Special Functions. Bromelain has been established as a natural means to increase antibiotic potency. This has been documented in several clinical studies, but there is no standard dosage or standard of care for this specific use.

Bromelain may help improve sinus inflammation and manage pain when consumed orally.

More recently, bromelain has been explored for its use in managing the COVID-19 infection. While the laboratory and animal research are promising, there are no human data to support its use.  The research on bromelain for improvement of cardiovascular disease risk factors is mixed, with not enough evidence to warrant a recommendation at this time.

Recommended Intakes & Toxicity. Suggested doses in adults range from 40 to 400 milligrams (mg) per day and is dependent on the purity of the supplement. Safety has been confirmed for daily oral intake of up to 240 mg per day. Some bromelain doses may include Rorer units, a direct measure of the enzyme’s activity or potency. A common dosage is 50,000 Rorer units.

Oral intake is not associated with significant safety concerns. Minor side effects such as digestive discomfort and headache have been reported. Although rare, some people exhibit allergic reactions to bromelain.

Bromelain exhibits anticoagulation effects in blood, and caution should be exercised if blood thinning medications are also used.

Most clinical research has been conducted on adults, with very few studies conducted on children, pregnant and lactating women, and older adults. Thus, the current intake recommendations and safety assessment is valid for adults, but not other life stage groups.

Sources. Bromelain is found naturally occurring in pineapple.  It’s found in the fruit, the stems, and the leaves. However, the concentration of bromelain in pineapple fruit is too low for the food source to provide a therapeutic benefit.  Supplements in tablet and capsule form can deliver a range of bromelain dosages. There is currently no industry standard for bromelain dosage in supplements.

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Special Functions. Psyllium has been a popular dietary fiber supplement due to its high digestive tolerance and additional benefits to human health. Psyllium forms a thick gel when dissolved in water. This is the primary reason for the health benefits attributed to psyllium.

When consumed immediately prior to a meal, psyllium (roughly 10 grams per day) may aid in weight management. Body weight dropped by an average of almost five pounds when consumed by overweight and obese individuals for at least two months.

Blood cholesterol may be managed with psyllium. An average daily intake of 10.2 grams of psyllium may reduce low-density lipoprotein (“bad” LDL) cholesterol in individuals with and without elevated cholesterol. The data supporting this effect is based on 28 clinical trials, thus demonstrating the robustness of the benefit. Psyllium binds to dietary lipids and liver-secreted bile acids, resulting in increased lipid and bile excretion, decreased circulating cholesterol levels, and reduced risk of cardiovascular disease.

Management of blood glucose after consuming psyllium occurs primarily in individuals with elevated glucose blood glucose levels. Consuming psyllium over the short-term, like immediately before a meal, can reduce glycemic response to a meal. Longer-term psyllium intake, over the course of several months, can reduce fasting blood glucose levels and hemoglobin A1C (HbA1c) levels.

Because psyllium is poorly fermented in the large intestine, it can accelerate intestinal transit time and increase stool softness. Both of these attributes can aid in laxation. Dosages of 15-18 grams per day, consumed for at least seven days, may be helpful for improving laxation.

Recommended Intakes & Toxicity. When used as a supplement to increase daily fiber intake, doses of up to 20 grams per day can be consumed without notable gastrointestinal side effects. Psyllium benefits weight management, blood cholesterol levels, and blood glucose levels at intakes of 10 grams per day. Some of these benefits are only experienced with consistent daily psyllium consumption over several months.

When hydrated, this powder will form a thick gel. As a result, psyllium has inherent risks of consumption. Capsule forms of psyllium are not recommended due to choking and intestinal blockage risk. Powdered forms have limited risk. Daily doses exceeding 20 grams of psyllium may cause digestive distress.

Sources. Psyllium is frequently sold as a supplemental powder.

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Special Functions. Many different benefits are promoted for oregano oil, including antimicrobial, antifungal, antioxidant, anti-inflammatory, and antidiabetic. Most evidence for these benefits comes from laboratory and animal trials, not human clinical trials, and, these benefits should be considered with caution.

The antibacterial benefit is one of the most widely advertised benefits based on substantive evidence in laboratory settings. Oregano oil may exert an antibacterial effect on many pathogenic bacteria species, as well as provide an antifungal benefit. However, these laboratory studies have not been validated with human clinical trials. Oregano oil can cause skin irritation, so topical application should be monitored carefully for adverse effects.

Oregano oil contains a rich blend of phytochemicals that have antioxidant properties. These compounds are attributed to a benefit for reducing oxidative stress as well as reducing inflammation, as a benefit based on laboratory studies.

The antidiabetic effect has been demonstrated in both animal and laboratory studies. As with the previously mentioned benefits, this has not been confirmed in human clinical trials.

Recommended Intakes & Toxicity. Oregano oil does not have a scientifically backed recommended intake. Manufacturer serving sizes should be interpreted with caution due to the range of active ingredients in different products. There is currently no standardization for oregano oil potency in the industry.

Oregano oil is listed as a Generally Recognized as Safe essential oil by the U.S. Food and Drug Administration (FDA). Caution should be exercised if an individual is concurrently taking medications for blood glucose control or blood thinning. Some evidence demonstrates that oregano oil can enhance the effects of these medications, which could result in a harmful drug-supplement interaction.

Sources. The source of phytochemicals in oregano is found in the essential oil, made from an extract of leaves and stems. Preparations range in concentration from 0.03 to 4.6 percent active compounds. With this much variability in active proportions, the potency of oregano oil preparations will vary from manufacturer to manufacturer.

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Special Functions. The mixture of bioactive compounds found in hibiscus are thought to provide a range of benefits on the body. Of note, habitual intake of hibiscus tea can reduce blood pressure in hypertensive individuals.

Other benefits have been suggested, such as enhanced memory, management of urinary tract infections, management of blood lipids, management of obesity, and management of metabolic syndrome. There is no clinical consensus on the use of hibiscus to improve any of these conditions.

Recommended Intakes & Toxicity. Hibiscus is considered Generally Recognized as Safe by the U.S. Food and Drug Administration and is well tolerated in healthy individuals. The effective intake of hibiscus tea for managing hypertension, across multiple studies, was 1.25-10 grams of tea leaf brewed in two-thirds cup to two cups of water and consumed one to three times daily for two to six weeks.

Limited safety concerns have been documented, such as stomach upset, gas, and constipation. In addition, individuals that have certain allergies to plants in the Malvaceae family (baobab, cacao, durian, marsh mallow) may also exhibit allergy to hibiscus.

Hibiscus may also adversely interact with certain medications, so be sure to discuss the use of hibiscus with your doctor.

Sources. Hibiscus tea is a commonly used to consume hibiscus, and it has the most dilute bioactive compound, based on the nature of the preparation. It contains, on average, 0.5 milligrams (mg) anthocyanin/gram hibiscus tea leaf. Supplements containing hibiscus, such as extracts and tinctures, are also on the market. These more concentrated forms, such as hibiscus extract, consumed as a supplement, may have seven times higher the anthocyanin content (3.6 mg/gram extract) versus tea. This range of active ingredient concentration will result in different degrees of efficacy.

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Special Functions. L-carnitine is produced by the body from the essential amino acid, lysine. When consuming a diet with adequate lysine, the body is capable of producing enough L-carnitine for all physiological functions. L-carnitine is a key component of fatty acid transport and fatty acid metabolism within the cells, enabling long chain fatty acids to cross from the cytosol to the mitochondria, to be metabolized for energy. However, clinical research does not support the role of L-carnitine and an increase fat metabolism. L-carnitine is an antioxidant that may help improve recovery after exercise by reducing muscle damage and pain. In older adults, there may be a benefit of supplementing L-carnitine to help maintain muscle mass, but further research is needed to confirm this effect. EN recommends talking with your health care provider before taking L-carnitine or any new supplement.

Recommended Intakes & Toxicity. There is no stated recommended intake for L-carnitine. This compound has been demonstrated to be safe at doses up to three grams per day. Symptoms of excess consumption include fishy body odor, nausea, vomiting, abdominal cramps, and diarrhea. Other compounds related to L-carnitine, such as acetyl-L-carnitine and propionyl-L-carnitine, are also available as supplements, however, the function and safety of these compounds differ from L-carnitine.

Sources. The richest sources of L-carnitine are red meat, followed by pork. It is also present in smaller amounts in dairy, fish, and chicken. Plant-based foods contain very small amounts of less than one milligram (mg) per serving. The typical American diet provides 23 to 135 mg per day, while a strict vegetarian diet may provide only one mg per day. However, L-carnitine’s precursor, lysine, is abundant in many plant-based foods, including legumes and pulses. Vegetarians and vegans are not typically at risk for L-carnitine deficiency, as long as their bodies can synthesize this compound from an adequate dietary intake of lysine. In supplement format, the bioavailability of L-carnitine is quite low, with only five to 25 percent of ingested L-carnitine being absorbed. This contrasts with food sources of L-carnitine with 54 to 86 percent rates of absorption.

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Special Functions. Vitamin B12 is required for the body to gain energy from fatty acids and amino acids. It facilitates a reaction that ultimately enables the aforementioned starting materials to enter the citric acid cycle, a key metabolic pathway for cellular energy creation.

Vitamin B₁₂ has a unique relationship with folate in which these vitamins work together to transform homocysteine to the amino acid methionine. If this conversion is not operating correctly, it can lead to altered gene expression associated with cancer development and increased risk of cardiovascular disease. Additionally, vitamin B₁₂ is responsible for re-activating folate that has been used for nucleic acid synthesis, so vitamin B₁₂ deficiency can manifest itself as a folate deficiency.

Vitamin B₁₂ absorption requires exposure to gastric acid and association with intrinsic factor, which facilitates absorption in the small intestine. If gastric acid production is low or if intrinsic factor fails to bind with vitamin B₁₂, deficiency can result, regardless of intake. In older adults, vitamin B₁₂ deficiency can often be accompanied by atrophic gastritis, a chronic inflammation of the stomach.

Symptoms of vitamin B₁₂ deficiency include an induced folate deficiency, neurological symptoms, malformed red blood cells (megaloblastic anemia), and possibly gastrointestinal side effects.

Vitamin B₁₂ status is linked with health conditions including cardiovascular disease, cancer, neural tube defects in a fetus when the mother’s diet is deficient, cognitive function, depression and osteoporosis.

Recommended Intakes & Toxicity. The Recommended Dietary Allowance (RDA) is 2.4 micrograms/day for adults ages 19 and older. It’s advised that adults aged 51 years and older obtain some of the daily vitamin B12 from supplements or fortified foods to offset the risk of absorption-based deficiency.

Large doses of folate can mask a vitamin B₁₂ deficiency and result in permanent neurological damage.

There is no tolerable upper intake level (UL) for vitamin B₁₂, and vitamin B₁₂ toxicities have not been observed.

Sources. Vitamin B12 is found primarily in animal-derived foods such as meat, eggs, dairy, seafood, certain fish as well as in mushrooms, algae, nutritional yeast and some fermented foods. Individuals on a strict vegan diet may need to carefully select food sources of vitamin B12 to ensure adequate intake.

Vitamin B₁₂ can be found in most multivitamin/multimineral supplements and also as a standalone supplement. Intramuscular injections of vitamin B₁₂ may be needed in deficiency states where absorption in the small intestine is impaired.

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Special Functions. When whole, RYR contains carbohydrates, protein, and a small amount of fat, along with pigments, sterols, and isoflavones. The exact composition of RYR is dependent on the type of rice and yeast. There is a certain degree of variability in function and safety. Several types of bioactive compounds known as “monacolins” are found in RYR. The most effective monacolin is monacolin K, which is structurally identical to the statin, lovastatin. As with its pharmacological twin, monacolin K inhibits cholesterol production in the liver. However, monacolin K from RYR has a wide range of efficacy which makes its effects less predictable than a statin.

Many clinical studies have been conducted in RYR and its lipid lowering effect. A review of 20 clinical trials demonstrated that RYR had an LDL cholesterol-lowering impact that was similar to low intensity/low dose statins such as pravastatin, simvastatin, and lovastatin. A reduction of 15 to 25 percent was reported in subjects of different ethnicities, demonstrating the wide-ranging benefit of this supplement. Other markers of cardiovascular disease health have been measured after RYR, including triglycerides, HDL-cholesterol, c-reactive protein, flow mediated dilation, and pulse wave velocity. All of these outcomes improved with RYR supplements, although the magnitude of improvement varied among studies.

Recommended Intakes & Safety. The FDA issued warnings in 2007 and 2013 regarding use of RYR focused on efficacy, safety, and lack of product standardization. Because the efficacy of RYR varies depending on the product, the cholesterol-lowering benefit is also variable.

One disadvantage to RYR is the presence of potentially harmful compounds. One of these compounds, citrinin, can harm kidney function and impair fertility. When considering RYR supplements, supplements that are certified as citrinin-free are preferred.

Clinical research supports effective doses of three to 10 mg monacolin K from RYR, per tablet. A greater benefit of RYR may be realized when a heart-healthy diet is also followed.

Sources. Both RYR and RYR extract are commonly found as dietary supplements. These may be combined with other nutritional and bioactive compounds that aid in cholesterol lowering such as soluble fiber, plant sterols, probiotics, and phytochemicals. Be sure to talk with your doctor before adding RYR to your regimen.

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Special Functions. There is a genuine need for BCAAs during muscle protein synthesis and repair. When BCAAs are lacking, muscle protein synthesis will be hindered. However, consuming BCAAs alone will not stimulate muscle protein synthesis. Physical activity that warrants muscle repair is necessary to trigger muscle protein synthesis. The six other essential amino acids need to be available in sufficient quantity for muscle protein synthesis to occur after exercise.

In addition to muscle protein synthesis, BCAAs can be used for energy. They are more easily converted to glucose in the body than most other amino acids.

Did you know that in older adults, a BCAA supplementation may aid in muscle maintenance? However, many studies showed no significant benefit of adding BCAA supplementation to a physical activity routine in older adults.

Recommended Intakes & Safety. Just as the total protein Recommended Dietary Allowance (RDA) is stated in grams of protein per kilogram of body weight, the RDAs for leucine, isoleucine, and valine are body weight specific: 42 milligrams (mg) per kilogram (kg) of body weight per day (d) of leucine, 19 mg/kg/d of isoleucine, and 24 mg/kg/d of valine for adults aged 19 years old and older.

There is no specific tolerable upper intake level (UL) set for the BCAAs. If consumed in excess, there is a potential for the BCAAs to compete with other amino acids for absorption. Excessive BCAAs are unlikely to have a benefit.

Sources. BCAA supplements are common. They are available in capsules, gummies, drink mixes and more. Many BCAA supplements contain other ingredients, such as electrolytes, herbal extracts, and other bioactive compounds. It’s critical to understand the entire formula before recommending a specific product. Many BCAA supplements provide the amino acids in a ratio of two parts leucine to one part isoleucine and one part valine. This ratio of two:one:one has been demonstrated to have the most beneficial effect on muscle protein synthesis. BCAAs are naturally occurring in a range of food sources, including grains, legumes/pulses, dairy, meat, and eggs.

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Do you need activated charcoal?

  discourage the use of activated charcoal after a poisoning incident without medical supervision. It has been added to foods and beverages like nutritional tonics, granola, chocolate, and chewing gum. Activated charcoal in foods and beverages is often promoted for digestive wellness, but the evidence is mixed. Activated charcoal is also used in water filtration systems and at-home filtered pitchers to remove impurities from drinking water.

Activated charcoal is a specific type of carbon that binds to other substances, which is why it has been used as a remedy for poisoning. This charcoal isn’t the same as your barbeque briquets. Although typically derived from wood, activated charcoal is specially manufactured for human consumption. It is processed in a unique way that adds millions of microscopic holes to the granules’ surface. This enhances its ability to bind harmful compounds via increased surface area. Some types of activated charcoal also include a sugar alcohol called sorbitol. Sorbitol speeds up laxation and enables quicker passing of harmful substances.

Research in the 1980s showed a possible benefit of activated charcoal for digestive discomfort by reducing flatulence. It is claimed to “detoxify” or “cleanse,” supported by current medical practice using this substance as a poisoning remedy.

Recommended intakes & safety. There is limited clinical evidence for routine intake of activated charcoal. If poisoning is suspected, medical attention should be sought immediately. It’s not recommended to self-administer activated charcoal in a poisoning incident because additional medical care may be necessary, such as monitoring vital signs.

People with constipation may have increased constipation after taking activated charcoal. It can interact with certain prescription medications, noting potential safety concerns with its use.

Sources. Supplements containing 250 milligrams of activated charcoal are common. In foods and beverages, activated charcoal is often a component of a specialty salt labeled as “black salt” or “lava salt.” The amount of activated charcoal per serving of food or beverage may not be declared on the label.

Summary. Activated charcoal is known as a therapy for poisoning. However, it should not be considered an “at-home” solution if poisoning occurs. Medical professionals should be engaged if poisoning is suspected. There is little evidence for taking activated charcoal to support digestive wellness. This, coupled with possible drug interactions, warrants consultation with a medical professional prior to recommending activated charcoal.

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the most abundant. Gingerol is also responsible for some of the “spicy” flavor we experience when we consume ginger. In ginger supplements, the gingerol content may be declared. The typical gingerol content in a ginger extract is five percent. Let’s dive in to the science behind gingerol.

Special Functions. Ginger has been recognized for its health-promoting properties since the 13th century, and even possibly earlier. Traditional uses include management of a wide range of conditions. One of the active compounds responsible for these benefits is linked to gingerol, the most abundant polyphenol in ginger. If exposed to air, light, or heat, these can convert to related compounds called shogaol, which has a spicier flavor than gingerol.

Gingerol has a range of physiological benefits as demonstrated in pre-clinical studies including reduced nausea, reduced inflammation, improved body composition, and improved glycemic control and metabolic markers of glycemic health. Additionally, many human clinical studies have been conducted to confirm these benefits.

Compelling clinical data also supports the use of ginger post-surgery to manage nausea and often also vomiting associated with the procedure.

Recommended Intakes & Safety. In clinical studies involving ginger, the specific content of gingerol is not always reported, which makes defining a recommended intake difficult.

Ginger is a GRAS (Generally Regarded As Safe) ingredient in the U.S., when used in typical cuisine. As an extract found in supplements, gingerol has been deemed safe in relatively high doses. Side effects may include heartburn, abdominal discomfort, weight gain, headache, dry mouth, and nausea.

There is a possibility of ginger extract-drug interactions with warfarin for blood thinning. However, only one study was conducted on this interaction and further research is needed to make a clear safety recommendation on drug interactions.

Sources. Gingerol is naturally occurring in ginger root. It is an active compound in ginger extracts used in supplements. The amount of gingerol in the extract is dependent on the variety of ginger and processing conditions.

Summary. Gingerol has extensive clinical research that supports reduced nausea and vomiting, reduced inflammation, improved body composition, and improved glycemic control and metabolic markers of glycemic health. As always, talk with your health care professional before adding any new supplements.

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