Adverse reactions
A significant concern expressed by clinicians relates to the interaction of herbal supplements with a superfamily of drug metabolising proteins known as cytochrome p450 enzymes, which are present mainly in the liver. Six cytochrome p450 enzymes are responsible for metabolising an estimated 80% of prescribed medications [23]. However, ingredients found in some common herbal supplements can interfere with their normal function – leading to altered metabolism of drugs, creation of toxic metabolites or in the worst cases, production of tissue-damaging reactive metabolites such as oxygen free radicals, which can cause organ failure [24]. Multiple compounds in Gingko biloba , hyperforin from St. John’s Wort, ginsenosides in ginseng, and diallyl sulphide in garlic interfere with the function of cytochrome p450 enzymes, which introduces the possibility of side effects, interactions with medication, or toxicity [24]. Over the past two decades, the utilisation of pre- workout supplements has surged, driven by the quest for weight loss and enhanced sports performance. Among these supplements, those which have naturally high levels of the stimulant synephrine, such as Citrus aurantium (Bitter Orange) extracts, have gained significant popularity. Synephrine, a cardiovascular stimulant associated with weight loss, has, however, been linked to a growing number of adverse events. A recent study [25] highlighted 30 case reports of patients experiencing medical issues such as chest pain, palpitations, syncope, and dizziness following the use of synephrine-containing supplements. Shockingly, five patients were left disabled or remained on medication at their last follow-up. The absence of legislation in most countries regarding the permissible amount of synephrine in dietary supplements therefore raises significant concerns about consumer safety.
Adverse reaction monitoring
The potential for dietary supplements to cause adverse effects has prompted the creation of monitoring systems on both sides of the Atlantic. In the US, the FDA’s Center for Food Safety and Applied Nutrition (CFSAN) operates the CAERS adverse event reporting system: a database of adverse event and product complaint reports submitted to the FDA about foods, dietary supplements, and cosmetics [26]. Meanwhile, in the EU, EudraVigilance is a system for managing and analysing suspected adverse reactions to medicines which have been authorised or are being studied in clinical trials in the European Economic Area (EEA) [27].
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