Medicamentsen-ligne vous propose les traitements dont vous avez besoin afin de prendre soin de votre santé sexuelle. Avec plus de 6 ans d'expérience et plus de 90.000 clients francophones, nous étions la première clinique fournissant du acheter levitra original en France à vente en ligne et le premier vendeur en ligne de Viagra dans le monde. Pourquoi prendre des risques si vous pouvez être sûr avec Medicamentsen-ligne - Le service auquel vous pouvez faire confiance.

Obr_169.fm

Blackwell Science, LtdOxford, UKOBRobesity reviews1467-78812004 The International Association for the Study of Obesity. 693111Review ArticleAdverse events of herbal food supplements M. H. Pit- obesity reviews
Adverse events of herbal food supplements for body
weight reduction: systematic review*

Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Herbal weight-loss supplements are marketed with claims of effectiveness. Our earlier systematic review identified data from double-blind, randomized controlledtrials for a number of herbal supplements. The aim of this systematic review was Received 25 May 2004; revised 1 October to assess all clinical evidence of adverse events of herbal food supplements for body weight reduction for which effectiveness data from rigorous clinical trialsexist. We assessed Ephedra sinica, Garcinia cambogia, Paullinia cupana, guar Address reprint requests to: MH Pittler, gum, Plantago psyllium, Ilex paraguariensis and Pausinystalia yohimbe. Litera- Complementary Medicine, Peninsula Medical ture searches were conducted on Medline, Embase, Amed and The Cochrane School, Universities of Exeter and Plymouth, 25 Library. Data were also requested from the spontaneous reporting scheme of the Victoria Park Road, Exeter, EX2 4NT, UK. E- World Health Organization. We hand-searched relevant medical journals and our own files. There were no restrictions regarding the language of publication. The *See editorial, this issue pp. 89–92.
results show that adverse events including hepatic injury and death have beenreported with the use of some herbal food supplements. For herbal ephedra andephedrine-containing food supplements an increased risk of psychiatric, auto-nomic or gastrointestinal adverse events and heart palpitations has been reported.
In conclusion, adverse events are reported for a number of herbal food supple-ments, which are used for reducing body weight. Although the quality of the datadoes not justify definitive attribution of causality in most cases, the reported risksare sufficient to shift the risk–benefit balance against the use of most of thereviewed herbal weight-loss supplements. Exceptions are Garcinia cambogia andyerba maté, which merit further investigation.
Keywords: Adverse event, herbal supplement, safety, systematic review
obesity reviews (2005) 6, 93–111
22.9% of the US adult population was considered obese, Introduction
which increased to 30.5% in NHANES 1999–2000; 64.5% The prevalence of overweight and obesity is increasing at were classified as overweight (6). In the UK, the National an alarming rate and obesity has become one of the most Audit Office extrapolating prevalence data to the year 2005 important avoidable risk factors for morbidity and mortal- suggests that levels of obesity in England could reach those ity (1). The risk of developing, for instance, cancer, diabetes now experienced in the USA. In 1980, 8% of women and or heart disease increases with the degree of overweight in 6% of men were classified as obese; in 1998 the prevalence both men and women (2–5). Based on a body mass index had nearly trebled to 21% of women and 17% of men (7).
(BMI) in the healthy range – 18.5–24.9 kg m-2 – almost The increase in obesity rates occurred more rapidly in one-third of the US adult population must now be consid- England than in other European countries (8). One of the ered obese (BMI ≥ 30) and an additional third is over- major factors responsible for the increase in prevalence rates is a decrease in energy expenditure from physical Nutrition Examination Survey (NHANES) III(1988–94), 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
These considerations and the notoriously poor compli- herbal food supplements. Reports detailing adverse events ance with conventional weight management programmes after intake of single constituents of herbal extracts, cases emphasize the importance of effective, safe and acceptable of accidental poisoning, adverse events linked to occupa- therapeutic options. It is therefore not surprising to see the tional handling and studies assessing unconscious patients plethora of herbal over-the-counter slimming aids on offer, were excluded. Articles published in other languages than which are marketed with claims of effectiveness. Our ear- lier systematic review identified data from double-blind,randomized controlled trials (RCTs) for a number of herbal food supplements (10). The weight of the evidence, how-ever, seems small for most supplements and therefore even The searches identified largely anecdotal evidence. The moderate adverse events may shift the risk–benefit balance evidence relates to Ephedra sinica, Garcinia cambogia, against their use. The aim of this systematic review was to Paullinia cupana, guar gum, Plantago psyllium, Ilex assess all clinical evidence of adverse events reported with paraguariensis and Pausinystalia yohimbe. Herbal mono- the use of herbal food supplements for reducing body preparations and combination preparations were impli- weight for which effectiveness data from rigorous clinical cated. In many instances, the documentation of case reports and clinical trials is insufficient. Little information existsfor a number of important issues such as main toxic con-stituents, mechanisms that caused the adverse events and We conducted systematic literature searches on Medline,Embase, Amed and The Cochrane Library. Based on the findings of our earlier review (10), we conducted searcheson the herbal food supplements for which data from ran- Ephedra sinica or ma-huang is an evergreen shrub, which domized, double-blind trials are available. Thus, the search is native to central Asia and contains ephedrine as its pri- terms were ephedra, Ephedra sinica, Garcinia cambogia, mary active constituent (11). Food supplements containing guar gum, Cyamopsis tetragonolobus, psyllium, Plantago ephedra alkaloids have been linked to adverse central ner- ovata, yerba maté, Ilex paraguariensis, guarana, Paullinia vous system events and adverse cardiovascular events cupana, yohimbe, Pausinystalia yohimbe, adverse event, (12,13). Based on 50 randomized and non-randomized tri- adverse effect, adverse drug reaction and side effect. Each als, the most rigorous safety assessment to date concludes database was searched from 1995 to January 2004. Data that herbal ephedra and ephedrine-containing food supple- were also requested from the spontaneous reporting ments are associated with an increased risk of heart palpi- scheme of the World Health Organization (WHO, Collab- tation, psychiatric, autonomic and gastrointestinal adverse orating Centre for International Drug Monitoring, Upp- events (14). Since this assessment, additional reports of adverse events have been published, which are listed in accessed 14 January 2004). To identify additional pub- lished or unpublished material, we conducted hand-searches in our own files and in a sample of relevant medical journals (Erfahrungsheilkunde 1996–2004, For-schende Komplementärmedizin Klassische Naturheilkunde Garcinia cambogia, contains hydroxycitric acid, which has 1995–2004, Phytomedicine 1995–2004, Alternative and been shown to inhibit citrate cleavage enzyme, suppresses Complementary Therapies 1995–2004) and conference de novo fatty acid synthesis and food intake, and conse- proceedings (FACT – Focus on Alternative and Comple- quently decreases body weight gain (52). Garcinia cambo- mentary Therapies 1996–2004). The bibliographies of all gia extract has been tested in a number of trials. These trials located papers were searched for further information.
and case reports detail few and mild adverse events for both There were no restrictions regarding the language of pub- Garcinia cambogia and hydroxycitric acid (Tables 1 and 2).
lication. The screening and selection of articles and theextraction of data were performed independently by two reviewers (M.H.P., K.S.) and verified by a third (E.E.).
Disagreements during this process were largely due to read- Guarana is prepared from the seeds of Paullinia cupana ing errors and were resolved through discussion between and is indigenous to the Amazon basin (96). Guarana has the coauthors. All data (e.g. clinical trials, post-marketing been tested in a combination preparation with Ilex para- surveillance studies, case reports) were considered for guariensis (yerba maté, see below). It contains relatively inclusion. To be included articles were required to report large amounts of caffeine and is reported to prolong the data on adverse events reported with the therapeutic use of speed of gastric emptying (12). A number of adverse events 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements ts of adverse events associated with herbal weight-loss supplements 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements ting adverse events associated with herbal weight-loss supplements 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements pain, constipation, bloating (83 patients 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements are reported with the use of guarana and include irritability, Discussion
heart palpitations, anxiety and other central nervous sys-tem events (Table 1).
The reviewed evidence indicates that a range of adverseevents has been reported with the use of herbal weight-losssupplements (Tables 1 and 2). Although the number of cases and clinical trials may collectively look impressive, Guar gum is a dietary fibre derived from the Indian cluster the quality of the data does not. Frequently, the provided bean (Cyamopsis tetragonolobus). An earlier review sug- information is incomplete and important documentation is gested predominately gastrointestinal adverse events (97).
lacking. In some instances the herbal ingredients are not Most frequently, flatulence, diarrhoea and nausea were sufficiently characterized and, in most, the mechanism of reported by patients receiving guar gum. In 3% of the action is not fully understood. Often, the information pro- patients these were severe enough to necessitate the with- vided is insufficient for making inferences about causality.
drawal from the trials. These findings are corroborated by In fact, in many of the above reports and clinical trials, an our present analysis of case reports and clinical trials assumption of a causal relationship was made only because other plausible reasons could not be identified. Therefore,in these cases, it may be unnecessarily alarmist to accept acause–effect relationship. On the other hand, the reported risks imply the potential for harm and there is a possibility Psyllium is a water-soluble fibre derived from the husks of that they do signify causality even though they do not prove ripe seeds of Plantago psyllium (12,96). Clinical trials and it. In addition, the absence of convincing data of a cause– case reports suggest adverse events for this food supple- effect relationship cannot be taken as an indication of ment. Particularly gastrointestinal complaints such as flat- safety. Thus, considering firstly that the evidence of effec- ulence, bloating, indigestion and nausea were reported. In tiveness seems small for most herbal supplements (10), and addition, a number of patients reported, vomiting and ret- secondly considering the principle of ‘first do no harm’, the rosternal pain after the use of psyllium. In many trials, reported adverse events seem sufficient to shift the risk– however, these adverse events are reported to have also benefit balance against the use of most herbal weight-loss occurred in the placebo group (Tables 1 and 2).
supplements. Exceptions are Garcinia cambogia and yerbamaté which, in our view, merit further investigation.
Patients frequently use food supplements in combination with conventional medication. Therefore, a potential for Yerba maté is prepared from Ilex paraguariensis, an ever- herb–drug interactions exists. Perhaps ironically, for many green tree native to South America. Few data are available patients the motivation for using food supplements is that on this herbal preparation. The only double-blind RCT they are perceived as risk-free, a notion that – at least in on the subject did not report on adverse events (98).
the UK – is heavily promoted by the media, which tend to Epidemiological data suggest that the habit of ingesting hot be biased in favour of alternative therapies (103). There is maté drinks over long periods of time is linked to oesoph- also evidence to suggest that adverse events experienced ageal cancer (99). However, this seems to be related to with the use of herbal food supplements are less likely to chronic thermal injury rather than to a pharmacological be reported to a healthcare professional than similar adverse events experienced with conventional medicines(104). Collectively, these factors are likely to increase therisks of food supplements in clinical practice. In addition, issues concerning the quality of herbal food supplements Yohimbe (Pausinystalia yohimbe) is a tall evergreen tree, such as adulteration with prescription drugs or other con- which is native to Central Africa. Yohimbine, an alpha-2 taminants increase risks. Herbal medicines are marketed as receptor antagonist, is the main active constituent of the food supplements in many countries and therefore are sub- ground bark of Pausinystalia yohimbe. Most clinical stud- ject to less stringent controls. In the USA, for instance, ies relate to the effects of this isolated constituent of producers of food supplements do not have to demonstrate yohimbe bark. It is often promoted for erectile dysfunction efficacy, safety and quality similar to conventional drugs and as a weight-loss supplement. The adverse events (105). The effectiveness of any regulation that may exist in reported with the use of yohimbine are well documented this area is further diminished by the advent of internet and include hypertension, anxiety and agitation (100–102).
For a herbal preparation of yohimbe, one case report of Considering the present popularity of herbal food sup- severe acute headache and hypertension is reported plements (106–108), the number of identified adverse events may seem small and their nature benign. This may 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
indicate that herbal food supplements are relatively (i.e.
3. Field AE, Coakley EH, Must A, Spadano JL, Laird N, Dietz compared with prescription drugs) safe. However, it could WH, Rimm E, Colditz GA. Impact of overweight on the risk of also suggest that adverse events are under-reported.
developing common chronic diseases during a 10-year period.
Arch Intern Med 2001; 161: 1581–1586.
Regardless of this unresolved issue, the most relevant ques- 4. Key TJ, Allen NE, Spencer EA, Travis RC. The effect of diet tions for clinical decision-making do not merely relate to on risk of cancer. Lancet 2002; 360: 861–868.
the adverse events reported for any given herbal food sup- 5. Kenchaiah S, Evans JC, Levy D, Wilson PWF, Benjamin EJ, plements but to the risk–benefit ratio. Some herbal weight- Larson MG, Kannel WB, Vasan RS. Obesity and the risk of heart loss supplements have been tested for effectiveness in failure. N Engl J Med 2002; 347: 305–313.
6. Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence
clinical trials, but for most supplements which are on the and trends in obesity among US adults 1999–2000. JAMA 2002; market such data are not available (10,109). Research 288: 1723–1727.
efforts to answer this question should be intensified. Mean- 7. National Audit Office. Tackling Obesity in England. Stationery while, vigilance of healthcare professionals could be a valu- able first step to enhance consumer safety. It should be 8. Seidell JC, Flegal KM. Assessing obesity: classification and
epidemiology. Br Med Bull 1997; 53: 238–252.
paired with more adequate education of all parties 9. Heini AF, Weinsier RL. Divergent trends in obesity and fat involved. Patients could be informed to demystify herbal intake patterns: the American paradox. Am J Med 1997; 102:
food supplements from the aura of being natural and there- fore risk-free. Also, regulators could control herbal food 10. Pittler MH, Ernst E. Systematic review: dietary supplements for reducing body weight. Am J Clin Nutr 2004; 79: 529–536.
11. Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine.
Limitations of our review pertain to the potential incom- Expanded commission E monographs. American Botanical Coun- pleteness of the reviewed evidence. Literature searches were limited to the period between 1995 and January 2004.
12. Haller CA, Benowitz NL. Adverse cardiovascular and cen- Although this may have limited the scope of the review, tral nervous system events associated with dietary supplements events that occurred before 1995 may no longer be of containing ephedra alkaloids. N Engl J Med 2000; 343: 1833–
1838.
interest and supplements may already have been discontin- 13. Morgenstern LB, Viscoli CM, Kernan WN, Brass LM, Brod- ued or banned. Other limitations pertain to the fact that erick JP, Feldmann E, Wilterdink JL, Brott T, Horwitz RI. Use of case reports are often published as short reports or letters ephedra-containing products and risk for hemorrhagic stroke.
and may appear in journals that are not indexed in elec- Neurology 2003; 60: 132–135.
tronic databases. Therefore, we cannot be sure that all 14. Shekelle PG, Hardy ML, Morton SC, Maglione M, MojicaWA, Suttorp MJ, Rhodes SL, Jungvig L, Gagné J. Efficacy and reports were located. Moreover, the number of published safety of ephedra and ephedrine for weight loss and athletic per- adverse events will be affected by a larger than usual level formance. JAMA 2003; 289: 1537–1545.
of under-reporting. In this area of healthcare, patients often 15. Krome CN, Tucker AM. Cardiac arrhythmia in a professional do not tell their physician about the use of herbal medicines football player. Physician Sportsmed 2003; 31: 21–25, 29.
and the likelihood of an adverse event being reported or 16. Schweinfurth J, Pribitkin E. Sudden hearing loss associated
with ephedra use. Am J Health Syst Pharm 2003; 60: 375–377.
published is slim. In many countries a formal post-market- 17. Rezkalla SH, Mesa J, Sharma P, Kloner RA. Myocardial ing surveillance system for herbal medicines is not in place.
infarction temporally related to ephedra – a possible role for the Thus, the cases summarized above may well represent only coronary microcirculation. WMJ 2002; 101: 64–66.
a fraction of the true number of adverse events linked to 18. Matsumoto K, Mikoshiba H, Saida T. Nonpigmenting soli- tary fixed drug eruption caused by a Chinese traditional herbalmedicine ma huang (Ephedra Hebra), mainly containing pseu- In conclusion, adverse events are reported for a number doephedrine and ephedrine. J Am Acad Dermatol 2003; 48: 628–
of herbal food supplements, which are used for reducing body weight. Although the quality of the data does not 19. Chu Hwan R, Henning JS. Exertional heatstroke in an infan- justify definitive attribution of causality in most cases, the try soldier taking ephedra-containing dietary supplements. Mil reported risks are sufficient to shift the risk–benefit balance Med 2003; 168: 429–430.
20. Foxford RJ, Sahlas DJ, Wingfield KA. Vasospasm-induced
against the use of most of the reviewed herbal weight-loss stroke in a varsity athlete secondary to ephedrine ingestion. Clin supplements. Exceptions are Garcinia cambogia and yerba J Sport Med 2003; 13: 183–185.
maté, which merit further investigation.
21. Chu WW. Acute respiratory failure in a young woman taking
herbal medications. J Crit Ill 2001; June. [WWW document] URL

References
article.jhtml (accessed 13 January 2004).
22. Estes JD, Stolpman D, Olyaei A, Corless CL, Ham JM, 1. World Health Organization. Obesity: Preventing and Managing Schwartz JM, Orloff SL. High prevalence of ptientially hepato- the Global Epidemic. World Health Organization: Geneva, 1998.
toxic herbal supplement use in patients with fulminant hepatic 2. National Task Force on the Prevention and Treatment of Obe- failure. Arch Surg 2003; 138: 852–858.
sity. Overweight, obesity and health risk. Arch Intern Med 2000; 23. Boerth JM, Caley CF. Possible case of mania associated with 160: 898–904.
ma-huang. Pharmacotherapy 2003; 23: 380–383.
2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements 24. Charatan F. Ephedra supplement may have contributed to 48. Kalman D, Incledon T, Gaunard I, Schwartz H, Krieger D.
sportsman’s death. BMJ 2003; 326: 464.
An acute clinical trial evaluating the cardiovascular effects of an 25. Wettach GE, Falvey SG. A mysterious blood pressure increase herbal ephedra – caffeine weight loss product in healthy over- in a drilling naval reservist. Mil Med 2002; 167: 521–523.
weight adults. Int J Obesity 2002; 26: 1363–1366.
26. Case CC, Maldonado M. Diabetic ketoacidosis associated 49. Haller CA, Jacob P III, Benowitz NL. Pharmacology of ephe- with metabolife: a report of two cases. Diabetes Obes Metab dra alkaloids and caffeine after single-dose dietary supplement use.
2002; 4: 402–406.
Clin Pharmcol Ther 2002; 71: 421–432.
27. Ryan CK, Reamy B, Rochester JA. Ischemic colitis associated 50. McBride BF, Karapanos AK, Krudysz A, Kluger J, Coleman with herbal product use in a young women. J Am Board Fam Pract CI, White CM. Electrocardiographic and hemodynamic effects of 2002; 15: 309–312.
a multicomponent dietary supplement containing ephedra and 28. Warner RB, Lee AG. Leber hereditary optic neuropathy asso- caffeine. JAMA 2004; 291: 216–221.
ciated with the use of ephedra alkaloids. Am J Ophthalmol 2002; 51. Girola M, De Bernardi M, Contos S, Tripodi S, Ventura P, 134: 918–920.
Guarino C, Marletta M. Dose effect in lipid-lowering activity of 29. Verduin ML, Labbate LA. Psychosis and delirium following a new dietary integrator (Chitosan, Garcinia cambogia extract and metabolife use. Psychopharmacol Bull 2002; 36: 42–45.
chrome). Acta Toxicol Ther 1996; 17: 25–40.
30. Naik SD, Freudenberger RS. Ephedra-associated cardiomyop- 52. Heymsfield SB, Allison DB, Vasselli JR, Pietrobelli A, Green- athy. Ann Pharmacother 2004; 38: 400–403.
field D, Nunez C. Garcinia cambogia (hydroxycitric acid) as a 31. Chen C, Biller J, Willing SJ, Lopez AM. Ischemic stroke after potential antiobesity agent. JAMA 1998; 280: 1596–1600.
using over the counter products containing ephedra. J Neurol Sci 53. Thom E. A randomized, double-blind, placebo-controlled trial 2004; 217: 55–60.
of a new weight-reducing agent of natural origin. J Int Med Res 32. Bajaj J, Knox JF, Komorowski R, Saeian K. The irony of 2000; 28: 229–233.
herbal hepatitis. Dig Dis Sci 2003; 48: 1925–1928.
54. Rothacker DQ, Waitman BE. Effectiveness of a Garcinia cam- 33. Anonymous. Case Reports for Ephedra. World Health Orga- bogia and natural caffeine combination in weight loss – a double- nization ADR database (accessed 14 January 2004).
blind, placebo-controlled pilot study. Int J Obes 1997; 21 (suppl.
34. Anonymous. Case Reports for Garcinia cambogia. World Health Organization ADR database (accessed 14 January 2004).
55. Antonio J, Colker CM, Torina GC, Shi Q, Brink W, Kalman 35. Donadio V, Bonsi P, Zele I, Monari L, Liguori R, Vetrugno D. Effects of a standardized guggulsterone phosphate supplement R, Albani F, Montagna P. Myoglobinuria after ingestion of on body composition in overweight adults: a pilot study. Curr extracts of guarana, Ginkgo biloba and kava. Neurol Sci 2000; Ther Res 1999; 60: 220–227.
56. Hayamizu K, Ishii Y, Kaneko I, Shen M, Okuhara Y, Shigam- 36. Baghkhani L, Jafari M. Cardiovascular adverse reactions atsu N, Tomi H, Furuse M, Yoshino G, Shimasaki H. Effects of associated with guarana: is there a causal effect? J Herb Pharma- garcinia cambogia (hydroxycitric acid) on visceral fat accumula- cother 2002; 2: 57–61.
tion: a double-blind, randomized, placebo-controlled trial. Curr 37. Cannon ME, Cooke CT, McCarthy JS. Caffeine-induced car- Ther Res Clin E 2003; 64: 551–567.
diac arrhythmia: an unrecognized danger of healthfood products.
57. Román Ramos R, Flores Sáenz JL, Alarcón Aguilar FJ.
Med J Aust 2001; 174: 520–521.
Extracto de Garcinia cambogia en el control de la obesidad. Inves- 38. Anonymous. Case Reports for Guarana. World Health Orga- tigatión Médica Internacional 1995; 22: 97–100.
nization ADR database (accessed 14 January 2004).
58. Bourin M, Bougerol T, Guiton B, Broutin E. A combination 39. Anonymous. Case Reports for Guar Gum. World Health of plant extracts in the treatment of outpatients with adjustment Organization ADR database (accessed 14 January 2004).
disorder with anxious mood: controlled study versus placebo.
40. Fraquelli M, Colli A, Cocciolo M, Conte D. Adult syncytial Fundam Clin Pharmacol 1997; 11: 127–132.
giant cell chronic hepatitis due to herbal remedy. J Hepatol 2000; 59. Fernandes Galduróz JC, de Araújo Carlini E. The effects of 33: 505–508.
long-term administration of guarana on the cognition of normal, 41. Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF Jr.
elderly volunteers. São Paulo Med J 1996; 114: 1073–1078.
Psyllium laxative-induced anaphylaxis, asthma, and rhinitis.
60. Sesmilo G, Coves MJ, Gomis R. Guar gum in the treatment Allergy 1996; 51: 266–268.
of NIDDM. Diabetes Care 1995; 18: 584–585.
42. Germán A, Aregall S, Boada L, Tomás S. Shock anafiláctico 61. Blake DE, Hamblett CJ, Frost PG, Judd PA, Ellis PR. Wheat tras la ingestión de un laxante. Med Clin (Barc) 1995; 104: 559.
bread supplemented with depolymerized guar gum reduces the 43. Salguero Molpeceres O, Seijas Ruiz-Coello MC, Hernández plasma cholesterol concentration in hypercholesterolemic human Núñez J, Caballos Villar D, Díaz Picazo L, Ayerbe García-Monzón subjects. Am J Clin Nutr 1997; 65: 107–113.
L. Obstrucción esofgica por la fibra dietética Plantago ovata una 62. Jensen CD, Haskell W, Whittam JH. Long-term effects of complicación prevenible mediante la información. Gastroenterol water-soluble dietary fiber in the management of hypercholester- Hepatol 2003; 26: 248–250.
olemia in healthy men and women. Am J Cardiol 1997; 79: 34–
44. Manbeck MA, Walter MH, Chen YK. Gastric bezoar forma- tion in a patient with scleroderma: endoscopic removal using the 63. Knopp RH, Superko HR, Davidson M, Insull W, Dujovne A, gallstone mechanical lithotripter. Am J Gastroenterol 1996; 91:
Kwiterovich PO, Zavoral JH, Graham K, O’Connor RR, Edel- mann DA. Long-term blood cholesterol-lowering effects of a 45. Hulbert DC, Thorpe PJ, Winning AJ, Beckett MW. Fatal dietary fiber supplement. Am J Prev Med 1999; 17: 18–23.
bronchospasm after oral ingestion of isphagula. Postgrad Med J 64. Tai ES, Fok ACK, Chu R, Tan CE. A study to assess the effect 1995; 71: 305–306.
of dietary supplementation with soluble fibre (Minolest®) on lipid 46. Anonymous. Case Reports for Plantago Psyllium. World levels in normal subjects with hypercholesterolaemia. Ann Acad Health Organization ADR database (accessed 30 January 2004).
Med Singapore 1999; 28: 209–213.
47. Ruck B, Shih RD, Marcus SM. Hypertensive crisis from herbal 65. Riikonen S, Savonius H, Gylling H, Nikkilä KA-M, Tuomi treatment of impotence. Am J Emerg Med 1999; 17: 317–318.
Miettinen TA. Oral guar gum, a gel-forming dietary fiber relieves 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
Adverse events of herbal food supplements obesity reviews
pruritus in intrahepatic cholestasis of pregnancy. Acta Obstet seed husk on serum lipids in subjects with hypercholesterolemia.
Gynecol Scand 2000; 79: 260–264.
Am J Clin Nutr 1998; 67: 367–376.
66. Kovacs EMR, Westerterp-Plantenga MS, Saris WHM, Goos- 81. Ho YH, Tan M, Seow-Choen F. Micronized purified fla- ens I, Geurten P, Brouns F. The effect of addition of modified guar vonidic fraction compared favorably with rubber band ligation fum to a low-energy semisolid meal on appetite and body weight and fiber alone in the management of bleeding hemorrhoids. Dis loss. Int J Obesity 2001; 25: 307–315.
Colon Rectum 2000; 43: 66–69.
67. Gylling H, Riikonen S, Nikkilä K, Savonius H, Miettinen TA.
82. Oliver SD. The long-term safety and tolerability of ispaghula Oral guar gum treatment of intrahepatic cholestasis and pruritus husk. J R Soc Med 2000; 120: 107–111.
in pregnant women: effects on serum cholestanol and other non- 83. Rodríguez-Morán M, Guerrero-Romero F, Laczano-Burciaga cholesterol sterols. Eur J Clin Invest 1998; 28: 359–363.
G. Lipid- and glucose-lowering efficacy of plantago psyllium in 68. Vajifdar BU, Goyal VS, Lokhandwala YY, Mhamunkar SR, type II diabetes. J Diabetes Comp 1998; 12: 273–278.
Mahadik SP, Gawad AK, Halankar SA, Kulkarni HL. Is dietary 84. Sierra M, García JJ, Fernández N, Diez MJ, Calle AP, Far- fiber beneficial in chronic ischemic heart disease? J Assoc Physi- mafibra Group. Therapeutic effects of psyllium in type 2 diabetic cians India 2000; 48: 871–876.
patients. Eur J Clin Nutr 2002; 56: 830–842.
69. Salenius JP, Harju E, Jokela H, Riekkinen H, Silvasti M. Long 85. Wahington N, Harris M, Musselwhite A, Spiller RC. Moder- term effects of guar gum on lipid metabolism after carotid endar- ation of lactulose-induced diarrhea by psyllium: effect on motility terectomy. BMJ 1995; 310: 95–96.
and fermentation. Am J Clin Nutr 1998; 67: 317–321.
70. Patrick PG, Gohman SM, Marx SC, DeLegge MH, Greenberg 86. Van Beusekom HJ, Van de Laar MAFJ, Franssen MJAM, Van NA. Effect of supplements of partially hydrolyzed guar gum on Valburg JAA, Gijzel WP, Couvée JE. The moderate intestinal side the occurrence of constipation and use of laxative agents. J Am effects of auranofin do not require prophylactic therapy with a Diet Assoc 1998; 98: 912–914.
bulkforming agent. Clin Rheumatol 1997; 16: 471–476.
71. Hosobuchi C, Rutanassee L, Bassin S-L, Wong N-D. Efficacy 87. Zumarraga L, Levitt MD, Suarez F. Absence of gaseous symp- of acacia, pectin and guar gum-based fiber supplementation in the toms during ingestion of commercial fibre preparations. Aliment control of hypercholesterolaemia. Nutr Res 1999; 19: 643–649.
Pharmacol Ther 1997; 11: 1067–1072.
72. Alam NH, Meier R, Rausch T, Meyer-Wyss B, Hildebrand P, 88. Barroso Aranda J, Contreras F, Bagchi D, Preuss HG. Efficacy Schneider H, Bachmann C, Minder E, Fowler B, Gyr K. Effects of a novel chitosan formulation on fecal fat excretion: a double- of a partially hydrolyzed guar gum on intestinal absorption of blind, crossover, placebo-controlled study. J Med 2002; 33: 209–
carbohydrate, proteine and fat: a double-blind controlled study in volunteers. Clin Nutr 1998; 17: 125–129.
89. Murphy J, Stacey D, Crook J, Thompson B, Panetta D.
73. Anderson JW, Davidson MH, Blonde L, Brown WV, Howard Testing control of radiation-induced diarrhea with a psyllium WJ, Ginsberg H, Allgood LD, Weingand KW. Long-tern choles- bulking agent: a pilot study. Can Oncol Nurs J 2000; 10: 96–100.
terol-lowering effects of psyllium as an adjunct to diet therapy in 90. MacMahon M, Carless J. Ispaghula husk in the treatment of the treatment of hypercholesterolemia. Am J Clin Nutr 2000; 71:
hypercholerolaemia: a double-blind controlled study. J Cardiovasc Risk 1998; 5: 167–172.
74. Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP.
91. Brock FE, Uehleke B, Wöhling H. Psyllium is an effective and Effects of psyllium on glucose and serum lipid responses in men safe drug in the treatment of hypercholesterinemia. Pharm Phar- with type 2 diabetes and hypecholesterolemia. Am J Clin Nutr macol Lett 2001; 2: 68–71.
1999; 70: 466–473.
92. Romero AL, Romero JE, Galaviz S, Fernandez ML. Cookies 75. Chicouri MJ. Clinical study of psyllium husk combined to enriched with psyllium or oat bran lower plasma LDL cholesterol microencapsulated paraffin in intestinal primary constipation ther- in normal and hypercholesterolemic men from Northern Mexico.
apy. Rev Bras Med 2001; 58: 672–676.
J Am Coll Nutr 1998; 17: 601–608.
76. Bonithon-Kopp C, Kronborg O, Giacosa A, Räth U, Faivre 93. Lodge N, Evans ML, Wilkins M, Blake PR, Fryatt I. A J. Calcium and fibre supplementation in prevention of colorectal randomized cross-over study of the efficacy of codeine phosphate adenoma recurrence: a randomized intervention trial. Lancet versus ispaghula husk in patients with gynaecological cancer expe- 2000; 356: 1300–1306.
riencing diarrhoea during pelvic radiotherapy. Eur J Cancer Care 77. Fernández-Bañares F, Hinojosa J, Sanchez-Lombrana JL, 1995; 4: 8–10.
Navarro E, Martinez-Salmeron JF, Garcia-Puges A, Gonzalez- 94. Spence JD, Huff MW, Heidenheim P, Viswanatha A, Munoz Huix F, Riera J, Gonzalez-Lara V, Dominguez-Abascal F, Gine C, Lindsay R, Wolfe B, Mills D. Combination therapy with colesti- JJ, Moles J, Gomollon F, Gassull MA. Randomized clinical trial pol and psyllium mucilloid in patients with hyperlipidemia. Ann of Plantago ovata seeds (dietary fiber) as compared with Intern Med 1995; 123: 493–499.
mesalamine in maintaining remission in ulcerative colitis. Spanish 95. Davidson MH, Dugan LD, Burns JH, Sugimoto D, Story K, Group for the Study of Crohn’s Disease and Ulcerative Colitis Drennan K. A psyllium-enriched cereal for the treatment of hyper- (GETECCU). Am J Gastroenterol 1999; 94: 427–433.
cholesterolemia in children: a controlled, double-blind, crossover 78. Weingand KW, Le NA, Kuzmak BR, Brown WV, Daggy BP, study. Am J Clin Nutr 1996; 63: 96–102.
Miettinen TA, Howard BV, Howard J. Effects of psyllium on 96. Capassso F, Gagniella TS, Grandolini G, Izzo AA. Phytother- cholesterol and low-density lipoprotein metabolism in subjects apy. Springer: Berlin, Heidelberg, 2003.
with hypercholesterolemia. Endocrinol Metab 1997; 4: 141–150.
97. Pittler MH, Ernst E. Guar gum for body weight reduction.
79. Dettmar PW, Sykes J. A multi-centre, general practice com- Meta-analysis of randomized trials. Am J Med 2001; 110: 724–
parison of ispaghula husk with lactulose and other laxatives in the treatment of simple constipation. Curr Med Res Opin 1998; 14:
98. Andersen T, Fogh J. Weight loss and delayed gastric emptying following a South American herbal preparation in overweight 80. Davidson MH, Maki KC, Kong JC, Dugan LD, Torri SA, Hall patients. J Hum Nutr Diet 2001; 14: 243–250.
HA, Drennan KB, Anderson SM, Fulgoni VL, Saldanha LG, Olson 99. Castellsague X, Munoz N, De Stefani E, Victora CG, Castel- BH. Long-term effects of consuming foods containing psyllium letto R, Rolon PA. Influence of mate drinking, hot beverages and 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111
obesity reviews
Adverse events of herbal food supplements diet on esophageal cancer risk in South America. Int J Cancer conventional OTC medicines face-to-face interviews with 515 2000; 88: 658–664.
users of herbal remedies. Br J Clin Pharmacol 1998; 45: 496–500.
100. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a 105. DeAngelis CD, Fontanarosa PB. Drugs alias dietary supple- systematic review and meta-analysis of randomized clinical trials.
ments. JAMA 2003; 290: 1519–1520.
106. Blumenthal M. Market report. Herbalgram 2002; 55: 60.
101. De Smet PAGM, Smeets OSNM. Potential risks of health 107. Ernst E, White AR. The BBC survey of complementary med- food products containing yohimbe extracts. BMJ 1994; 309: 958.
icine use in the UK. Complement Ther Med 2000; 8: 32–36.
102. Mansoor GA. Herbs and alternative therapies in the hyper- 108. MacLennan AH, Wilson DH, Taylor AW. The escalating tension clinic. Am J Hypertens 2001; 14: 971–975.
cost and prevalence of alternative medicine. Prev Med 2002; 35:
103. Ernst E, Weihmayr T. UK and German media differ over complementary medicine. BMJ 2000; 321: 707.
109. Ernst E, Pittler MH, Stevinson C, White AR, Eisenberg D.
104. Barnes J, Mills SY, Abbot NC, Willoughby M, Ernst E.
The Desktop Guide to Complementary and Alternative Medicine. Different standards for reporting ADRs to herbal remedies and 2005 The International Association for the Study of Obesity. obesity reviews 6, 93–111

Source: http://free.uwc.ac.za/ripmixlearners/_media/j_1_1_.1467-789x.2005.00169.pdf

Microsoft word - program amended 6.doc

18 December 2006 Time ISCOC Registration Opening Ceremony ( Venue: GRAND BALLROOM 1) Signature Lecture 1 ( Venue: GRAND BALLROOM 1) HARNESSING A SINGLET OXENE FOR THE CONTROLLED OXIDATION OF ALKANES: A CATALYST FOR THE FACILE CONVERSION OF METHANE TO METHANOL UNDER AMBIENT CONDITIONS Chair: Thomas MAK Reception Plenary 1 ( Venue: GRAND BALLROOM 1) Plen

Supported living referral

REQUEST FOR PROPOSAL All TDD Nursing Providers Michelle Lindrose, Service and Support Administrator Denise Scott, Service and Support Administrator Supervisor October 17, 2013 Client: # 437 This person is a 30 year old male with tuberous sclerosis, seizures, mild mental retardation, and visual issues who requires up to 24 hours supervision. He resides with his mother an

Copyright © 2010-2014 Pharmacy Pills Pdf