Background. In addition to honey, honeybees produce many byproducts, including beeswax, bee venom, royal jelly, propolis, and bee pollen. Honeybees collect pollen from plants, mix it with a small amount of saliva or nectar, and place it in “baskets” on their hind legs. The field or worker bees collect and transport the bee pollen to the hive. It is estimated that a colony of bees can collect between 50 and 250 grams of pollen per day (~15 to 45 kilograms or ~33 to 99 pounds of bee pollen per year)! The composition of bee pollen can vary widely since it is sourced from different plant species, geographies, and seasons. Bee pollen has an extensive history of use in traditional medicine, especially in Traditional Chinese Medicine and in Ayurvedic practices. Bee pollen is estimated to contain more than 200 bioactive substances, including nutrients, amino acids, vitamins, lipids, enzymes, and antioxidants.

Evidence. Likely due to the content of polyphenols in bee pollen, cell and animal studies demonstrate significant antioxidant and anti-inflammatory effects. To date, data from clinical trials is limited and not conclusive. Additional research is required to better determine the therapeutic role of use of bee pollen in human health, especially for allergies, inflammatory conditions, and antibacterial effects.

Safety and Side Effects. In recent years, the F.D.A. removed several supplements that contained bee pollen from the market over concerns of mislabeled or prohibited ingredients. Whether purchased at a health store or from the local beekeeper, be sure that you buy from a reputable source to help ensure safety. Although not all side effects are known, bee pollen is thought to be possibly safe and well-tolerated for most individuals in the short-term (30 days or less). Bee pollen allergies are rare but those who are allergic can experience serious or adverse reactions, such as itching, swelling, shortness of breath, or anaphylaxis. Please avoid if you have an allergy to certain types of pollen.

Interactions. Bee pollen might increase the effect of anti-coagulants (warfarin) or may result in increased bleeding or bruising. As with any new diet or supplement regimen, please consult with your physician to discuss if supplementing with bee polllen may be appropriate for you.

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Like Shakespeare, many value the aesthetic appeal of a rose. But, what about its taste? While consuming this beautiful plant may not be the first thing that comes to mind, parts of the rose, including the rose hip, are edible and have nutritional value. EN shines a light on the rose hip, including its traditional uses.

Overview: The rose hip comes from various types of rose plants. Dietary supplements commonly utilize Rosa canina, known as the “dog rose.” These pseudo, or accessory, fruits remain on the plant after the rose blooms fade. Mature rose hips are typically red or orange, about a half-inch in size (resembling a small crabapple), and have a slightly sweet and tart flavor. Rose hips are edible and typically ripen in the late summer or fall. The seeds within the rose hip are discarded, and the fruit is consumed fresh, dehydrated, or processed into a powder. Rose hips were utilized by indigenous peoples in traditional foods and medicines (i.e., jellies, sauces, teas). Teas were traditionally used for conditions such as arthritis.

Due to its phytochemical composition, rose hip supplements are of therapeutic interest for conditions involving oxidative stress and/or inflammation. Nearly 150 chemical compounds have been isolated and identified in rose hips including vitamins, notably vitamin C, phenolic compounds, fatty acids, bioflavonoids, and tannins.

Evidence: While data are not conclusive, there is evidence to suggest that rose hip (five grams daily for four months) may improve joint pain/discomfort and improve knee function/mobility. While preliminary data show promise, larger studies are needed to confirm other benefits of supplementation for people with diabetes, high blood pressure, and high cholesterol.

Safety and Side Effects: There are no known side-effects associated with consumption of rose hip in foods or moderate supplementation of Rosa canina extracts. Higher doses (40 or more grams) may elicit gastrointestinal side effects (diarrhea). Rose hip supplements may also raise the risk of kidney stones due to high vitamin C content.

Interactions: Rose hip supplements may interact with medications, including those for cancer and blood clotting, as well as estrogens and lithium. Please consult with your healthcare provider before starting a new supplement.

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Overview. Mangosteen (Garcinia mangostana) is a tropical plant native to Southeast Asian countries including Malaysia, Thailand, and India. However, it wasn’t until 2007 that fresh mangosteen was imported into the U.S. due to previous concerns about invasive fruit flies. It is called “the queen of fruits” for its complex, sweet taste and extensive use in traditional medicine for skin infections, wounds, and diarrhea. Nutritionally, mangosteen packs a punch with nutrients that many U.S. adults may lack (fiber, potassium, vitamin C). It also contains a high concentration of phytochemicals that are thought to be antioxidant, anti-inflammatory, and potentially cardioprotective. Commercial interest in these benefits steered the development of mangosteen extract powders, capsules, and juice concentrates.

Evidence. Though early cell and animal data suggested a potential application of mangosteen-derived compounds in various therapies (cancer, neurological), there is limited strong clinical evidence linking mangosteen supplementation with improved outcomes. However, small studies suggest that mangosteen gel or extracts might be helpful for individuals with serious gum infections.

Safety. In its whole form, mangosteen is likely safe for most healthy individuals. However, while the safety of mangosteen extracts was demonstrated in animals, it is not as clear in humans. When taken orally as a supplement, 560 milligrams of daily mangosteen extract is reported to be possibly safe up to 12 weeks, though side effects were reported (constipation, nausea, vomiting, and fatigue). It may also increase the risk of bleeding in individuals with clotting disorders or upcoming surgery, since it contains xanthones that might slow blood clotting.

Interactions. If you are taking anticoagulant medication, be aware that they may interact with mangosteen supplements. The antioxidant effects of mangosteen supplements may also interact with cognition-enhancing medication (donepezil) or anti-cancer therapies. Please consult with your healthcare provider before changing your diet or adding supplements.

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Overview. Among the over 2,000 species of edible mushrooms, lion’s mane mushroom (commonly known as Yamabushitake or monkey’s head; scientifically known as Hericium erinaceus) emerged as a species with both culinary and therapeutic potential. Long before it made its way into mainstream usage, lion’s mane was widely consumed in East Asian countries to support health. If lion’s mane is available in its fresh, edible form, it can often be found as a dietary supplement (powdered or tablet) or incorporated into fermented beverages and teas. In addition to containing significant amounts of macro- and micronutrients, the mycelium (root-like structure) and the fruiting body (spore-containing portion) of lion’s mane mushroom contain bioactive compounds that may have anti-inflammatory, antioxidative, and neuroprotective activity.

Evidence. Currently, lion’s mane is most extensively studied in animal models for its anti-inflammatory potential in gastrointestinal diseases and for neuroprotective potential for symptoms related to neurodegenerative conditions, including Alzheimer’s disease or mild cognitive impairment and depression and anxiety. The bioactive compounds of lion’s mane (hericenones and erinacines) are thought to promote nerve growth factors which regulate growth, development, and maintenance of neurons. However, while cell and animal data are promising, especially for cognitive decline, to date, there is a lack of high-quality human clinical data to fully support the use of lion’s mane for any specific health condition or disease.

Safety and Interactions. Toxicity information of lion’s mane supplements in humans is limited, but available evidence suggests that it is generally well-tolerated, especially when consumed fresh. Clinical studies typically utilize one to three gram dosages divided throughout the day. Possible mild side effects are stomach upset or nausea. The chemical profile and safety of mushrooms varies by species, strain, and growing environment, so use caution until more toxicological studies are available. While data are limited, some reports suggest that lion’s mane may interfere with blood clotting and blood glucose. As always, consult with your doctor before starting any new supplements.

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Overview. PS is a compound similar to a dietary fat and is present in high amounts in human neural tissue. It regulates functions of key proteins in cell membranes. PS concentrations in the brain appear to decline with age. Low levels of PS may result in nerve cell deterioration and have been linked to cognitive impairment. Proponents of PS supplementation suggest that therapeutic doses may help to protect nerve cells from degenerating, in turn, preventing or slowing the progression of cognitive decline. PS is naturally found in soybeans, fish, eggs, and liver. It is also available as a dietary supplement in capsule or powder form sourced primarily from fish or soy in 100 to 200 milligram (mg) amounts.

Evidence. While there is interest in PS for improvements in sleep and stress, several studies show promise for the effect of long-term supplementation on improved cognitive abilities (including working memory) in older adults. Early data in adults with age-associated memory impairment showed improvements in visual memory and face recognition with supplementation of 300 mg of soy-based PS over three months. However, results should be interpreted carefully as improvements lasted only a few months and generally only for those with the least severe symptoms. Larger controlled studies are needed to determine whether PS has a role in memory loss prevention and treatment.

Safety and Side Effects. The U.S. Food and Drug Administration has not approved PS to treat any medical conditions, but PS derived from fish, soy lecithin, and sunflower are generally recognized as safe. PS is no longer sourced from animal organs due to potential safety risks. Those with shellfish allergies should look for PS from sunflower and non-shellfish sources. It is generally well-tolerated with few side effects. Mild side effects may include stomach upset, insomnia, or headache. PS may decrease the effectiveness of anticholinergic medications, so always talk with your healthcare provider before taking any new dietary supplements.

Until stronger evidence is available for a specific dietary supplement to prevent cognitive decline, smart lifestyle choices that lower your risk of heart disease and diabetes (such as regular exercise and a nutrient-rich diet) may still be your best long-term investment in protecting your brain health.

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Background. The body produces and secretes digestive enzymes throughout the gastrointestinal system. Their primary role is to aid the digestion of food. Digestion starts in the mouth with the salivary enzymes (amylase). Digestive enzymes are also in the pancreas, stomach, and small intestines that break down carbohydrates, fats, and proteins. While there are many digestive enzymes, the pancreas is responsible for producing the most important enzymes: amylase (breaks down carbohydrates), lipase (breaks down fats), and protease (breaks down proteins). The small intestine also produces enzymes lactase and sucrase to break down lactose and sucrose. Many foods, primarily fruits and fermented foods, contain digestive enzymes including pineapple (bromelain) and papaya (papain).

Evidence. So, if the body produces digestive enzymes and they are in foods, why do people use supplements? Generally, most healthy individuals don’t need additional enzymes to adequately digest and absorb foods. However, people with enzyme insufficiency often require exogenous digestive enzymes since they don’t release adequate amounts. These typically include exocrine pancreatic sufficiency, lactose intolerance (cannot digest milk sugar), or congenital sucrase-isomaltase deficiency (cannot digest certain sugars). Despite the large market and popularity of digestive enzyme supplements for a wide variety of conditions (IBS, gluten intolerance) or common digestive complaints, there’s limited and mixed data on the effects of over-the-counter (OTC) digestive enzymes for healthy adults. However, a small clinical trial reported that consumption of prescription enzymes given to healthy adults before and after a high-fat meal reported significantly less gas, bloating, and fullness versus controls.

Safety and Side Effects. The only FDA-regulated enzyme replacement therapy pancreatic insufficiency and it is available by prescription. However, the risks of taking other OTC supplemental digestive enzymes are low for the general population. The most reported side effects are mild digestive complaints. Individuals on blood thinners should be cautious of bromelain since it could increase risk of bleeding. In high doses, papain may cause as esophageal perforation. Please connect with your doctor before starting a new supplement.

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Background. SAMe is found in nearly every tissue and fluid in the body. It is made from methionine, an amino acid in foods. The primary role of SAMe is to regulate key cellular functions by maintaining cell membranes and brain chemicals (serotonin, melatonin, and dopamine).

Evidence. SAMe is primarily studied for depression and osteoarthritis. Though evidence is not conclusive, data suggests SAMe may be helpful. Several short-term studies reported improved depressive symptoms with SAMe alone or in combination with selective serotonin reuptake inhibitors (SSRIs). Other studies showed similar decreases in osteoarthritis symptoms (e.g., pain, joint function) with SAMe supplementation versus nonsteroidal anti-inflammatory drugs (NSAIDs). While SAMe produced fewer side effects, it may take a longer time for symptom relief to occur.

Availability. SAMe is not available from foods; it’s mainly in tablets or capsules. Recommended doses vary depending on health condition. Since many studies investigating SAMe administered it intravenously or via muscular injection, it is not clear whether oral supplementation is as effective. Since some data suggest that SAMe is not well-absorbed by the body, it is recommended to take with other nutrients to enhance absorption, like vitamin B12 or folic acid.

Safety and Side Effects: There is limited data on the long-term safety of SAMe, though one trial reported no serious side effects after two years of supplementation and it is considered generally safe. Reported side effects are typically mild and include nausea, headache, or digestive problems. Starting with lower doses may help lessen digestive side effects. While uncommon, restlessness and insomnia were associated with taking SAMe, so it is not recommended at night. SAMe could increase risk of infection and anxiety/mania, so those with weakened immune systems and bipolar disorder should not use without medical supervision.

Interactions: SAMe may interact with prescription antidepressants and other drugs that increase serotonin. Use caution when using in combination with St. John’s wort. Since it has the potential for side effects and interactions with medications, please consult with your physician before taking SAMe.

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Background: Riboflavin, or vitamin B2, plays a key role in energy production, cellular function, growth and development, and metabolism of nutrients. It has antioxidant properties and contributes to the proper functioning of the immune system. Like other water-soluble vitamins, the body does not store riboflavin in substantial amounts, so regular dietary consumption is necessary. Riboflavin is found in various foods, especially meats, dairy, fortified grains, and dark green leafy vegetables. Since riboflavin is soluble in water, boiling foods causes nearly twice as much riboflavin to be lost in cooking water versus steaming or microwaving. Bacteria in our large intestine produce riboflavin, but not enough to meet our daily requirements.

The Recommended Dietary Allowance for riboflavin for adult women and men is 1.1 and 1.3 milligrams per day (mg/day), respectively. Animal studies suggest that some disorders can develop from long-term riboflavin deficiency. While riboflavin deficiency is rare in healthy U.S. adults, some individuals may be at risk for inadequacy due to insufficient intakes from dietary sources (older adults, vegans/vegetarians) or because of increased requirements (athletes, pregnancy). Riboflavin is commonly available as a supplement or as part of a multivitamin/mineral supplement, which generally provides at least 100 percent of daily needs.

Evidence: High-dose riboflavin supplementation (400mg/day) was studied as a potential adjunct therapy for some health conditions including migraine headaches, cancer, certain eye disorders, and multiple sclerosis. Despite mixed results from various trials, several small studies report a beneficial effect of 400mg/day for three months on reduction of migraine frequency in adults and children. While higher quality data is needed, several professional societies support the use of riboflavin for migraine prevention.

Safety and Interactions: Riboflavin is not known to cause side effects or harm. Since no toxic levels were observed from food sources or supplementation, a tolerable upper intake level (maximum daily dose not likely to cause side effects in the general population) was not set for riboflavin. Our bodies can only absorb a limited amount and the kidneys remove excess riboflavin in urine. High doses may cause bright yellow colored urine. Remember to talk to your doctor before starting a new diet or supplement regimen.

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Overview. According to the World Health Organization, aging is the primary risk factor for many eye conditions, including cataracts, glaucoma, and age-related macular degeneration (AMD). One nutrient that emerged as a key player in efforts to slow the development of these diseases is a carotenoid, lutein. Carotenoids are a class of nearly 800 naturally occurring yellow, orange, and red pigments synthesized by various plants, algae, and bacteria, but not by humans. Therefore, lutein must be obtained from the diet. The main dietary sources include dark green leafy vegetables (spinach, kale), corn, and eggs. Lutein is a fat-soluble nutrient, so it’s better absorbed by the body when paired with fat in a meal. Americans typically consume about one to two milligrams (mg) per day, which may not be enough to obtain the purported health effects. Lutein is available as a dietary supplement either alone or in combination with other nutrients.

Evidence. Lutein and zeaxanthin, a structurally similar carotenoid, are the only carotenoids that accumulate in the human retina and lens where they absorb and buffer blue light to help maintain optimal vision. To date, many research efforts focus on lutein’s effects on intermediate or late AMD, such as the Age-Related Eye Disease Study (AREDS). While no supplement can prevent AMD, data from the AREDS2 trial suggest that a combination of nutrients including antioxidants, two mg zeaxanthin and ten mg lutein, may help slow the progression to advanced AMD in people who already had AMD. At this time, more evidence is needed to determine lutein’s role management of other eye conditions, including cataracts and diabetic retinopathy.

Safety. Since lutein is not considered an essential nutrient by the US Food and Drug Administration, there is no determined tolerable upper intake level. However, a 2006 risk assessment determined that lutein is safe up to 20 mg per day from both supplement and dietary sources with few reported side effects aside from mild skin yellowing. More data are needed to support long-term usage at high levels. Please check with your doctor before starting a new supplement or making significant changes to your diet.

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Overview. Shark cartilage powder, sourced from cartilage from the fins of hammerhead sharks or spiny dogfish, is commonly promoted as a therapy for arthritis, psoriasis, and also cancer. Commercial shark cartilage is a popular and controversial dietary supplement available in oral capsule and powder forms in various doses (often 750 milligrams). Shark cartilage gained popularity as a supplement in the 1970s due to claims that sharks avoid cancer. While these claims were since disproven, it sparked interest in potential antiangiogenic properties of shark cartilage. So, since cartilage is a bodily tissue where no blood vessels are present, it was thought that molecules isolated from shark cartilage may inhibit blood vessel growth in tumors.

Evidence. Unfortunately, to date, there is no clinical data to support that shark cartilage is effective in treating cancer, including breast, colon, lung, prostate, and brain cancer. Additionally, the efficacy of shark cartilage in supporting joint health is uncertain, as there is a lack of sufficient reliable information and the potential health risks linked with long-term use are not adequately assessed. This is not to say that cartilage-derived supplements such as collagen may not be beneficial for joint health. In data not specific to shark cartilage, a 2019 meta-analysis of randomized placebo-controlled trials found that collagen supplements may significantly decrease osteoarthritis stiffness.

Safety and Interactions. Oral shark cartilage supplements are reported as safe for most individuals with short-term use, though there is limited data to support this claim. While rare, side effects of supplementation may include nausea, vomiting, GI upset, or a poor taste in the mouth. Shark cartilage may stimulate the immune system, so individuals with auto-immune disorders should avoid use. This supplement also contains calcium. People with hypercalcemia (elevated calcium levels) should use caution. Shark cartilage may interact with other medicines, including antibiotics, immunosuppressants, and diabetes medicines. Please consult your doctor before starting a new diet or supplement regimen.

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