Antidiabetic agents, seizure drugs, steroids, or NSAIDS. Use cautiously with anemia, thyroid disorders, and with a history of stroke or heart attack. Avoid if pregnant or breastfeeding.
Avocado: Avocados are fruits that are a nutritious source of potassium. Avocados added to the diet may lower total cholesterol, LDL ("bad" cholesterol), HDL ("good" cholesterol) and triglycerides. Additional study is needed before a strong conclusion can be made.
A combination of avocado/soybean unsaponifiables (ASU) has been found beneficial in osteoarthritis (OA) of the knee and hip. Additional study using avocado (Persea Americana)alone is needed.
Avoid if allergic or hypersensitive to avocado, banana, chestnut, or natural rubber latex. Avoid with monoamine oxidase inhibitors (MAOIs). Use cautiously with anticoagulants (like warfarin). Doses greater than those found in a normal diet are not recommended if pregnant or breastfeeding. Some types of avocado may be unsafe when breastfeeding.
Barley: Barley is a cereal used as a staple food in many countries. It is commonly used as an ingredient in baked products and soup in Europe and the United States. Barley malt is used to make beer and as a natural sweetener called malt sugar or barley jelly sugar. There is good evidence to support the use of barley along with a cholesterol-lowering diet in mild cases of high cholesterol. Larger and longer studies are warranted to more rigorously confirm lasting benefits.
Avoid if allergic or hypersensitive to barley flour or beer. Barley appears to be well tolerated in non-allergic, healthy adults in recommended doses for short periods of time, as a cereal or in the form of beer. Use cautiously with diabetes, asthma, or irregular heartbeat. Contamination of barley with fungus has occurred. Traditionally, women have been advised against eating large amounts of barley sprouts during pregnancy. Infants fed with a formula containing barley water, whole milk, and corn syrup have developed malnutrition and anemia, possibly due to vitamin deficiencies.
Beta-glucan: Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. There are several human trials supporting the use of beta-glucan for glycemic (blood sugar) control. Although early evidence is promising, additional study is needed before a strong conclusion can be made.
When taken by mouth, beta-glucan is generally considered safe. Avoid if allergic or hypersensitive to beta-glucan. Avoid using particulate beta-glucan. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid if pregnant or breastfeeding.
Betaine anhydrous: Betaine is found in most microorganisms, plants, and marine animals. Homocystinuria is a severe form of hyperhomocysteinemia that is caused by genetic defects in homocysteine-metabolizing genes, most commonly the cystathionine beta-synthase (CBS) gene. Patients with severely elevated homocysteine due to a genetic deficiency may use betaine treatment, in combination with other vitamins and diet restrictions, to reduce the risk of vascular events. Further studies are needed to determine whether betaine supplementation can lower cardiovascular risk within the general population.
Overall, betaine supplementation has shown significant reductions in both fasting and postmethionine load homocysteine. However, additional studies are needed to make a strong conclusion.
Avoid if allergic or hypersensitive to betaine anhydrous or cocamidopropyl betaine, a form of betaine. Use cautiously with kidney disease, obesity, or psychiatric conditions. Avoid if pregnant or breastfeeding.
Borage seed oil: Borage (
Borago officinalis) is an herb native to Syria that has spread throughout the Middle East and Mediterranean. Borage flowers and leaves may be eaten and borage seeds are often pressed to produce oil that is very high in gamma-linolenic acid (GLA). GLA has known anti-inflammatory effects that may make it beneficial in treating rheumatoid arthritis. A few human studies have generally found positive results and no side effects were reported. However, more research is needed to determine the optimal dose and administration.
Avoid if allergic or hypersensitive to borage, its constituents, or members of the Boraginaceae family. Avoid in patients with weakened immune systems. Use cautiously with bleeding disorders or if taking warfarin or other anticoagulant or antiplatelet (blood-thinning) agents. Use cautiously with epilepsy or if taking anticonvulsants. Avoid during pregnancy because prostaglandin E agonists, such as borage oil's GLA may have teratogenic and labor-inducing effects.
Boswellia: Boswellia, a close relative of the Biblical incense frankincense, has been popularly used as a cancer treatment, specifically to reduce brain tumors or edema caused by these tumors. Although there are numerous lab and animal studies showing that boswellia decreases inflammation and has anticancer effects, there is only early evidence in humans that boswellia may decrease intracranial tumors or edema.
Avoid if allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid reflux disease (GERD). Use cautiously if taking lipid-soluble medications, agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use cautiously with impaired liver function or lung disorders. Use cautiously in children. Avoid if pregnant (due to potential abortifacient effects) or if breastfeeding.
Calcium: Calcium is the most abundant mineral in the human body and has several important functions. More than 99% of total body calcium is stored in the bones and teeth, where it supports the structure. The remaining 1% is found throughout the body in blood, muscle, and the intracellular fluid. Several studies have found that introducing calcium to the system may have blood-pressure lowering effects. These studies indicate that high calcium levels lead to sodium loss in the urine, and lowered parathyroid hormone (PTH) levels, both of which result in lower blood pressure. However, human study found that these results did not hold true for middle-aged patients with mild-to-moderate essential hypertension. In the DASH (Dietary Approaches to Stop Hypertension) study, three daily servings of calcium-enriched, low-fat dairy products reduced systolic and diastolic blood pressure. This research indicates that calcium intake at the recommended level may be help prevent and treat moderate hypertension. Treatment of high blood pressure should only be done under supervision of a qualified healthcare professional.
Avoid if allergic or hypersensitive to calcium or lactose. High doses taken by mouth may cause kidney stones. Avoid with high levels of calcium in the blood, high levels of calcium in urine, high levels of parathyroid hormone, bone tumors, digitalis toxicity, ventricular fibrillation, kidney stones, kidney disease, or sarcoidosis (inflammation of lymph nodes and various other tissues). Calcium supplements made from dolomite, oyster shells, or bone meal may contain unacceptable levels of lead. Use cautiously with achlorhydria (absence of hydrochloric acid in gastric juices) or irregular heartbeat. Calcium appears to be safe during pregnant or breastfeeding women; talk to a healthcare provider to determine appropriate dosing during pregnancy and breastfeeding.
Carob: Carob pods have been used as food and in medicinal applications since prehistoric times. Fiber, such as oat fiber, has been shown to reduce serum cholesterol levels. Carob pod fiber or carob bean gum may also have this ability, although additional research is needed to confirm these findings.
Avoid if allergic/hypersensitive to carob (Ceratonia siliqua), its constituents, or any plants in the Fabaceae family, including tamarind. Avoid with metabolic disorders; with a chromium, cobalt, copper, iron, or zinc disorder or deficiency; kidney disorders; or acute diarrhea. Avoid in underweight infants. Use cautiously in patients with anemia; known allergy to peanuts and other nuts; complications with powdered, bulk-forming laxative drinks; diabetes; or high cholesterol. Use cautiously if taking oral agents. Use cautiously in hypouricemic patients. Avoid if pregnant or breastfeeding.
Chia: Chia is a member of the mint family and has been historically used as a staple food in the ancient Aztec diet. Early studies in animals and humans suggest that diets containing chia seed may decrease risk factors for cardiovascular disease (CVD). Evidence suggests that the benefits of Salba? in humans are similar to those of other whole grains. Further study is needed.
There is limited safety data on chia. Avoid if allergic or sensitive to chia, sesame, or mustard seed. Use cautiously with low blood pressure or bleeding disorders. Use cautiously if taking anticancer, antioxidant, blood pressure-lowering, blood-thinning agents, or agents that are broken down in the liver. Avoid if pregnant or breastfeeding.
Chitosan: Chitosan comes from chitin, which is part of the outer layer of insects and shellfish. Study results suggest that chitosan may help improve cholesterol levels when combined with a low-calorie diet.
While some studies suggest that chitosan is an effective weight-loss therapy, others have found it is ineffective. More evidence is needed.
Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar levels or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
Chromium: Chromium is an essential trace element that exists naturally in trivalent and hexavalent states. Chromium has been studied in the treatment of diabetes and high blood sugar levels. It may also help regulate blood sugar levels in patients with low blood sugar disorders. More research is needed in this area to make a strong conclusion.
Trivalent chromium appears to be safe because side effects are rare or uncommon. However, hexavalent chromium may be poisonous (toxic). Avoid if allergic to chromium, chromate, or leather. Use cautiously with diabetes, liver problems, weakened immune systems (such as HIV/AIDS patients or organ transplant recipients), depression, Parkinson's disease, heart disease, stroke, or if taking medications for these conditions. Use cautiously if driving or operating machinery. Use cautiously if pregnant or breastfeeding.
Coenzyme Q10: Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for basic functioning of cells. CoQ10 levels decrease with age. Early research suggests that CoQ10 causes small decreases in blood pressure (systolic and possibly diastolic). Low blood levels of CoQ10 have been found in people with hypertension, although it is not clear if CoQ10 deficiency is a cause of high blood pressure. Well-designed long-term research is needed to strengthen this conclusion.
Allergy associated with Coenzyme Q10 supplements are lacking, although rash and itching have been reported rarely. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Use cautiously with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke. Use cautiously if taking anticoagulants or antiplatelets, blood pressure agents, blood sugar agents, cholesterol agents, or thyroid agents. Avoid if pregnant or breastfeeding.
Coleus: The root extract of coleus is known as forskolin. Forskolin may improve heart function in patients with cardiomyopathy. However, additional study is needed to confirm these findings.
Avoid if allergic to Coleus forskohlii, other members of the Lamiaceae, or any of their constituents. Avoid oral and parenteral preparations that contain forskolin in patients with autosomal dominant PKD (polycystic kidney disease). Avoid in children, breastfeeding women, pregnant women, or in those who are trying to become pregnant. Avoid with active bleeding with a history of bleeding, bleeding disorders, or drug-related hemostatic problems. Use cautiously in patients taking anticoagulants antidiabetic agents, thyroid agents, or heart medications. Stop taking coleus at least two weeks before dental or surgical procedures with bleeding risks. Use cautiously with asthma, diabetes, low blood sugar levels, thyroid disorders, heart disease, acid reflux, or other gastric acid problems.
Cordyceps: Cordyceps is a fungus that grows on caterpillar larvae. Commonly known as "dong chong xia cao" (summer-plant, winter-worm) in Chinese, cordyceps has been used as a tonic food in China and Tibet and as a food supplement and tonic beverage. Cordyceps may lower total cholesterol and triglyceride levels, although these changes may not be permanent or long lasting. Longer studies with follow up are needed to determine the long-term effects of cordyceps on hyperlipidemia.
Avoid if allergic or hypersensitive to cordyceps, mold, or fungi. Use cautiously with diabetes, bleeding disorders, or prostate conditions. Use cautiously if taking anticoagulants, immunosuppressants, hormonal replacement therapy, or oral contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or breastfeeding.
Devil's claw: Devil's claw (
Harpagophytum procumbens) originates from the Kalahari and Savannah desert regions of South and Southeast Africa.
There is increasing scientific evidence suggesting that devil's claw is safe and beneficial for the short-term treatment of pain related to degenerative joint disease or osteoarthritis (taken for 8-12 weeks) and may be equally effective as drug therapies such as non-steroidal anti-inflammatory drugs like ibuprofen (Advil?, Motrin?) or may allow for dose reductions or discontinuation of these drugs in some patients. However, most studies have been small with flaws in their designs. Additional well-designed trials are necessary.
Avoid if allergic to devil's claw or to plants in the Harpagophytum procumbens family. Use cautiously with stomach ulcers or with a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers, or with prescription drugs used for these conditions. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
DHEA: DHEA (dehydroepiandrosterone) is a hormone that is produced by the adrenal glands. Most human trials investigating the effect of DHEA on weight or fat loss support its use for this purpose. Further research is needed to confirm these results.
Avoid if allergic to DHEA. Avoid with a history of seizures. Use cautiously with adrenal or thyroid disorders or if taking anticoagulants or drugs, herbs, or supplements for diabetes, heart disease, seizure, or stroke. Stop use two weeks before and immediately after surgery/dental/diagnostic procedures with bleeding risks. Avoid if pregnant or breastfeeding.
Gamma oryzanol: Gamma oryzanol occurs in rice bran oil and has been extracted from corn and barley oils as well. Early evidence suggests that gamma oryzanol may reduce hyperlipidemia. Gamma oryzanol seems to reduce total cholesterol, LDL, HDL and triglycerides. Additional study is needed to establish gamma oryzanol's effect on hyperlipidemia.
Avoid if allergic/hypersensitive to gamma oryzanol, its components, or rice bran oil. Use cautiously if taking anticoagulants, central nervous system (CNS) suppressants, growth hormone, agents that alter blood sugar levels, immunomodulators, luteinizing hormone or luteinizing hormone-releasing hormone, prolactin, cholesterol-lowering agents, thyroid agents, or herbs or supplements with similar effects. Use cautiously with diabetes, hypothyroidism, hypoglycemia, hyperglycemia, or high cholesterol. Avoid if pregnant or breastfeeding.
Garlic: The Garlic bulb is made of many cloves that are wrapped in a paper-thin, white skin. It is used both medicinally and as a spice in food. Multiple studies in humans have reported small reductions in total blood cholesterol and low-density lipoproteins ("bad cholesterol") over short periods of time (4-12 weeks). It is unclear if there are benefits after this amount of time. Effects on high-density lipoproteins ("good cholesterol") are not clear. This remains an area of controversy. Well-designed and longer studies are needed in this area.
Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (like hyacinth, tulip, onion, leek, chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders. Stop using supplemental garlic two weeks before and immediately after dental/surgical/diagnostic procedures with bleeding risks. Avoid supplemental doses if pregnant or breastfeeding.
Ginseng: Several studies report a blood sugar-lowering effect of American ginseng (
Panax quinquefolium) in individuals with type 2 diabetes, both on fasting blood glucose and on postprandial glucose levels. These results are promising, especially as ginseng does not seem to cause dangerous low blood sugar levels. Future research needs to evaluate long-term efficacy of American ginseng in treating type 2 diabetes compared to standard oral hypoglycemic drugs.
Ginseng appears to have antioxidant effects that may benefit patients with heart disorders. Some studies suggest that ginseng also reduces the oxidation of low-density lipoprotein (LDL or "bad") cholesterol and brain tissue. Better studies are needed to make a firm conclusion.
Avoid ginseng with known allergy to plants in the Araliaceae family. There has been a report of a serious life-threatening skin reaction, possibly caused by contaminants in the ginseng formulation.
Globe artichoke: Globe artichoke is a popular phytomedicine in Europe. It is purported to possess diuretic, choleretic, anti-dyspeptic, lipid-lowering, and antioxidant properties. Early human study suggests that cynarin and artichoke extracts may reduce serum cholesterol and triglyceride levels. However, additional study is needed to a make a strong recommendation.
Use cautiously if allergic or hypersensitive to members of the Asteraceae or Compositae family (e.g., chrysanthemums, daisies, marigolds, ragweed, arnica) due to possible cross-reactivity. Use cautiously with cholelithiasis or biliary/bile duct obstruction or kidney disease. Avoid if pregnant or breastfeeding.
Glucosamine: Glucosamine is a natural compound that is found in healthy cartilage. Several human studies and animal experiments report benefits of glucosamine in treating osteoarthritis of various joints of the body. However, the evidence is less plentiful than that for knee osteoarthritis. Some of these benefits include pain relief (possibly due to an anti-inflammatory effect of glucosamine) and improved joint function. Overall, these studies have not been well designed. Although there is some promising research, more study is needed in this area before a firm conclusion can be made.
Avoid if allergic or hypersensitive to shellfish or iodine. Some reports suggest a link between glucosamine/chondroitin products and asthma. Use cautiously with diabetes or with a history of bleeding disorders. Avoid if pregnant or breastfeeding.
Greater celandine: UkrainT, a drug made from greater celandine (
Chelidonium majus), has been studied for the treatment of various cancers. These human studies have consistently reported positive outcomes, with UkrainT demonstrating immune system modulating and stimulating properties, cytotoxic effects on cancer cells, and improvements in the clinical course of the disease. However, and higher-quality studies are called for.
Avoid if allergic/hypersensitive to greater celandine, its constituents, or members of the Papaveraceae family. Avoid with liver disease. Use cautiously if taking amphetamines, morphine, hexobarbital, MAOIs, dopaminergic, or serotonergic drugs. Use cautiously if undergoing radiation therapy. Avoid if pregnant or breastfeeding due to a lack of safety evidence.
Gymnema: Preliminary human research reports that gymnema (
Gymnema sylvestre) may be beneficial in patients with type 1 or type 2 diabetes when it is added to diabetes drugs being taken by mouth or to insulin. Further studies of dosing, safety, and effectiveness are needed before a strong conclusion can be made.
Avoid if allergic or sensitive to plants in the Asclepiadaceae (milkweed) family. Use cautiously with prescription drugs that may lower blood sugar levels. Dosing adjustments may be necessary.
Hibiscus: The
Hibiscus genus contains several species, many of which have been used medicinally. Extracts of hibiscus may lower the systolic and diastolic blood pressure. Additional studies are needed to confirm these results, although the use of hibiscus for lowering blood pressure looks promising.
Avoid if allergic or hypersensitive to hibiscus, its constituents, or members of the Malvaceae family. Use cautiously with high or low blood pressure. Based on animal study, excessive doses of hibiscus for relatively long periods may have a deleterious effect on the testes of rats. Hibiscus rosa-sinensis has exhibited anti-fertility activity, and the benzene extract of the flower petals may suppress implantation. Use cautiously if pregnant or trying to become pregnant, or if breastfeeding.
L-carnitine: The human body produces L-carnitine in the liver, kidneys, and brain. Evidence from human trials suggests that L-carnitine and L-propionyl-carnitine (propionyl-L-carnitine) are effective in reducing symptoms of angina. Carnitine may not offer further benefit when patients continue conventional therapies. Additional study is needed to confirm these findings.
Avoid with known allergy or hypersensitivity to carnitine. Use cautiously with peripheral vascular disease, high blood pressure, alcohol-induced liver cirrhosis, or diabetes. Use cautiously in low-birth-weight infants and in individuals on hemodialysis. Use cautiously if taking anticoagulants, beta-blockers, or calcium-channel blockers. Avoid if pregnant or breastfeeding.
Magnesium: Magnesium (Mg) is the second most abundant intracellular cation (positively charged ion) in the human body and is involved in more than 300 enzymatic reactions. Oral Mg has been reported to reduce the risk of developing type 2 diabetes; it also has been reported to improve glycemic control in type 2 diabetic patients. Other than a modest decrease in blood pressure, oral Mg supplementation was found to have minimal impact on other important biochemical parameters related to diabetes-associated end-organ disease in non-insulin-dependent diabetes mellitus (NIDDM).
Avoid use as a laxative in patients with gastrointestinal disorders, such as obstruction or ileus. Avoid intravenous magnesium in women with toxemia during the first few hours of labor. Use cautiously with bleeding disorders. Use cautiously if taking antiplatelets agents, antidiabetic agents, blood pressure-lowering agents, or antibiotics. Use topical magnesium sulfate cautiously. Use intravenous magnesium sulfate cautiously with eclampsia.
Meditation: Many forms of meditation have been practiced for thousands of years throughout the world, with many techniques originating in Eastern religious practices. In general, it appears that regular practice of meditation may promote relaxation and reduce blood pressure. More research is needed before strong conclusions can be made. However, meditation may be recommended in addition to a healthy diet and regular exercise for the prevention (vs. treatment) of high blood pressure.
Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professionals before starting meditation and should explore how meditation may or may not fit in with their current treatment plans. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
Music therapy: Music is an ancient tool of healing that was recognized in the writings of Pythagoras, Aristotle, and Plato. Today, music is used to influence physical, emotional, cognitive, and social well-being, as well as to improve the quality of life for healthy, disabled, or sick people. It may involve either listening to or performing music, with or without the presence of a music therapist. Routine chest physiotherapy (CPT) is a component of preventative therapy in children with cystic fibrosis, which requires significant time and energy. There is some evidence that children's tolerance and enjoyment of physiotherapy may benefit from music therapy.
Music therapy is generally known to be safe.
Niacin: Niacin is a B-complex vitamin found in a many foods, including liver, poultry, fish, nuts, and dried beans. It is needed for the nervous system and gastrointestinal tract function. Niacin decreases blood levels of cholesterol and lipoprotein (a), which may reduce the risk of atherosclerosis ("hardening" of the arteries). However, niacin may also increase homocysteine levels, which may have the opposite effect. Overall, the scientific evidence supports the use of niacin in combination with other drugs (but not alone) to decrease cholesterol and slow the process of atherosclerosis. More research is needed in this area before a firm conclusion can be drawn.
Niacin decreases levels of cholesterol, lipoprotein (a), and fibrinogen, which can reduce the risk of heart disease. However, niacin also increases homocysteine levels, which can increase this risk. Numerous studies have looked at the effects of niacin, alone and in combination with other drugs, for the prevention of heart disease and fatal heart attacks. Overall, this research suggests benefits of niacin, especially when combined with other cholesterol-lowering drugs.
Avoid if allergic to niacin or niacinamide. Avoid with a history of liver disease, liver dysfunction, irregular heartbeats (arrhythmia), heart disease, bleeding disorders, asthma, anxiety, panic attacks, thyroid disorders, stomach ulcers, gout, or diabetes. Avoid if pregnant or breastfeeding.
Omega-3 fatty acids: Omega-3 fatty acids are found in fish oil and certain plant/nut oils. Fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Good evidence suggests that consuming fish may help prevent primary heart disease. Several large studies of populations ("epidemiologic" studies) report a significantly lower rate of death from heart disease in men and women who regularly eat fish. Other epidemiologic research reports no such benefits. It is not clear if reported benefits only occur in certain groups of people, such as those at risk of developing heart disease. Overall, the evidence suggests benefits of regular consumption of fish oil. However, well-designed randomized controlled trials which classify people by their risk of developing heart disease are necessary before a firm conclusion can be drawn.
Multiple studies report improvements in morning stiffness and joint tenderness in patients with rheumatoid arthritis who regularly take fish oil supplements for up to three months. Benefits have been reported as additive with anti-inflammatory medications, such as nonsteroidal anti-inflammatory drugs (such as ibuprofen). However, because of weaknesses in study designs and reporting, better research is necessary before a strong favorable conclusion can be made. Effects beyond three months of treatment have not been well evaluated.
Patients who are allergic to fish should avoid fish oil or omega-3 fatty acid products derived from fish. People who are allergic to nuts should avoid alpha linolenic acid or omega-3 fatty acid products that are derived from nuts. Avoid during active bleeding. Use cautiously with bleeding disorders, diabetes, low blood pressure, or if taking drugs, herbs, or supplements that treat any such conditions. Use cautiously before surgery. Pregnant and breastfeeding women should not consume doses that exceed the recommended dietary allowance (RDA).
Pantethine: Pantethine is a natural compound. It is the active form of pantothenic acid. Numerous trials have examined the effects of pantethine taken by mouth on lipids. Reductions in total cholesterol, low-density lipoprotein (LDL), and triglycerides have occurred; however, additional study is needed in this area to confirm these findings.
Avoid if allergic or hypersensitive to pantethine or any component of the formulation. Use cautiously with bleeding disorders. Avoid if pregnant or breastfeeding.
Peony: Peony root has been used in traditional Chinese medicine (TCM) for centuries. Peony flowers are also used medicinally, for example, in cough syrups and in herbal teas. Pulmonary heart disease is a structural problem with the heart that is caused by a problem with the respiratory system. Studies suggest that peony may benefit patients with pulmonary heart disease. More research is needed before a strong conclusion can be made.
Avoid if allergic or sensitive to peony. Avoid with bleeding disorders or if taking drugs, herbs, or supplements that increase bleeding risk. Use cautiously with estrogen-sensitive cancers or if taking drugs, herbs, or supplements with hormonal activity. Avoid if pregnant or breastfeeding.
Physical therapy: The goal of physical therapy is to improve mobility, restore function, reduce pain, and prevent further injuries. Several techniques, including exercises, stretches, traction, electrical stimulation, and massage, are used. Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Physical therapy has been compared to a sham group (subtherapeutic ultrasound), and the researchers found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. One method of physical therapy, infrared short-wave diathermy-pulsed patterns and interferential therapy, showed more effectiveness than intra-articular hyaluronan drugs in two studies. More research using consistent treatment protocols and outcomes measures would be helpful in this area.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with their qualified healthcare professionals before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature, although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy, and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
Policosanol: Policosanol is a natural mixture that lowers cholesterol. The effects of policosanol supplementation on exercise-ECG testing responses have been studied in individuals with coronary heart disease (CHD). Beneficial changes were noted in functional capacity, rest and exercise angina (chest pain), cardiac events, and maximum oxygen uptake. Although this represents early compelling evidence, further research is necessary before a clear conclusion can be reached.
Avoid if allergic or hypersensitive to policosanol. Use cautiously if taking aspirin or blood pressure medications. Use cautiously with high blood pressure. Use cautiously if pregnant or breastfeeding.
Probiotics: Probiotics are beneficial bacteria that are sometimes called friendly germs. They help maintain a healthy intestine and help the body digest foods. They also help keep harmful bacteria and yeasts in the gut under control. Most probiotics come from food sources, especially cultured milk products. There is recent evidence that supplementation with
Lactobacillus casei may help reduce the recurrence of colorectal tumors in patients who have previously undergone surgery for colon cancer.
Probiotics are generally considered safe and well-tolerated. Avoid if allergic or hypersensitive to probiotics. Use cautiously if lactose intolerant. Caution is advised when using probiotics in neonates born prematurely or with immune deficiencies.
Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help with problem solving. There is good evidence that psychotherapy may enhance cancer patients' quality of life by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy, or group therapy. Studies conflict on whether therapy improves self-esteem, death anxiety, self-satisfaction, etc. While some patients seek psychotherapy in hopes of extending survival, there is no conclusive evidence on its effects on medical prognosis.
Although group therapy may somewhat decrease pain in people with rheumatoid arthritis and depression, individual therapy coupled with antidepressants may be more effective.
Several studies indicate that people who are overweight or obese may benefit from behavioral and cognitive-behavioral psychotherapy in combination with diet and exercise.
Some forms of psychotherapy may evoke strong emotional feelings and expression.
Qi gong: Qi gong is a type of traditional Chinese medicine (TCM) that is thought to be at least 4,000 years old. It is traditionally used for spiritual enlightenment, medical care, and self-defense. There is good evidence from several human studies that Qi gong, when used with conventional treatments, may be of benefit for high blood pressure. Initial research reports fewer deaths among people with high blood pressure who practice Qi gong. There is some evidence that internal Qi gong relaxation exercises may be safe for helping to control high blood pressure associated with pregnancy. Further research is warranted.
Qi gong is generally considered to be safe in most people when learned from a qualified instructor. Use cautiously with psychiatric disorders.
Rose hip: Rose hips have traditionally been used by herbalists as an anti-inflammatory and antiarthritic agent. A constituent isolated from dried and milled fruits of
Rosa canina has demonstrated anti-inflammatory properties, and Hyben Vital?, a standardized rose hips extract, has been shown to have antioxidant properties. Rose hip extracts have been studied in patients with osteoarthritis, with some evidence of benefit. Additional high-quality human research is needed in this area to confirm these results.
Avoid if allergic to rose hips, rose pollen, their constituents, or members of the Rosaceae family. Use cautiously if taking anticoagulant or antiplatelet agents, anticancer agents, anti-HIV medications, anti-inflammatory agents, antilipemics, aluminum-containing antacids, antibiotics, salicylates or salicylate-containing herbs, or laxatives. Use cautiously in patients who are avoiding immune system stimulants.
Sage: Sage has been used in Europe for centuries as a spice and a medicine. Alzheimer's disease is characterized by memory loss that interferes with social and occupational functioning. Early evidence suggests that sage oil may be useful in the treatment of Alzheimer's disease.
Avoid if allergic or hypersensitive to sage species, their constituents, or to members of the Lamiaceae family. Use cautiously with high blood pressure. Use the essential oil or tinctures cautiously in patients with epilepsy. Avoid with previous anaphylactic reactions to sage species, their constituents, or to members of the Lamiaceae family. Avoid if pregnant or breastfeeding.
SAMe: SAMe has been studied extensively in the treatment of osteoarthritis. SAMe reduces the pain associated with osteoarthritis and appears to be well tolerated in this patient population. Although an optimal dose has yet to be determined, SAMe appears as effective as non-steroidal anti-inflammatory drugs (NSAIDs). Additional study is warranted to confirm these findings.
Avoid if allergic or hypersensitive to SAMe. Avoid with bipolar disorder. Avoid during the first trimester of pregnancy or if breastfeeding. Use cautiously with diabetes, anxiety disorders, or during the third trimester of pregnancy.
Selenium Selenium is a mineral found in soil, water, and some foods. Initial evidence has suggested that selenium supplementation reduces the risk of developing prostate cancer in men with normal baseline PSA (prostate specific antigen) levels and low selenium blood levels.
Avoid if allergic or sensitive to products containing selenium. Avoid with a history of non-melanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
Stevia: Stevioside is a natural plant glycoside isolated from the plant
Stevia rebaudiana, which has demonstrated blood pressure-lowering effects. Despite evidence of benefits in some human studies and support from laboratory and animal studies, more research is warranted to compare stevia's effectiveness with the current standard of care and make a firm conclusion. Stevia appears to have no major side effects.
Avoid if allergic or hypersensitive to the daisy family (Asteraceae/Compositae), including plants like ragweed, chrysanthemums, marigolds, and many other herbs. Use cautiously with low blood pressure, calcium deficiency, or low blood sugar levels. Use cautiously if taking blood pressure-lowering agents or antidiabetic agents. Avoid with impaired kidney function or other kidney diseases. Avoid if pregnant or breastfeeding.
Sweet almond: The almond tree is native to western Asia and North Africa, but it is now grown in most temperate regions. The sweet almond is a popular and nutritious food. Early studies in humans and animals report that whole almonds may lower total cholesterol and low-density lipoprotein (LDL/"bad" cholesterol) and raise high-density lipoprotein (HDL/"good" cholesterol"). It is not clear what dose may be safe or effective.
Avoid if allergic or hypersensitive to almonds or other nuts. Use cautiously with heart disease, diabetes, or low blood sugar levels. Use cautiously if taking cardiovascular agents (including antilipemics), antidiabetic agents, estrogens, phytoestrogens, or fertility agents. Use cautiously if pregnant or breastfeeding.
TENS(transcutaneous electrical nerve stimulation): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached in various patterns, depending on the specific condition and treatment goals. Early studies of TENS in knee osteoarthritis report improvements in joint stiffness and pain, although it is unclear if walking distance or swelling improved. Most research is not well designed or reported, and better studies are necessary before a clear conclusion can be reached.
Avoid with implantable devices, such as defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation (such as neuropathy) or with seizure.
Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several human studies suggest that yoga is helpful in people with heart disease. However, it is not clear if yoga reduces the risk of heart attack or death or if yoga is better than any other form of exercise therapy or lifestyle/dietary change. Therefore, yoga may be a useful addition to standard therapies (such as medications for blood pressure or cholesterol) in people at risk for heart attacks, but further research is necessary before a strong conclusion can be made.
There is promising early evidence that yoga therapy may help treat arthritis (both osteoarthritis and rheumatoid arthritis). More research is needed to confirm these results.
Yoga is generally considered safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine or fragile or atherosclerotic neck arteries. Avoid if at risk for blood clots or with high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung diseases. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction. However, poses that put pressure on the uterus, such as abdominal twists, should be avoided during pregnancy.
Zinc: Zinc formulations have been used since ancient Egyptian times to treat a variety of medical conditions. In several studies, zinc supplements seemed to counteract underactive thyroids (a condition called hypothyroidism) and slightly reduce the number of infections in children with Down syndrome. However, zinc did not seem to improve weak immune systems. Additional human research is needed before a firm conclusion can be made.
Zinc may improve blood cholesterol levels in hemodialysis patients. There is some evidence that zinc may improve cholesterol ratio of HDL "good cholesterol" versus LDL "bad cholesterol," which would be considered a positive effect. Well-designed human trials are needed before a strong conclusion can be made.
Zinc is generally considered safe when taken at the recommended dosages. Avoid zinc chloride because evidence of safety and effectiveness are currently lacking. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.