Susan Bowerman

An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents.

OBJECTIVES Some strains of Chinese red yeast rice, when prepared by solid fermentation, produce compounds called monacolins that inhibit cholesterol production. When used as a dietary supplement to achieve and maintain healthy cholesterol levels, Chinese red yeast rice has significant potential to reduce health care costs and contribute to public health by reducing heart disease risk in individuals with moderate elevations of circulating cholesterol levels. Whereas one proprietary strain of Chinese red yeast rice has been demonstrated to lower cholesterol levels significantly in clinical trials, other strains being sold as Chinese red yeast rice dietary supplements have not undergone similar evaluation. In order to determine whether the results of a clinical trial conducted with one strain of Chinese red yeast rice could be generalized to other preparations of Chinese red yeast rice, nine different commercially available dietary supplements were purchased tested for chemical constituents. DESIGN Monacolins were measured by high performance liquid chromatography (HPLC) that separates the various monacolins in Chinese red yeast rice. Citrinin concentration, a toxic fermentation byproduct, was measured by radioimmunoassay. RESULTS Total monacolin content varied from 0% to 0.58% w/w and only 1 of 9 preparations had the full complement of 10 monacolin compounds. Citrinin was found at measurable concentrations in 7 of the 9 preparations. CONCLUSIONS The findings from clinical trials demonstrating significant and clinically relevant cholesterol reduction using a defined Chinese red yeast rice preparation containing 10 different monacolins cannot be generalized to preparations that do not contain the same levels and profile of monacolins. Standardized manufacturing practices should be established for Chinese red yeast rice sold as a dietary supplement in order ensure equivalence of content of active ingredients in preparations being sold to the public and to limit the production of unwanted byproducts of fermentation such as citrinin. In common with other botanical dietary supplements, the full potential of this product will not be realized until standards for production and labeling of Chinese red yeast rice are further developed.

Applying Science to Changing Dietary Patterns

The intake of 400-600 g/d of fruits and vegetables is associated with reduced incidence of many common forms of cancer. These foods contain phytochemicals that can modulate gene expression to inhibit carcinogenesis via multiple pathways. Many phytochemicals are colorful, providing an easy way to communicate increased diversity of fruits and vegetables to the public. Red foods contain lycopene, the pigment in tomatoes, which is localized in the prostate gland and may be involved in maintaining prostate health. Yellow-green vegetables, such as corn and leafy greens, contain lutein and zeaxanthin, which are localized in the retina where age-related macular degeneration occurs. Red-purple foods contain anthocyanins, which are powerful antioxidants found in red apples, grapes, berries and wine. Orange foods, including carrots, mangos, apricots, pumpkin and winter squash, contain beta-carotene. Orange-yellow foods, including oranges, tangerines and lemons contain citrus flavonoids. Green foods, including broccoli, Brussels sprouts and kale, contain glucosinolates. White-green foods in the onion family contain allyl sulfides. Consumers are advised to ingest one serving of each of the above groups daily, putting this recommendation within the National Cancer Institute and American Institute for Cancer Research guidelines of five to nine servings per day. The color code provides simplification, but it is also important as a way to help consumers to find common fruits and vegetables easily while traveling, eating in restaurants or working. At home, simple ways of preparing foods rapidly and easily are needed to influence dietary patterns.

A controlled trial of protein enrichment of meal replacements for weight reduction with retention of lean body mass

BackgroundWhile high protein diets have been shown to improve satiety and retention of lean body mass (LBM), this study was designed to determine effects of a protein-enriched meal replacement (MR) on weight loss and LBM retention by comparison to an isocaloric carbohydrate-enriched MR within customized diet plans utilizing MR to achieve high protein or standard protein intakes.MethodsSingle blind, placebo-controlled, randomized outpatient weight loss trial in 100 obese men and women comparing two isocaloric meal plans utilizing a standard MR to which was added supplementary protein or carbohydrate powder. MR was used twice daily (one meal, one snack). One additional meal was included in the meal plan designed to achieve individualized protein intakes of either 1) 2.2 g protein/kg of LBM per day [high protein diet (HP)] or 2) 1.1 g protein/kg LBM/day standard protein diet (SP). LBM was determined using bioelectrical impedance analysis (BIA). Body weight, body composition, and lipid profiles were measured at baseline and 12 weeks.ResultsEighty-five subjects completed the study. Both HP and SP MR were well tolerated, with no adverse effects. There were no differences in weight loss at 12 weeks (-4.19 ± 0.5 kg for HP group and -3.72 ± 0.7 kg for SP group, p > 0.1). Subjects in the HP group lost significantly more fat weight than the SP group (HP = -1.65 ± 0.63 kg; SP = -0.64 ± 0.79 kg, P = 0.05) as estimated by BIA. There were no significant differences in lipids nor fasting blood glucose between groups, but within the HP group a significant decrease in cholesterol and LDL cholesterol was noted at 12 weeks. This was not seen in the SP group.ConclusionHigher protein MR within a higher protein diet resulted in similar overall weight loss as the standard protein MR plan over 12 weeks. However, there was significantly more fat loss in the HP group but no significant difference in lean body mass. In this trial, subject compliance with both the standard and protein-enriched MR strategy for weight loss may have obscured any effect of increased protein on weight loss demonstrated in prior weight loss studies using whole food diets.

Reduced body weight and adiposity with a high-protein diet improves functional status, lipid profiles, glycemic control, and quality of life in patients with heart failure: a feasibility study.

Background:The effectiveness of high-protein (HP) diets in reducing body weight and adiposity and potentially improving clinical outcomes in heart failure (HF) is not known. Objective:This feasibility study was conducted to evaluate the impact of 3 dietary interventions on body weight and adiposity, functional status, lipid profiles, glycemic control, and quality of life (QOL) in overweight and obese patients with HF and type 2 diabetes mellitus. Design:Fourteen patients with HF with a body mass index greater than 27 kg/m2 were randomized to an HP diet, a standard protein diet, or a conventional diet. Data were obtained at baseline and 12 weeks. Results:There were no significant differences in age (59 ± 10 years), sex (78% male), New York Heart Association class (43% class II, 57% class III), and HF etiology or left ventricular ejection fraction (26 ± 7) between the groups at baseline. Patients on the HP diet demonstrated significantly greater reductions in weight (P = .005), percent body fat (P = .036), total cholesterol (P = .016), triglyceride concentrations (P = .034), and low-density lipoprotein cholesterol (P = .041) and greater improvements in functional status (6-minute walk [P = .010] and VO2 peak [P = .003]), high-density lipoprotein cholesterol (P = .006), and physical QOL scores (P = .022) compared with those on standard protein and conventional diets. Conclusion:A 12-week HP diet resulted in moderate weight loss and reduced adiposity in a small sample of overweight and obese patients with HF that were associated with improvements in functional status, lipid profiles, glycemic control, and QOL. However, these preliminary findings must be confirmed in studies with more participants and long-term follow-up.

Antioxidant-rich spice added to hamburger meat during cooking results in reduced meat, plasma, and urine malondialdehyde concentrations

Background: Emerging science has shown the effect of oxidation products and inflammation on atherogenesis and carcinogenesis. Cooking hamburger meat can promote the formation of malondialdehyde that can be absorbed after ingestion. Objective:We studied the effect of an antioxidant spice mixture on malondialdehyde formation while cooking hamburger meat and its effects on plasma and urinary malondialdehyde concentrations. Design: Eleven healthy volunteers consumed 2 kinds of burgers in a randomized order: one burger was seasoned with a spice blend, and one burger was not seasoned with the spice blend. The production of malondialdehyde in burgers and malondialdehyde concentrations in plasma and urine after ingestion were measured by HPLC. Results:Rosmarinic acid from oregano was monitored to assess the effect of cooking on spice antioxidant content. Forty percent (19 mg) of the added rosmarinic acid remained in the spiced burger (SB) after cooking. There was a 71% reduction in the malondialdehyde concentration (mean ± SD: 0.52 ± 0.02 μmol/250 g) in the meat of the SBs compared with the malondialdehyde concentration (1.79 ± 0.17 μmol/250 g) in the meat of the control burgers (CBs). The plasma malondialdehyde concentration increased significantly in the CB group as a change from baseline (P = 0.026). There was a significant time-trend difference (P = 0.013) between the 2 groups. Urinary malondialdehyde concentrations (μmol/g creatinine) decreased by 49% (P = 0.021) in subjects consuming the SBs compared with subjects consuming the CBs. Conclusions: The overall effect of adding the spice mixture to hamburger meat before cooking was a reduction in malondialdehyde concentrations in the meat, plasma, and urine after ingestion. Therefore, cooking hamburgers with a polyphenol-rich spice mixture can significantly decrease the concentration of malondialdehyde, which suggests potential health benefits for atherogenesis and carcinogenesis. This trial was registered at clinical trials.gov as NCT01027052.

Phytochemical Assays of Commercial Botanical Dietary Supplements

The growing popularity of botanical dietary supplements (BDS) has been accompanied by concerns regarding the quality of commercial products. Health care providers, in particular, have an interest in knowing about product quality, in view of the issues related to herb-drug interactions and potential side effects. This study assessed whether commercial formulations of saw palmetto, kava kava, echinacea, ginseng and St. Johns wort had consistent labeling and whether quantities of marker compounds agreed with the amounts stated on the label. We purchased six bottles each of two lots of supplements from nine manufacturers and analyzed the contents using established commercial methodologies at an independent laboratory. Product labels were found to vary in the information provided, such as serving recommendations and information about the herb itself (species, part of the plant, marker compound, etc.) With regard to marker compound content, little variability was observed between different lots of the same brand, while the content did vary widely between brands (e.g. total phenolic compounds in Echinacea ranged from 3.9–15.3 mg per serving; total ginsenosides in ginseng ranged from 5.3–18.2 mg per serving). Further, the amounts recommended for daily use also differed between brands, increasing the potential range of a consumers daily dose. Echinacea and ginseng were the most variable, while St. Johns wort and saw palmetto were the least variable. This study highlights some of the key issues in the botanical supplement market, including the importance of standardized manufacturing practices and reliable labeling information. In addition, health care providers should keep themselves informed regarding product quality in order to be able to appropriately advise patients utilizing both conventional and herbal medicines.

Antioxidant capacity and phytochemical content of herbs and spices in dry, fresh and blended herb paste form

We determined whether nine common herbs (basil, chili, cilantro, dill, garlic, ginger, lemongrass, oregano, and parsley) and one herb mixture (Italian Herbs) retain the antioxidant capacity (AC) and content of phenolics and characteristic marker compounds during processing to dry and paste forms. Oregano exhibited the highest AC among the herbs tested in dry and fresh forms. Compared with fresh herbs, the AC in dry form was decreased in garlic, chili, dill, oregano and parsley and paste form of oregano and basil. With the exception of dried garlic and lemongrass in fresh and paste form, all herbs in dry, paste, and fresh form contained significant AC. The AC was correlated significantly to the total phenolic content in both dry and fresh form. However, there was no significant correlation between the AC and the concentration of chemical marker compounds. In summary, processed herbs contribute significant amounts of AC to the diet.

Body Weight Loss with Phentermine Alone Versus Phentermine and Fenfluramine with Very-Low- Calorie Diet in an Outpatient Obesity Management Program: A Retrospective Study

BACKGROUND Obesity, which is epidemic in the United States, is associated with increased morbidity and mortality. The combination of diet, exercise, and a behavior-modification program often does not result in ideal body weight. OBJECTIVE The aim of this study was to determine the efficacy of phentermine (Phen) alone compared with phentermine plus fenfluramine (Phen-Fen), when used in combination with a very-low-calorie diet (VLCD) for weight loss in an outpatient obesity center. METHODS We analyzed data collected at the UCLA outpatient University Obesity Center between 1993 and 1999. Data for patients who attended the center for at least 12 weeks and at least 4 visits, who were taking Phen or Phen-Fen, and whose body mass index (BMI) was ≥30 kg/m(2) were included in this retrospective study. RESULTS During the study period, 3200 visits were recorded. Of 1133 potential participants, 446 patients were included in the analysis (309 women, 137 men; mean [SD] age, 46.7 [11.4] years; mean [SEM] body weight, 109.6 [26.7] kg; mean [SEM] BMI, 38.0 [7.6] kg/m(2)). Of these, 128 women and 60 men (mean [SEM] body weight at baseline, 103.4 [24.0] kg and 124.9 [28.2] kg, respectively) received Phen alone; 181 women and 77 men (mean [SEM] body weight at baseline, 102.5 [21.4] kg and 124.9 [30.2] kg, respectively) received Phen-Fen. No statistically significant differences were found between the Phen and Phen-Fen groups in mean age, body weight, or BMI for women or men at baseline. No significant differences in the time of weight loss were found when a VLCD was used with Phen alone compared with the Phen-Fen combination for either sex even at 12 weeks. For women, the mean total body weight loss was 7.4% in the Phen group and 8.7% in the Phen-Fen group, but these differences were not significant. For men, the mean total body weight loss was 7.8% in the Phen group and 8.2% in the Phen-Fen group, but these differences were not significant. No significant differences in BMI, severe adverse events, or dropout rate were found between the 2 treatment groups for men or women. CONCLUSIONS This outpatient study did not detect any significant difference between adjunctive uses of Phen compared with Phen-Fen pharmacotherapy when used with VLCD over 12 weeks. Phen can be used to achieve significant weight loss when combined with VLCD. The tolerability and positive physical response further suggest that Phen is a valuable medication for obesity management in the outpatient setting.