Immune-boosting Foods: Citrus Fruits

Grapefruit, oranges, tangerines, lemons and limes are all excellent sources of ascorbic acid, the form of vitamin C found in plants. As a component of food, this nutritional superstar has myriad immune functions, including enhancing the movement of phago¬cytes, boosting NK-cell activity and building and maintaining mucous membranes and collagen, a tissue that plays a vital role in wound healing.

Vitamin C is also required for the manufacture of hormones that help the body deal with stress and it helps convert toxins to water-soluble substances that can be excreted by the body. But it's just one of more than 100 phytochemicals that citrus fruits contain. Both oranges and grapefruit are also loaded with naringenin, which is thought to work against HIV infection and tumour formation.

The oil in citrus rinds contains Iimonene, which researchers think helps enzymes to deactivate cancer-causing substances in the body. Iimonene may also encourage tumours to shrink by slowing down the rate at which the cells divide.

The proof: Contrary to popular claims, vitamin C cannot cure the common cold or make cancer patients live longer. Even so, its importance for health can't be disputed. Many studies have found an unmistakable correlation between low levels of vitamin C in the blood and increased risk of cancer, especially cancer of the oesophagus, mouth, pancreas and stomach. Just by adding a small amount of lemon peel to their diets, participants in one US study appear to have lowered their incidence of skin cancer by as much as 34 per cent.

Put citrus fruits to work: Most animals manufacture their own vitamin C, but humans have lost their ability to do so. Since the body doesn't store the vitamin (any excess is eliminated through the urine), try to get a little bit every day. (There is no benefit in taking large doses of supplements.) To benefit from limonene, add a twist of citrus peel to your drink.

Immune-boosting Foods: Garlic

Garlic fans adore the bulb's pungent flavour and so should health seekers. Several of the same chemicals that contribute to garlic's intense flavour also appear to help block cancer by preventing the formation of some carcinogens that damage DNA. Garlic may also stimulate an increase in the production of the immune-system chemicals interleukin-2, tumour necrosis factor and interferon gamma — the same substances that are used by doctors in some cancer dierapies that are based on manipulation of the immune system. 

The proof. Fresh garlic juice can kill various microorganisms. Small studies have hinted at its effectiveness in promoting human health. Some studies even suggest that eating lots of chopped garlic may lower the risk of colon and stomach cancer by up to 35 per cent and 50 per cent respectively. The reduction in stomach cancer among garlic eaters suggests that the tasty bulb contains compounds that stop the growth of ulcer-causing Helicobacter pylori bacteria, since gastric ulcers have been identified as a strong risk factor for stomach cancer. 

Put garlic to work. How much garlic do you need to eat to harness its healing powers? Generally, benefits have been observed in people who eat 5 to 18 g (about two to six cloves) of raw or lighdy cooked garlic a week. (Overcooking can destroy the beneficial enzymes.) Add garlic to stir-fries; toss it in sauces, stews and soups; or opt instead to use its close cousins - shallots, onions, chives or leeks. Be wary of garlic pills; some contain few active ingredients, so fresh garlic is best. Also, although some folk remedies involve applying crushed garlic directly to the skin, don't, as it could be too strong for you and would cause severe irritation.

P/S: After chopping garlic, let it sit on the kitchen bench for about 15 minutes before cooking. This allow ample time for its various health-protective substances to form. Heat stops this important process.

Immune-boosting Foods: Broccoli

Cancer institutes around the world value broccoli as the number-one anticancer food, and with good reasons. As well as being rich in disease-fighting vitamin C, it also contains sulforaphane, a phyto-chemical that occurs naturally in broccoli and other vegetables of the cruciferous family — kale, cabbage, cauliflower, bok choy, brussels sprouts and many salad greens. Sulforaphane stimulates the body's production of substances called Phase II detoxification enzymes. These enzymes destroy carcinogens (cancer-causing substances) and free radicals before they can attack healthy cells. Second, cruciferous vegetables are loaded with indole-3-carbinol (I3C), a phytochemical shown to inhibit the growth of the type of cancer cells in the breast that are responsive to estrogen. In fact, researchers are now examining the feasibility of putting I3C in a pill to combat breast cancer.

The proof: When scientists fed rats hearty servings of broccoli for a few days, then exposed them to a potent compound that induces breast cancer, the broccoli eaters were half as likely to develop tumors as animals on the standard feed. And the broccoli eaters that did develop cancer ended up with fewer and smaller tumors.

Put broccoli to work: Regardless of how you prepare cruciferous vegetables, eating them is good for you. But if you want to rev up your body's disease-fighting abilities fast, look a little further down the family tree to broccoli sprouts. Scientists at Johns Hopkins University have found that, gram for gram, these tender shoots can contain up to 20 times more sulforaphane than mature broccoli. In other words, 30 g of sprouts yields as much protective power as about 625 g of cooked broccoli!

Ask for broccoli sprouts at your local greengrocer or supermarket, but if you can't find them, why not grow your own? Sprouts of all kinds are powerhouses of health and are very quick and easy to grow. Health food shops will supply you with special sprouting seeds that have not been treated with pesticides and recommend a sprouter that suits the size of your household. Simply follow the manufacturer's instructions. Refrigerate your fat-free, low-kilojoule broccoli sprouts and rinse in fresh, clean water before using. Serve generously in sandwiches and salads before the use-by date.

Immune-boosting Food: Blueberry

Anthocyanins, the pigments that give blueberries their stunning deep colour, have potent immune-stimulating properties. Because they are antioxidants, anthocyanins protect capillaries (tiny blood vessels) from oxidative damage. In doing so, they promote brisk blood flow through the circulatory channels through which many immune cells travel to reach parts of the body that need their help. Protection against oxidation also helps ensure good circulation of lymph, the fluid that carries immune cells through its own system of channels.

Moreover, blueberries are rich in concentrated tannins, astringent substances also found in tea. According to US research, these tannins prevent E. coli bacteria from sticking to the cells that line the urinary tract, where they can cause infection. Scientists think that tannins block the growth of the part of the bacteria that gives the bugs their adhesive property. Tannins also contain compounds called catechins. Several studies suggest that catechins shield us against some types of cancer.

The proof: When US researchers measured the levels of antioxidants in 40 different fruits and vegetables, blueberries came out near the top. In fact, a 12S g serving of fresh blueberries supplies enough antioxidants to almost double our average daily intake. The study suggests that eating a fistful of blueberries (or their cousins, cranberries) daily will go a long way towards preventing urinary tract infections and promoting good overall health. Blueberries are at their peak in January and February, but canned and frozen are available year-round.

Put blueberries to work: Use fresh berries to add texture to your breakfast cereal and in fruit salads. Or add fresh, frozen, or dried blueberries to pancake or muffin batters. Don't like blueberries? Other berries, including raspberries, blackberries and strawberries, deliver many of the same cancer-fighting phytochemicals. Like blueberries, they're loaded with fibre (all those tiny seeds) and ellagic acid, shown in early studies to inhibit the development of cancer. This may explain, in part, why research at the Harvard School of Public Health, involving 1271 people, found that strawberry lovers were less likely to develop cancer than those who rarely ate the fruit.

Immune-boosting Food: Tomatoes

Need more proof of the healing power of food? Look no further than the humble tomato, which has earned more high scores than any other menu item in studies of cancer-fighting foods. Along with a rich supply of vitamin C, tomatoes are loaded with lycopene. This powerful antioxidant gives them their luscious red colour and it has been convincingly shown to defend the body against cancer. Tomatoes are second only to carrots as a source of beta-carotene, a member of the carotenoid family of phytochemicals (see page 48).They are also excellent sources of the flavonoids quercetin and kaempferol, which inhibit the growth of cancer cells.

The proof: In a review of 72 studies published in the American Journal of the National Cancer Institute, researcher Edward Giovannucci, MD, of the Harvard Medical School, concluded that eating tomatoes and tomato-based products consistently led to higher levels of lycopene in the blood and a lower risk of a variety of cancers. In earlier research, Dr Giovannucci found that the risk of prostate cancer was a third lower in men who consumed tomato products, such as pasta sauce, at least twice a week.

Women reap benefits from lycopene, too. When researchers measured lycopene levels in breast-tissue samples from 109 women, those with higher levels of the nutrient were found to be less likely to develop breast cancer. More direct cancer-fighting benefits came to light when researchers at the University of Milan, Italy, put healthy young women on a tomato-free diet for three weeks, followed by three weeks of a tomato-rich diet. The results were startling. On the tomato-rich diet, the levels of lycopene in the women's blood increased, while the free-radical damage to the DNA in their lymph cells dropped by about 33 per cent.

Put tomatoes to work: Because lycopene is fat-soluble, it is more accessible to the body when the foods that contain it are prepared and eaten with a small amount of fat. In other words, pizza slathered with tomato sauce is preferable to tomatoes sliced raw and tossed in a salad.

Do you find that hard to believe? In one study, volunteers ate either a mock pizza made of bread, tomato paste and corn oil or a pile of fresh tomato slices without oil. Several hours after the meal, the pizza eaters' blood levels of lycopene were two and a half times higher than those of the salad eaters.

Similarly, when researchers at the University of California put patients with prostate cancer on a high-fibre diet that included small amounts of fat and 200 ml of tomato-vegetable juice a day, they detected a 'highly significant increase' of lycopene and other phytochemicals in the patients' blood. In a major European study, lycopene was shown also to lower the risk of heart attack. Its protective effect was found to be especially beneficial to nonsmokers.

Let's Talk About the Immune-boosting Foods

One of the first things you need to know about your immune system is that these forces, which defend you against infection and other illnesses, cannot wage their best battle unless they are being well nourished.

Because eating too few of the right nutrients can weaken your body and allow germs and disease to gain a foothold, a good diet is the first and most important way to stay well. That's plain old common sense. But it's also been scientifically proved. Researchers now know that B-cells, T-cells, phagocytes and natural killer (NK) cells can't do their best at quashing cancer cells and other dangerous invaders, such as viruses and bacteria, without strong backup from the vitamins, minerals, fibre and phytochemicals found in healthy foods.

The latest proof is a study by US researchers, which found that women of older ages (say from 60 to 80) with good eating habits had immune function that was just as sound as that of younger women aged 20 to 40. This confirmed what several earlier studies had already suggested - that while genetic and environmental factors may do their part to gradually chip away at immune function, much of the decline often seen with advancing age is probably highly preventable with simple good nutrition.

You'd be surprised at how many chronic health problems start small and snowball into something more serious mainly because of a bad diet. Nutrient deficiencies that stem from poor eating habits can dampen the immune response and open the door to illness. In a vicious cycle, being sick creates an increased need for immune-boosting foods.

The arsenal of health-protective compounds in food can enhance immune functioning in measurable ways - for example, by increasing the number of white blood cells when the body is most vulnerable to infection. If this fact carries a ring of'boring, rigid diet', put your fears to rest. When it comes to eating, we've all had our fill of'no' and 'never'. Instead, this chapter is about choices. After reading up on the many flavour-packed foods with proven health-enhancing potential, you'll see how easy it is to devise an immune-boosting diet you'll love.

Foods versus supplements: Why bother with good-for-you foods when you can simply pop a pill?

While supplements have their place, by far the easiest, least expensive and most effective way to heighten your body's ability to fight disease is to eat a diet that is rich in immune-stimulating nutrients. These include vitamins and minerals as well as many other compounds — including ones that haven't even been discovered yet.

One important discovery made by scientists investigating the disease-fighting powers of foods is that their nutrients are absorbed better from food than from pills. It also turns out that foods work synergistically — in other words, their health benefits are greater when they are eaten together. For instance, tomatoes, chillies and garlic, the ingredients of the classic salsa, deliver more potent power to protect your health when they are eaten in combination than when they are eaten alone. This finding reinforces the notion that supplements can never replicate the benefits of a varied diet.

Another reason not to rely solely on supplements: research shows that you can get too much of certain immune boosters, including vitamin E (an antioxi-dant), by taking supplements. An overload of these nutrients might actually suppress immunity, making you more vulnerable to illness instead of less.

Besides helping your body to fight infection, eating more immune-boosting foods will give you a number of other health advantages. The dietary habits that strengthen immunity also reduce the risk of heart disease, stroke and diabetes. A diet based on plant foods, with moderate amounts of lean meat and low-fat dairy and small amounts of high-fat foods, is particularly effective in reducing the risk of cancer. For added health protection, always maintain a balance between kilojoule intake and physical activity.

Are bee products as effective as touted?

Although many intriguing claims are made for the healing powers of bee products, there is little evidence to support most of them. Yet bee pollen, royal jelly and propolis are popular nutritional supplements and continue to be the subject of scientific studies.

What They Are
There are three types of bee products (apart from honey) available in health-food shops: bee pollen, propolis and royal jelly. The most familiar of these is bee pollen. After the bees gather pollen from plants, they compress it into pellets, which beekeepers then collect from the hives. (A second type of pollen, also sold as bee pollen, is collected directly from plants, not from bees at all.) Bee pollen contains protein, B vitamins, carbohydrates and various enzymes. Propolis (also called bee glue) is a sticky antibiotic resin that bees collect from the buds of pine trees and use to repair cracks in their hives. Then there's royal jelly, a milky-white substance produced by the salivary glands of worker bees as a food source for the queen bee. (The specialized nutritional content of royal jelly may account for the fertility, large size and increased longevity of the queen bee.)

Common Uses

• May help hay fever symptoms.
• Aids in healing skin abrasions.

Forms

• Tablet
• Capsule
• Softgel
• Liquid
• Powder
• Cream
• Lozenge
• Dried and fresh pollen

Caution

• People with asthma or allergies to bee stings should be very careful when using bee products, and should avoid royal jelly entirely.
• Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What They Do
Bee products, especially bee pollen, have been touted as virtual cure-alls. Proponents assert that, among other things, these products slow ageing, improve athletic performance, boost immunity contribute to weight loss, fight bacteria and alleviate the symptoms of allergies and hay fever. Although bee pollen shows some promise in treating allergies and propolis may be effective as a salve for cuts and bruises, the scant research that has been conducted does not support the extravagant claims generally made for bee products.

Major Benefits
Bee pollen seems to help prevent the sneezing, runny nose, watery eyes and other symptoms of seasonal pollen allergies. Some scientists believe that ingesting small amounts of pollen can desensitize an individual to its allergenic compounds, much as allergy shots do. Because your body produces antibodies when exposed to even a tiny amount of pollen, your immune system then 'remembers' it, preventing an extreme reaction that causes classic allergy symptoms. Testing of this theory is under way, and until results are available there appears to be no harm for most people in trying bee pollen. Various advocates maintain that to get the full anti-allergy benefit, you need to use bee pollen that comes from a local source, which will desensitize you to the specific pollens in your own environment.

Additional Benefits
Bee propolis may play some role as a skin softener or wound healer. Research has shown that although propolis contains antibacterial compounds, these are not as effective as standard antibiotics or over-the-counter ointments in fighting infection. (Propolis, however, doesn't have the undesirable side effects of standard antibiotics.)

Because royal jelly enhances the growth, fertility and longevity of queen bees, many people think that it will do the same thing for humans. However, there's no evidence to support this view though royal jelly may be useful as an adrenal tonic in managing stress.

How to Take Them

• Dosage: The amount of bee pollen needed to relieve allergy symptoms varies from person to person. In general, start with a few granules a day and increase the dose gradually until you're up to 1-3 rounded teaspoons a day.
• Guidelines for use: Before the hay fever season, start taking very small amounts of bee pollen each day - a few" granules or a portion of a tablet. If you don't suffer any adverse reaction (see below) slowly increase your dosage until you experience relief from allergy symptoms. Take bee pollen supplements with plenty of water; you can also mix dried or fresh pollen with juice or sprinkle it over food.

Possible Side Effects
Because some individuals will have an allergic reaction to bee pollen, begin with a small amount so that you can determine if it will have an adverse effect on you. Watch for hives, itchy throat, skin flushing, wheezing or headache. Stop taking it immediately if any of these side effects occur.

Case Study

A killer drink
From childhood, Peter H knew he was allergic to bee stings and avoided the buzzing, venom-carrying insects like the plague. But, surprisingly, it was a health-food drink that almost killed him.

As was his habit, Peter often skipped lunch while he worked and then stopped at a health-food shop on the way home for a quick pick-me-up.

On the fateful day, he took the advice of an enthusiastic salesperson and ordered 'The High-Energy Smoothie', a special new yoghurt drink. Little did he realize it contained a generous scoop of some “energizing” bee product in addition to the touted ginseng, spirulina and wheatgrass.

The last thing Peter remembers about his close brush with oblivion was 'putting the glass to my lips'. When he woke, he found himself in an intensive care unit recovering from anaphylactic shock. His advice to others with a bee allergy: 'Watch those energy drinks. They can be lethal.'

Caveat emptor! - Read carefully before you buy

Even if studies show that an herb or a natural remedy works, there's no guarantee the one you buy will. No matter what their effects, supplements aren't considered medicines and therefore aren't subject to regulation by the Food and Drug Administration unless they prove blatantly unsafe. That leaves quality control largely at the whim of manufacturers. Among the potential problems:

Shoddy production
With no one looking over their shoulders, there is no guarantee that manufacturers will actually fill bottles with what label says is inside.

Natural variation
Even if the manufacturer does identify quality products, check the label for: care about quality, plants of the same species that are raised in different places or under different growing conditions can vary significantly in their chemical makeup.

Lack of knowledge
In many cases, nobody really knows which part of a plant produces the desired therapeutic effect (the root versus the leaves, for example). So the manufacturer may responsibly provide the herb that you want—just not the part that gives results.

Responsible manufacturers understand these problems and do their best to ensure quality. To identify quality products, check the label for:

• The botanical name if the product is plant-based
• The recommended dose in milligrams
• A batch or lot number and expiration date
• The manufacturer's name and address
• A statement that the product contains a standardized extract, which ensures a certain dose of the active ingredient.

Getting your serving of fiber

While food labels list grams of fiber for processed and packaged products, don’t worry about “counting fiber” to get the recommended 25 to 30 grams per day. It’s much better (and easier) to simply work as many grains, beans, and fresh fruits and vegetables into your diet as you can. Here are some smart strategies:

• Bump up beans. Whether dried or canned, beans and other legumes are among the best fiber sources you can find. For example, half a cup of black beans provides about a quarter of your recommended daily fiber intake.

• Hail the whole. Whole-grain foods contain far more fiber than more processed foods, in which such fiber-containing grain parts as the bran are thrown out. For example, whole-grain bread contains about twice the fiber as bread made with refined flour.

• Preserve the peel. Routinely thrown away, the peel is often the most fiber-filled part of a fruit or vegetable. You're better off eating apples, carrots, and potatoes with the peel still on (be sure to wash them first if you eat them raw).

• Savor stems. We also often toss out the stalky stems of vegetables like asparagus and broccoli, but that's where the plant's fiber is most densely concentrated. To make them less tough, chop the stalks into small pieces and cook them a bit longer, adding the florets slightly later.

• Use fibrous fixings. Products like bran cereal, oat bran, and wheat germ make good condiments when sprinkled over oatmeal (which is high in fiber itself), applesauce, cottage cheese, or salads. In recipes that call for bread crumbs, try substituting oats.

Are artificial sweeteners safe?

For people trying to reduce their calorie and carbohydrate intake, artificial, “nonnutritive” sweeteners have been a godsend, allowing a wide variety of foods and drinks to taste more delectable without sugar or added calories. But two of the most popular artificial sweeteners, saccharin and aspartame, have been battered by storms of controversy regarding their safety. Should you worry?

SACCHARIN
Back in the 1970s, the Food and Drug Administration banned saccharin (marketed as Sweet N' Low) after studies indicated that high doses of it caused cancer in rats. At the time, no other artificial sweetener existed, and the public, feeling the threat was overblown, clamored successfully to bring it back. But products that contained it had to be labeled with a warning. Since then, studies have suggested that differences between rat and human anatomy make the rats' risk inapplicable to people, and in 2000 saccharin was taken off the official list of cancer-causing compounds. Some consumer-advocate groups and nutrition researchers are uneasy about the change and claim the evidence of a cancer risk still warrants caution. Still, even they admit that if a risk exists, it's very small.

ASPARTAME
Heated debate preceded aspartame's FDA approval in 1981, partly because investigators found research by the manufacturer to be riddled with inconsistencies and errors. An outside advisory board recommended withholding approval, but was overruled by the FDA, which felt (after an audit) that the evidence proved aspartame (sold as NutraSweet) to be safe. Even after approval, skeptics charged that aspartame interfered with normal brain chemistry, triggering headaches, seizures, and (it was feared) brain cancer. However, numerous studies over the past 15 years have found these concerns to be groundless, and even strong advocacy groups, such as the Center for Science in the Public Interest, no longer sound alarms about aspartame.

THE BOTTOM LINE
The consensus is that in the amounts they're usually consumed, both saccharin and aspartame are safe. In addition, other nonnutritive sweeteners (such as sucralose and acesulfame-K) have come on the market, allowing food makers to blend sweeteners together, thus diluting the potential impact of any one compound.

Seven diet myths exposed!

Weight loss can be difficult, no thanks to popular misconceptions that have the ring of truth but can actually work against you. Among the more common myths:

1. Desserts are forbidden: The truth is, there's room in your diet for any kind of food, especially the ones you love most—as long as you control your total caloric intake (and grams of carbohydrate, if you tally them). Denying yourself your favorite foods can lead to binge eating and, ultimately, discouragement.
2. You have to lose a lot of weight to make a difference: The closer you can get to an ideal weight, the better, but small, sustained improvements at the beginning of a weight-loss program have the biggest impact on your health. Studies show that losing just 5 to 1 0 pounds can improve insulin resistance enough to allow some people with type 2 diabetes to quit medication or injections.
3. What you eat matters more than how much: Both matter, but recent research finds that the number of calories in your food is more important than where they come from. Example: A bagel might seem healthier than a doughnut hole, but dense bagels have the calorie content of six slices of bread. As long as you're not eating too much fat in other foods, the doughnut hole wins.
4. If you work out, you can eat whatever you want: That's robbing Peter to pay Paul. You can't lose weight if you reduce calories in one way but increase them in another.
5. Skipping meals make you lose weight fast: Actually, studies show that people who skip breakfast tend to be heavier than people who don't. And skipping meals tends to make you overeat later. If you have diabetes, it's important to keep up a steady intake of small portions of food throughout the day to keep your blood-sugar levels stable and reduce the risk of hypoglycemia.
6. Starches are fattening: If you are insulin resistant, your body may find it easier to convert carbohydrate calories to fat than to burn it as energy, but the fact remains that starches (and other carbohydrates) are less dense in calories gram for gram than other types of food. The main issue is calories, so if you load starchy foods with fat-sour cream and butter on a baked potato, for instance—or eat them in large quantities, the caloric load can add up.
7. You should never eat fast food: Never say never. Fast food can be worked into your meal plan if you choose well. Opt for grilled foods instead of fried, avoid or scrape away high-fat condiments like mayonnaise, and share those French fries to keep portion size down.
   

Safety guidelines when taking supplements

Because supplements, especially herbs, can have potent primary effects and side effects, keep these points in mind when using them:

Shop wisely
Although supplements supplied in the United States are strictly regulated, it's sensible to select brands with a reputation for quality.

Take the recommended dosages
As with conventional drugs, overdosing with a supplement can have serious consequences. With herbs and nutritional supplements, start with the lowest dose when a dosage range is given.

Monitor your reactions
At the first sign of an adverse reaction, stop taking the supplement. Also stop if the herb doesn't seem to be working for you. (But give it enough time to work - remember that some herbs may take a month, or even longer, to have a noticeable effect.)

Take a break
Doctors using conventional drugs often recommend taking 'drug holidays' for non-life-threatening conditions such as persistent headache, eczema or mild depression. The same applies to supplements: take for specified periods, then stop temporarily to see if the condition has improved. If the problem returns, you may need to take the supplement long term as a 'maintenance' medication.

Avoid risks
If you have symptoms that indicate a serious problem, don't self-treat it: see a doctor or other qualified health professional. Very young or elderly people, and pregnant or breast-feeding women, should also consult a doctor before using supplements. And always ask your doctor or pharmacist about possible interactions with drugs you are taking.

Taking supplements effectively and safely

All supplements marketed in the United States must include directions for use on their labels. The entries in this blog provide more detailed information about the benefits, uses, side effects and forms of supplements, as well as the doses that are considered safe and effective. In the back of the book, you'll find a section listing the interactions between supplements and some commonly prescribed medications. Here are some general guidelines to keep in mind.

The proper balance - All nutrients influence one another, and researchers have discovered a number of links that affect how well the body absorbs or utilizes them. For example, the fat-soluble vitamins (A, D, E and K) require some dietary fat to facilitate absorption, so its important to take these vitamins with food. Iron taken with meals is best absorbed with small amounts of meat and foods containing vitamin C. Calcium absorption is improved by taking supplements with meals, and the effect of calcium on building healthy bones is enhanced when it is taken with magnesium, zinc and silicon. Other nutrients, when taken in combination, likewise enhance one another's individual benefits. For example, biotin and other B-vitamins, taken with a mixed amino acid complex and vitamin C, all work to help the body to build the proteins needed for strong nails.

The proper amounts - Nutritional supplements are generally safe when consumed in the appropriate dosages. But it's important to remember that more isn't necessarily better - and sometimes it can be worse. For example, the mineral selenium is recommended for many purposes, from prevent­ing cataracts to protecting against cancer. But taking doses even slightly higher than those recommended can cause loss of hair and other adverse reactions. It's a good idea to avoid high doses of supplements, particularly extremely high ones ('megadoses').

Vitamins and minerals: Most vitamins can be taken in significantly higher doses than their RDIs without producing adverse reactions. However, some fat-soluble vitamins, which are stored in the body rather than excreted, may be toxic at high doses. In particular, overloading on vitamins A or D is dangerous. Although very high doses of some other vitamins - such as vitamin C — are not toxic, some people may experience side effects. Reducing the dosage can usually remedy the situation.

When taken in large doses or over time, some minerals can block the absorption of other minerals. Zinc, for instance, can hamper copper absorption. Also, large amounts of certain minerals are linked to disease - several studies show that too much iron in men, for example, increases the risk of heart disease. For these reasons, even doctors who believe the RDIs for many vitamins are too low think that the levels for minerals are generally adequate for optimal health.

Herbs: According to reviews by experts in pharmacology and toxicology, serious side effects or toxic reactions associated with herbal medicines are rare. Still, some once-popular medicinal herbs, such as foxglove and chaparral, are now recognized as toxic. Occasionally, some people exhibit serious allergic reactions to a herb, which may include hives or difficulty in breathing.


In Australia, herbal preparations are regulated under the Therapeutic Goods Act in the same way as other complementary health-care products. In New Zealand, they are regulated under the Dietary Supplements Regulations (under the Food Act). Products that contain standardized extracts may be more reliable than those that don't in terms of getting a proper dose of a particular supplement.

In addition, using some herbs for medicinal purposes can be risky for people with certain health conditions or for those on particular medications. Garlic, for example, may intensify the effects of anticoagulant drugs, while licorice - which helps to relieve digestive problems and enhances the immune system - can raise blood pressure. Some herbs may have no immediate adverse effects but may cause side effects or prove harmful when taken over the long term. When using supplements, always follow the dosage recommendations closely. In addition, always let your doctor know which supplements you are taking, and notify your doctor at once if your condition worsens or if any serious adverse reactions develop.

The issue of quality control – How do you know what a product actually contains? In the United States, manufacturers and suppliers are required to list all the active ingredients on product labels. Vitamin, mineral and herb supplements supplied must also comply with specific standards determined by the Food and Drug Adminis­tration. The contents of nutritional and herbal supplements are monitored regularly, and suppliers generally comply with the regulations. Established manufacturers and suppliers of supplements have a reputation to protect, and they also know that they face substantial penalties if they contravene government regulations.

As a general rule, the sensible course if you're not sure which brand to choose is to ask the advice of your doctor or any other health professional who regularly makes use of supplements.

Meeting the standards - know exactly what you're getting when buying health supplements

When you buy nutritional supplements, how do you know what you're getting? The official standard used in Australia for the identity, purity and potency of vitamins, minerals and herbs is a publication called the British Pharmacopoeia (commonly referred to as the BP). This is followed by the British Herbal Pharmacopoeia (BHP), the United States Pharmacopeia (USP) and the European Pharmacopoeia (EP).

The standards for materials listed in these pharmacopoeias are published after review by an independent body of experts. (There is a move towards harmonization in this area, and the BP will eventually coincide with the EP.)

Australia's Therapeutic Goods Act requires that all items covered by the BP comply with BP standards. Items not covered by the BP must comply with the standards specified in one of the other pharmacopoeias (as determined by the Therapeutic Goods Administration), or with special Therapeutic Goods Orders, which are standards that the TGA itself issues for such items. Because all products manufactured or supplied in Australia must comply with these standards, you won't find any reference to them on labels. The situation is quite different in the US, where compliance with the USP is voluntary. As a result, US manufacturers who either do comply with USP standards, or claim to do so, sometimes indicate this on the label.

Reading labels when buying supplements

Following are the key items of information that manufacturers are obliged to include on the labels of nutritional supplements.

Name of goods: Either the name of the goods (such as evening primrose oil) or, if there is no such name, the product name (that is, the proprietary or brand name - for example, the brand name of a proprietary tonic) must appear on the label.

Active ingredients: The names of all therapeutically active ingredients contained in the product must be listed. For example, the active ingredient in evening primrose oil is gamma-linolenic acid (GLA). For products such as multivitamin and mineral supplements, the active ingredients are the vitamins and minerals themselves, and all must be listed.

Amount of active ingredients: The quantity or proportion of all active ingredients must be stated. For example, in the case of evening primrose oil capsules, it might be said that each 1000 mg capsule contains 100 mg (10%) of linolenic acid. In the case of a multivitamin and mineral supplement, the amount of each vitamin and mineral the product contains must be stated (using the appropriate metric unit of measurement, as specified in the regulations). Most ingredients are given in micrograms (meg) or milligrams (mg). Fat-soluble vitamins, such as vitamins A. D and E, are usually expressed in International Units (IU).

List of excipients: Excipients are all ingredients contained in a product other than the active ingredients. These include such things as binders, fillers, coatings, preservatives and coloring agents. For consumers' benefit, manufacturers often choose to state that the product does not contain certain substances - such as colorings and artificial flavors, but also such items as yeast, dairy products, lactose, gluten and egg (to which some people are allergic).

Name of dosage form: This means the usual name of the pharmaceutical form of the product, such as tablets or capsules.

Quantity of goods: The quantity of the goods has to be specified - for example, the number of tablets or capsules in the container.

Warning statements: Where warnings apply to the product, these must be included on the label. The regulations specify the warnings required on particular categories of products. For example, iron tablets must carry the following warning: 'Use strictly as directed. Keep out of reach of children.

Batch number: The batch number of the goods must appear in one of the forms specified in the regulations. Examples are 'Batch' or 'Batch No'.

Expiry date: The expiry date must be shown in one of a number of specified forms, which include 'Expiry Date', 'Exp.’ ‘Use before' and 'Use by'. The expiry date indicates that the product will remain 'fresh' up to that date. In fact, supplements may retain their full potency for some time after the date indicated, but you cant be sure of this. It's always best to finish the product before the expiry date. This is particularly advisable in the case of the fat-soluble vitamins (A, D, E and K).

Storage conditions: Advice must be given on how best to store the product. Most nutritional supplements should be kept in a cool, dry place, which means they shouldn't be stored in the bathroom or the refrigerator, where moisture can damage them. However, there are some products that should be refrigerated after opening. If this is the case, the label will say so. Similarly, the label will say if the product should be stored below a certain temperature.

Directions for use: These directions tell you the suggested dosage (for example, one tablet swallowed whole) and when, how often and how best to take it (for example, three times a day with meals; or 30 minutes before a meal, with a glass of water). The suggested dosage is often followed by the words 'or as directed by your health professional'.

Supplier's name and address: The name and street address of the sponsor or supplier must be given. Many manufacturers include their telephone number, and some have a consumer advice number.

Statement of purpose: This specifies the purpose or purposes for which the product is intended to be used. For example, in the case of evening primrose oil, it might be stated that the product may offer temporary relief from conditions associated with a deficiency of gamma-linolenic acid (GLA), including some skin disorders and premenstrual syndrome.

Don't be confused by marketing hype when choosing supplements

In an effort to distinguish one brand from another, supplement manufacturers have devised their own jargon to promote their products. These terms commonly appear on labels and in advertisements. Each term implies a superior product, but none has a standard definition agreed upon by experts or specified in the regulations governing the manufacture and sale of supplements. However, manufacturers must hold evidence that substantiates the use of such terms, or they could be prosecuted in Australia under the Therapeutic Goods Act or the Trade Practices Act and in New Zealand under the Fair Trading Act, or similar acts in other countries. Pay attention to the specific ingredients and directions on a label rather than the hype of such terms as these:

■ Clinically Proven
■ Highly Concentrated
■ Maximum Absorption
■ Natural (or Naturally Occurring)
■ Pure
■ Quality Extract

When buying standardized extracts...

The amount of an active or main ingredient in a standardized herbal extract is often expressed as a percentage: milk thistle 'standardized to contain 80% silymarin' means that 80% of the extract contains that ingredient. Accordingly, recommendations in this blog for most standardized products are given as percentages. For example, a 150 mg dose of milk thistle standardized to contain 80% silymarin contains 120mg silymarin (150 x .80 = 120). Sometimes, though, a standardized extract product will simply state the actual amount of active ingredient you're getting (for example, 120 mg silymarin), rather than listing a percentage.

Helping you buy supplements - Their preparations and forms

The many choices available allow you to find supplements that are safe, effective and convenient. But some 'special' formulations appear to provide little additional benefit and are often not worth the extra expense.

Supplements come in a variety of forms that affect both their ease of use and, in some cases, their rate of absorption. (Each supplement entry lists the available forms for that supplement.)

Tablets:
Easily stored, tablets will usually keep longer than other forms in which supplements are marketed. In addition to the vitamin itself, tablets often contain generally inert additives known as excipients. These compounds bind, preserve or give bulk to the supplement and help tablets to break down more quickly in the stomach. Increasingly, supplements are becoming available in capsule-shaped, easy-to-swallow tablets called 'caplets'.

Capsules:
The fat-soluble vitamins A, D and E are typically packaged in 'softgel' capsules. Other vitamins and minerals are processed into powders or liquids and then encapsulated. Like tablets, capsules are easy to use and store. They also tend to have fewer additives than tablets, and there is some evidence that they dissolve more readily (although this doesn't mean that they are better absorbed by the body - just that they may be absorbed more quickly).

Powders:
People who find pills hard to swallow may prefer to use powders, which can be mixed into juice or water or stirred into food. (Ground seeds such as psyllium and flaxseed often come in pow­dered form.) Powders also allow dosages to be adjusted easily Because they may have fewer binders or additives than tablets or capsules, powders are useful for people who are allergic to certain sub­stances. In addition, powders are often cheaper than tablets or capsules.

Liquids:
Liquid formulas for oral use are easy to swallow and can be flavored. Many children's for­mulas are in liquid form. Some supplements (such as vitamin E) also come in liquids for applying topically to the skin. Eyedrops are another type of liquid.

Chewables:
Such supplements - usually sold as flavored tablets - are particularly recommended for those who have trouble getting whole pills down.

Lozenges:
A number of supplements are available as lozenges or 'drops' that dissolve gradually in the mouth, either for ease of use or, in the case of zinc lozenges, to help in the treatment of colds and flu.

Sublingual tablets:
A few supplements, such as vitamin B12, are formulated to dissolve under the tongue, providing quick absorption into the blood­stream without interference from stomach acids and digestive enzymes.

Special formulations - You will usually pay more for a supplement if the label says 'slow-release' or 'chelated'. Does it provide extra benefits? Hardly ever, according to the available data.

Slow-release formulas:
These formulas contain microcapsules, or have a coating of protein, that gradually breaks down to release the vitamin steadily into the bloodstream over 2-10 hours. 'Sustained-release' is another term for the same process.

There are no reliable studies showing that slow-release formulas are more efficiently utilized by the body than conventional capsules or tablets - in fact, in the case of the fat-soluble vitamins A, D and E, the gel-like substance that delays release may interfere with absorption.

Chelated minerals:
Chelation is a process in which a mineral is bonded to another substance, or 'chelator' - usually an amino acid. This attached substance is supposed to enhance the body's absorp­tion of the mineral.

In most cases, there's no evidence that chelated minerals are absorbed any better or faster than non-chelated minerals. In fact, there's no solid proof that any process or addition of ingredients improves the absorption of vitamins or most minerals.

Herbal remedies - You can buy whole herbs and make up your own formulations. But for ease of use, tablets, capsules and the other conveniently packaged forms described here (including forms for external use) are readily available in pharmacies, supermarkets and health-food shops.

Tablets and capsules:
You can avoid the taste of the herb if you take it in tablet or capsule form. Both tablets and capsules are prepared using either a whole herb or an extract containing a high concen­tration of the herb's active components. In either form, the constituents are ground into a powder that can be pressed into tablets or encapsulated. Some herbs are available in enteric-coated capsules, which pass through the stomach to the small intestine before dissolving, minimizing potential gastro­intestinal discomfort and, for some herbs, enhancing absorption into the bloodstream.

Tinctures:
These concentrated liquids are made by soaking the herb in water and ethyl alcohol. The alcohol extracts and concentrates the herb's active components. (Non-alcoholic concentrations can be made using glycerin.) Tinctures are usually taken in small doses - for example, 20 drops, or 1 ml, three times daily - diluted with water or juice.

Teas, infusions and decoctions:
Less concen­trated than tinctures, teas and infusions are brewed from the fresh or dried flowers, leaves or roots of a herb. These can be bought in bulk or as teabags. Although tea is usually made with boiling water, the herbal teas recommended in this book are prepared as infusions, using hot water on the verge of boiling, which preserves the beneficial oils that can be dissipated by the steam of boiling water. To make decoctions, the tougher parts of a herb (stems or bark) are usually simmered for at least half an hour.

Use these liquid remedies as soon as possible after brewing them, because they start to lose their potency within a few hours of exposure to air. Store them in tightly sealed glass jars in the refrigerator. and they'll retain some strength for up to three days.

Oils:
Oils extracted from herbs can be commer­cially distilled to form potent concentrations for external use. These so-called essential oils are usually placed in a neutral 'carrier' oil, such as almond oil, before being applied to the skin. (Milder infused' oils can be prepared at home.) Essential herbal oils should never be ingested. The exception is pepper­mint oil: a drop or two on the tongue may be helpful for bad breath, and peppermint oil capsules are beneficial for irritable colon.

Gels, ointments and creams:
Gels and oint­ments, which are made from fats or oils of aromatic herbs, are applied to the skin to soothe rashes or heal bruises or wounds. Creams are light oil-and-water mixtures that are partly absorbed by the skin, allow­ing it to breathe while keeping in moisture. Creams can be used for moisturizing dry skin, for cleansing, and for relieving rashes, insect bites or sunburn.

Standardized extracts - When herbs are recommended in this book, we often suggest you look for 'standardized extracts'. Herbalists and manufacturers use this term to describe the consis­tency of a product. When producing a herbal supplement, manufacturers can extract the active components from the whole herb. These active ingre­dients - for example, the capsaicin in cayenne peppers - are then concentrated into a supplement (tablets, capsules or tinctures). They are standardized to supply you with a precise amount in each dose.

Sometimes, instead of standardized extracts, manufacturers process the whole, or crude, herb. The herb is simply air- or freeze-dried, made into a powder, and then packaged into a supplement - again a capsule, tablet, tincture or other form.
Whether a standardized extract or the crude herb is better is an ongoing controversy among herbalists. Supporters of crude herb supplements contend that the whole herb may contain still unidentified active ingredients, and that only through ingesting the entire herb can all the benefits be obtained. Advocates of standardized extracts argue that the active ingredients in whole herbs can vary greatly, depending on where they're grown and how the herbs are harvested and processed, and that the only way to be sure you're receiving a consistent amount of active ingredients is to take standardized extracts.

Although standardized products are more consis­tent from batch to batch, this doesn't guarantee that they are more effective than whole-herb products. But in many cases, you would have to use a much greater amount of a whole herb to achieve a similar therapeutic effect. Moreover, reliability and consis­tency can be of great value, particularly when a product proves to be beneficial for a specific disorder.

Which ones are better, natural or synthetic health supplements?

Advertising claims imply that vitamins derived from 'natural' sources are better than 'synthetic' vitamins created chemically in a laboratory. They may state that their natural products are more potent or better absorbed - and manufacturers generally charge more for natural products. But what is 'natural'?

Most supplements, no matter what their source, are processed with chemicals in laboratories. Some that are labelled 'natural' are really synthetic vitamins with plant extract, or minute amounts of naturally derived vitamins, mixed in. Even the most natural products have undergone some refining and processing and contain some additives - to hold them together or to preserve them so that they don't deteriorate too quickly. However, most reputable manufacturers try to keep their products as pure as possible.

Some vitamins, such as vitamin B, are commonly synthesized, as the natural alternatives, such as yeast, can cause adverse reactions in many people. Others, such as vitamin B12 and coenzyme Q10, are grown on specific bacteria. However, the way the fat-soluble vitamins are processed can make a difference. For example, 'natural' vitamin E - made from soya bean or wheatgerm oil - is absorbed about twice as efficiently as the synthetic form. This is usually reflected in the price, as the naturally sourced product is more expensive to produce. Vitamin A from cod liver oil or halibut liver oil appears to be a little less toxic than the synthesized versions (though you still need to be careful with dosage, as vitamin A is stored in the liver), and beta-carotene naturally sourced from foods or algae is clinically more effective - perhaps because the naturally sourced versions also have small amounts of other substances (such as carotenoids) working synergistically in the supplement. Many companies are now manufacturing tablets and powders directly from fruits and vegetables to gain the broad spectrum of antioxidants and other nutrients needed for health.

Check the additives in any supplement in case you're allergic to any of them - and you may have to pay more for a supplement with fewer of these inert fillers. If in doubt, contact the manufacturer.

Getting real - What supplements won't do for you

Despite the many promising benefits that supplements can offer, its important to note their limitations - and to question some of the extravagant claims currently being made for them.

As the word itself suggests, supplements are not meant to replace the nutrients available from foods. Supplements will never make up for a poor diet: they can't counteract a high intake of saturated fat (which is linked to an increased risk of heart disease and cancer), and they can’t replace every nutrient found in food groups that you ignore. Also, although scientists have isolated and extracted a number of disease-fighting phytochemical compounds from fruits, vegetables and other foods, there may be many others that are undiscovered - and ones you can get only from foods. In addition, some of the known compounds may work only in combination with others in various foods, rather than as single, isolated ingredients in supplement form.

Supplements won't compensate for personal habits that are known to contribute to ill health, such as smoking or a lack of exercise. Optimal health requires a healthy lifestyle - this applies particularly to people who are determined to age as well as they can.

Although some of the benefits ascribed to supplements are unproved but plausible, other claims are far-fetched. Weight-loss preparations are the leading example. Though they're extremely popular, it's questionable whether any of them can help you to shed weight without the right food choices and regular exercise. Products that claim to 'burn fat' won't burn enough on their own for significant weight loss.

Similarly, claims of boosting performance, whether physical or mental, are difficult to prove - and any 'enhancement' will be limited at best in a healthy person. Although a supplement may improve mental functioning in someone experiencing mild to severe episodes of memory loss, it may have a negligible effect on the memory or concentration of most adults. Likewise, a supplement shown to combat fatigue isn't going to turn the average jogger into an endurance athlete. Nor is it clear that 'aphrodisiac' supplements enhance sexual performance if you aren't suffering from some form of sexual dysfunction.

No supplements have been found to cure any serious diseases - including cancer, heart disease, diabetes and AIDS. The right supplement, however, may help to improve a chronic condition and relieve symptoms such as pain or inflammation. But first you need to consult a health professional for treatment.