1 [email protected]@wnmeds.ac.nz or +64 (04) 918 5611 combinations of natural products...
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[email protected] or +64 (04) 918 5611
Combinations of Natural ProductsOpportunities and Dangers
Dr. Paul F. Davis
Bioactivity Investigation Group (BIG)
Wellington School of Medicine and Health Sciences
Wellington
New Zealand
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In Early Times Achieved Via Food
• Derived preparations from:– Animal– Plants– Fish– Birds
Becomes a tradition
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Traditional Chinese Medicine
• 3,500 years ago-origins
• 2,700 years ago (Zhou Dynasty)-regularly prescribed
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Arabian Medicine
• 1,800 years ago– Drugs
– Many conditions
• 1,100 years ago– Samanids
– Muhamad Zakariyya Razu
– Abu Ali Ibn Sina
• Records kept
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South American Medicine
• Incas– Bolivia– Kallaways (1500 years at least)
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Long history suggests efficacy
Recognised by current consumers
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Currently• Increasing use of Natural Products
– Preventative– Therapeutic
• Nutraceuticals• Functional Food• Food Supplements• Medicinal Food• US Market-$18 billion in 2001- 20% per annum
growth
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Tendency to use multiple products, multiple conditions
Anecdotal Information Basis
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Combinations
• Natural Products-Natural Products
• Natural Products-Prescription medicines
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Examples
• Garlic –used for hypertension, cardiovascular conditions, neoplasms and infections
• Cod Liver Oil- used for B-cell lymphoma, prostate cancer, breast cancer, hypertension, hypertryglycerdemia, arthritis, cardio vascular conditions
• Garlic + Cod Liver Oil- used for anti-coagulant (andecdotal)
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Examples
• Ginger– Has over 30 uses including inhibition of platlet
aggregation– Regarded as safe
• Potential Risks– Concurrent use with anti-coagulant prescriptions or
natural products– When combined with angelica, garlic, ginseg panax,
red clover, tumeric
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Risks for:
• Individuals
• Producers
• Marketers (international sales)
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Risks occur when:
• Consumer does the combining
• Marketer does the combining
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Beneficial or Detrimental
Product available in Korea, Japan, and China
• Oil derived from shark– Anti-angiogenic– Anti-inflammatory
• Mushroom Extract (b-glucan rich)– Immune enhancing
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• Shark Oil +Mushroom extract
– Reduction in proliferation of primary tumours
– Reduction in metastases
• Effect of combination is synergistic
• Neither of them or combination is anti-tumour
Beneficial or Detrimental
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• Echinachea-Immune enhancing (Cichoric acid)– Echinachea+Herbal Supplements-No reported adverse
effect
– Echinachea+Other Immune Stimulants-Additive effect
– Echinachea+Other Immune Stimulants-Suppresseive effect
Examples of these are commercially available
Beneficial or Detrimental
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Examples From BIG Research
• Lipid-rich extract from sharks is anti-angiogenic• Potency meant dilution required• Cooking oil (olive oil)-inactive• Combination
– 2x more active invitro– 6x more active invivo
Synergistic Activity-Beneficial Outcome
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Risks of Prescription Pharmaceutical
• Widely Publicised• Recent publicity on Cox-2 inhibitors• Also risk of combining 2 pharmaceuticals
(regulatory authority requirment)• Frequently these combinations are for
chronic conditions-Elderly often have several medical conditions
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Possible that Patients are Taking:
• Over the counter remedies + Prescribed therapies– Combination often not revealed at time of
prescribing – Non-prescription item commenced subsequent
to prescription
• Risky• Little research information
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Example-Warfarin
• An anti-thrombotic, anti-coagulant
• Activity decreased by:– American Ginseng– St John`s Wort– CoQ10
• No data on ginseng (Siberian)
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Example-Warfarin
• Not all combinations are detrimental
• Activity increased by combining with:– Garlic– Ginger– Ginkgo Biloba– Fish Oils– 60 other products
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Summary
All Natural Products:• Biologically active• Can interact with cells, pathways, like drugs• Modulate other activities• Own activities altered
Care and caution neededSimilar approach to that with pharmaceuticalsSignificant lack of data and informationNeed for Research is Urgent